Title Page

  • Date JHA Performed

  • Evaluator Name

  • Name?

  • Site conducted

  • Related SOP Title

  • Related SOP Document #

  • Department Representative Name (a dept. rep. should be involved in all JHA's, If a dept. rep. is not involved the JHA evaluator MUST explain why below.

  • Explain why dept. rep. is not involved.

JHA Procedure Step 1

  • Complete items for Procedure Step 1

Procedure Step 1

  • Step 1 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Procedure Step 2

  • Step 2 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Procedure Step 3

  • Step 3 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Procedure Step 4

  • Step 4 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Procedure Step 5

  • Step 5 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Procedure Step 6

  • Step 6 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Procedure Step 7

  • Step 7 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Procedure Step 8

  • Step 8 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Procedure Step 9

  • Step 9 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Procedure Step 10

  • Step 10 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Procedure Step 11

  • Step 11 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Procedure Step 12

  • Step 12 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Procedure Step 13

  • Step 13 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Procedure Step 14

  • Step 14 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Procedure Step 15

  • Step 15 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Procedure Step 16

  • Step 16 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Process Step 17

  • Step 17 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Process Step 18

  • Step 18 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Process Step 19

  • Step 19 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

Process Step 20

  • Step 20 Description (how is the step described in the SOP?)

  • What are the identified Hazard types?

  • What are the existing controls?

  • Describe the "other" controls

  • Describe each Engineering control for this step (enter N/A if none)

  • Describe each Administrative control for this step (enter N/A if none)

  • List existing PPE for this step

  • Describe the "other" PPE

  • List the ADDITIONAL recommended hazard controls for this step

  • List the ADDITIONAL PPE recommended for this step

  • Risk Evaluation for this Step: How LIKELY is an injury to occur during this step?

  • What would the CONSEQUENCE of an injury be?

  • What is the RISK SCORE for this step? (Likeliness # and Consequence Letter, e.g. 4B)

  • Additional Notes/Comments for this Procedure Step

  • Are there any more procedure steps in this SOP? (If No then Stop, If Yes then proceed to next page)

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