Job Hazard Analysis

• Document No.

• Audit Title

• Client / Site

• Worksite/Area/Department:

• Job Description:

• Inspected by:

• Date of Inspection:

1.0 Eye Hazards

• 1.1 - Chemical Exposure?

  Yes

  No

• 1.2 - High Heat/Cold

  Yes

  No

• 1.3 - Dust/Flying Debris

  Yes

  No

• 1.4 - Impact

  Yes

  No

• 1.5 - Light

  Yes

  No

2.0 Head Hazards

• 2.1 - Impact

  Yes

  No

• 2.2 - Electrical Shock

  Yes

  No

3.0 Foot Hazards

• 3.1 - Chemical Exposure

  Yes

  No

• 3.2 - High Heat/Cold

  Yes

  No

• 3.3 - Impact/Compression

  Yes

  No

• 3.4 - Slips/Trips

  Yes

  No

• 3.5 - Slippery/Wet Surfaces

  Yes

  No

• 3.6 - Explosive/Flammable Atmosphere

  Yes

  No

• 3.7 - Electrical

  Yes

  No

4.0 Hand Hazards

• 4.1 - Chemical Exposure

  Yes

  No

• 4.2 - Hight Heat/Cold

  Yes

  No

• 4.3 - Cuts/Abrasion

  Yes

  No

• 4.4 - Punctures

  Yes

  No

• 4.5 - Electrical Shock

  Yes

  No

• 4.6 - Blood Borne Pathogens

  Yes

  No

5.0 Body/Torso Hazards

• 5.1 - Chemical Exposure

  Yes

  No

• 5.2 - Extreme Heat/Cold

  Yes

  No

• 5.3 - Abrasion

  Yes

  No

• 5.4 - Impact

  Yes

  No

• 5.5 - Electrical/Arc Flash

  Yes

  No

6.0 Fall Hazards

• 6.1 - Falls 4ft. or greater to the next lower level

  Yes

  No

7.0 - Noise Hazards

• 7.1 - Noise Levels Above 85db

  Yes

  No

8.0 Respiratory Hazards

• 8.1 - Chemical Exposure

  Yes

  No

• 8.2 - Confined Spaces

  Yes

  No

• 8.3 - Particulate Exposure

  Yes

  No

• 8.4 - Welding/related Hazards

  Yes

  No