JOB HAZARD ASSESSMENT

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

PPE Required

• PPE for this task: Hard hat and safety glasses with side shield required for each worker on each job.

• Additional PPE needed:

  Select Gloves Protective clothing Face shield Goggles Safety harness Respiratory protection Cones Caution tape

  • Gloves
  • Protective clothing
  • Face shield
  • Goggles
  • Safety harness
  • Respiratory protection
  • Cones
  • Caution tape

Hand Protection

• 1. The hands/fingers will be exposed to:

  Select Abrasions caused by friction/moving part(s) Contusion caused by falling objects Burns caused by extreme heat/cold Irritation caused by chemicals/flammables Shock by electricity Crushing injury caused by pinch points Punctures caused by sharp-pointed objects

  • Abrasions caused by friction/moving part(s)
  • Contusion caused by falling objects
  • Burns caused by extreme heat/cold
  • Irritation caused by chemicals/flammables
  • Shock by electricity
  • Crushing injury caused by pinch points
  • Punctures caused by sharp-pointed objects

• 2. Have you inspected materials or jagged edges, burns, slivers, rough or slippery surfaces?

  Yes

  No

  N/A

• 3. Are you wearing jewelry or loose clothing that could be caught in moving machinery parts?

  Yes

  No

  N/A

• 4. For this task, my hands/fingers will be protected by the following type of glove.

  Select Cloth Leather Metal mesh Electrician's Rubber/PVC/etc. Hot Work

  • Cloth
  • Leather
  • Metal mesh
  • Electrician's
  • Rubber/PVC/etc.
  • Hot Work

Hazard Identification-Hazard Controls

• Chemical Exposure

  Select Chemical OK'd SDS available Container labeled Barricades Verified vessel is empty

  • Chemical OK'd
  • SDS available
  • Container labeled
  • Barricades
  • Verified vessel is empty

• Lift Equipment

  Select Scissors lift Man lift JLG Proper anchor Harness Lanyard Barricades Handrails Safety chain

  • Scissors lift
  • Man lift
  • JLG
  • Proper anchor
  • Harness
  • Lanyard
  • Barricades
  • Handrails
  • Safety chain

• Slips, wet surfaces

  Select Clean surface Barricade

  • Clean surface
  • Barricade

• Trips

  Select Relocate Barricade Use alternate path

  • Relocate
  • Barricade
  • Use alternate path

• Falls

  Select Less than 4 feet More than 4 feet Access/Egress Construct platform Tie-off Move work to ground Fall restraint guard rails, short lanyard Ladders, scaffold, steps

  • Less than 4 feet
  • More than 4 feet
  • Access/Egress
  • Construct platform
  • Tie-off
  • Move work to ground
  • Fall restraint guard rails, short lanyard
  • Ladders, scaffold, steps

• Falling Objects

  Select Seecure objects Guarding, covers PPE Barricading

  • Seecure objects
  • Guarding, covers
  • PPE
  • Barricading

• Hazards to others working in vicinity

  Select Communication Barricading Shielding Ventilation

  • Communication
  • Barricading
  • Shielding
  • Ventilation

• Hazards from others working in vicinity

  Select Communication Barricading Shielding Ventilation

  • Communication
  • Barricading
  • Shielding
  • Ventilation

• Fire, Combustible Materials/Explosion

  Select Remove materials Relocate work Shields Wet area Fire watch Isolation/LOTO Air testing/monitoring Fire extinguisher

  • Remove materials
  • Relocate work
  • Shields
  • Wet area
  • Fire watch
  • Isolation/LOTO
  • Air testing/monitoring
  • Fire extinguisher

• Housekeeping

  Select Area kept clear of trash/debris Tools organized Hoses/cords out of path/rolled

  • Area kept clear of trash/debris
  • Tools organized
  • Hoses/cords out of path/rolled

• Weather

  Select Possible winds shift Secure materials/equipment Line of fire - equipment and objects Consider stopping work in high winds Equipment erection-braced during construction Design specs reviewed

  • Possible winds shift
  • Secure materials/equipment
  • Line of fire - equipment and objects
  • Consider stopping work in high winds
  • Equipment erection-braced during construction
  • Design specs reviewed

• Heat/Cold Stress

  Select Ventilation Task rotation, shared tasks Work/rest regimen

  • Ventilation
  • Task rotation, shared tasks
  • Work/rest regimen

• Lifting, Pulling, Pushing

  Select Get equipment designed for the job Proper technique Smaller, lighter loads Prepared for "unexpected" release Move feet to turn with load

  • Get equipment designed for the job
  • Proper technique
  • Smaller, lighter loads
  • Prepared for "unexpected" release
  • Move feet to turn with load

• Repetitive Motion

  Select Proper technique Power tools rather than manual Get help, take breaks Seek advice

  • Proper technique
  • Power tools rather than manual
  • Get help, take breaks
  • Seek advice

• Rotating Equipment

  Select Isolation, LOTO Guarding, barricading No loose clothing Positioning

  • Isolation, LOTO
  • Guarding, barricading
  • No loose clothing
  • Positioning

• Pinch Point/Line of Fire

  Select Guarding Positioning

  • Guarding
  • Positioning

• Sharp Objects

  Select Guarding PPE, gloves, etc. Positioning

  • Guarding
  • PPE, gloves, etc.
  • Positioning

• Electrical Shock

  Select Isolation, LOTO Testing Grounding Shielding of equipment GFCI Electrically qualified Voltage __Procedure #, Min Clearance

  • Isolation, LOTO
  • Testing
  • Grounding
  • Shielding of equipment
  • GFCI
  • Electrically qualified
  • Voltage __Procedure #, Min Clearance

• Airborne/Flying Material

  Select Cover/shield source PPE< eye & face PPE, arms & body Positioning

  • Cover/shield source
  • PPE< eye & face
  • PPE, arms & body
  • Positioning

• Environmental Spill

  Select Containment Waste plan Waste containers Others

  • Containment
  • Waste plan
  • Waste containers
  • Others

• Confined Space

  Select Air mnitoring Ventiation needed Attendant required Asphyxiation Chemical hazard Electrical hazard Mechanical hazard

  • Air mnitoring
  • Ventiation needed
  • Attendant required
  • Asphyxiation
  • Chemical hazard
  • Electrical hazard
  • Mechanical hazard

• Thermal Burn

  Select Splash guard Isolation, LOTO Positioning Equipment covers Additional PPE

  • Splash guard
  • Isolation, LOTO
  • Positioning
  • Equipment covers
  • Additional PPE

• Cranes and Rigging

  Select Crane inspection Are lift weights known? Are slings and chokers inspected & correct sizes? Is crane lift area properly barricaded? Are operators certified to operate? Is wind speed known? Are personnel trained in proper rigging procedures? Are tag lines used to control all loads? Is a Critical Lift Plan needed? Rotating superstructure barricaded? Are mats/cribs in place on outriggers? Is a spotter needed when traveling?

  • Crane inspection
  • Are lift weights known?
  • Are slings and chokers inspected & correct sizes?
  • Is crane lift area properly barricaded?
  • Are operators certified to operate?
  • Is wind speed known?
  • Are personnel trained in proper rigging procedures?
  • Are tag lines used to control all loads?
  • Is a Critical Lift Plan needed?
  • Rotating superstructure barricaded?
  • Are mats/cribs in place on outriggers?
  • Is a spotter needed when traveling?

• Falls, falling objects

  Select Walk, use handrails on stairways Secure materials and tools barricade area below work Fasten chain on scissor lift Safe access to elevation Maintain three point contact when climbing Walking surfaces free of clutter, slip hazards Footwear in good condition Tie off above waist 5000 pound anchor (3" or larger) 100% protected above 4 feet Eyes looking in direction of travel rigged so doesn't contact level/object below

  • Walk, use handrails on stairways
  • Secure materials and tools
  • barricade area below work
  • Fasten chain on scissor lift
  • Safe access to elevation
  • Maintain three point contact when climbing
  • Walking surfaces free of clutter, slip hazards
  • Footwear in good condition
  • Tie off above waist
  • 5000 pound anchor (3" or larger)
  • 100% protected above 4 feet
  • Eyes looking in direction of travel
  • rigged so doesn't contact level/object below

• Food Safety

  Select 1. Will the scope of the work impact the food safety of the affected equipment? 2. Will the scope of the work impact the food safety of the surrounding equipment?

  • 1. Will the scope of the work impact the food safety of the affected equipment?
  • 2. Will the scope of the work impact the food safety of the surrounding equipment?

• Is a permit required?

  Yes

  No

  N/A

• Is a procedure required?

  Yes

  No

  N/A

• Do you have the proper tools and/or equipment to do this job?

  Yes

  No

  N/A

• Are your tools and/or equipment in good condition? (I.e., inspected?)<br>

  Yes

  No

  N/A

• Have you planned your escape route?

  Yes

  No

  N/A

• Did you perform an on-site inspection with the permit issuer?

  Yes

  No

  N/A