Johnson-Peltier Jobsite Hazard Analysis

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

• Add media

  Media

• Add drawing

  Drawing

• Work Type:

  Hazard Assessment

  Safe Work

  Hot Work

  Confined Space

Jobsite Hazard Analysis

• Locking/Tagging Equipment

  Yes

  No

  N/A

• Working 6' or more above grade

  Yes

  No

  N/A

• Hot Work

  Yes

  No

  N/A

• Confined Space Work

  Yes

  No

  N/A

• Excavating & Trenching

  Yes

  No

  N/A

• Electrical Work >50 volts <600 volts

  Yes

  No

  N/A

• Electrical Work >600 volts

  Yes

  No

  N/A

• Operating Crane, stinger, manlift, forklift, etc.<br>

  Yes

  No

  N/A

• Mechanical Work involving rotating equipment

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Physical Hazards

• Walkways

  Yes

  No

  N/A

• Cramped Work

  Yes

  No

  N/A

• Heat Stress

  Yes

  No

  N/A

• Heavy Liftingg

  Yes

  No

  N/A

• High Noise

  Yes

  No

  N/A

• Pressure

  Yes

  No

  N/A

• Hot Liquids

  Yes

  No

  N/A

• Hot Surfaces

  Yes

  No

  N/A

• Ladder Work

  Yes

  No

  N/A

• Lifting with Slings

  Yes

  No

  N/A

• Pinch Points

  Yes

  No

  N/A

• Road Hazards, Driving

  Yes

  No

  N/A

• Sharp Edges

  Yes

  No

  N/A

• Tripping/Objects

  Yes

  No

  N/A

• Overhead Lifting/Work

  Yes

  No

  N/A

• Electrical Work

  Yes

  No

  N/A

• Material Transfer; pipe; equipment; etc.

  Yes

  No

  N/A

• Ergonomics/Body Positioning

  Yes

  No

  N/A

• Chemicals/Gases/Asbestos/etc.

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• PPE: hard hat, safety glasses, boots, etc.

  Yes

  No

  N/A

Physical Hazard Controls

Emergency Action Planning

• Evacuation Routes

  Yes

  No

  N/A

• Staging Area

  Yes

  No

  N/A

• Emergency Equipment Needed

  Yes

  No

  N/A

• First Aid/CPR Trained

  Yes

  No

  N/A

• Rescue Procedures Discussion

  Yes

  No

  N/A

• Emergency Contact Information

  Yes

  No

  N/A

Hot Work

• Combustion Engine

  Yes

  No

  N/A

• Grinding/Equipment Guards

  Yes

  No

  N/A

• Electrical Tools: Threader/Bender/etc.

  Yes

  No

  N/A

• Hand Tools

  Yes

  No

  N/A

• Gas Monitor

  Yes

  No

  N/A

• Fire Watch

  Yes

  No

  N/A

• Remove Combustibles

  Yes

  No

  N/A

• Worksite Classification

  Yes

  No

  N/A

• Fire Extinguisher

  Yes

  No

  N/A

Confined Space

• LO/TO

  Yes

  No

  N/A

• PPE

  Yes

  No

  N/A

• Emergency Rescue

  Yes

  No

  N/A

• Lines Blocked/Isolated

  Yes

  No

  N/A

• Area Secure

  Yes

  No

  N/A

• Respirators

  Yes

  No

  N/A

• Ventilation

  Yes

  No

  N/A

• Fire ext.

  Yes

  No

  N/A

• Signs in Place

  Yes

  No

  N/A

• Rescue Equipment

  Yes

  No

  N/A

• Non-Entry: Tripod, rescue winch, etc.

  Yes

  No

  N/A

• Entry: Harness, Wristlets, etc.

  Yes

  No

  N/A

• Job Safety Rating

• Pass

  Off

  On

• Add signature

  Sign