Title Page
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
Job Tasks
-
Pull Wire
-
Potential Hazards
- Proper PPE Utilized (Specify in PPE Section)
- Fall Protection
- Proper Tool Inspection
- First-Aid Kit Readily Available
- Sufficient Drinking Water
- Extra Rest Breaks Due to Weather/Elements
- Proper Supervision
- Dress Appropriately
- Lockout/Tagout
- GFCI Protection
- Proper Communication
- Proper Equipment Inspection
- Using Correct Tools
- Using Correct Equipment
- Proper Planning
- Use of a Spotter / Buddy / Watch
- Proper Lifting Techniques/Stretching
- Good Housekeeping
- SDS Sheets Readily Available
- Respiratory Protection (dusk mask or respirator)
- Proper Excavation/Trenching Procedures (Sloping, Trench Box, etc.)
- Other
-
Additional Hazards:
-
Mitigations
- Proper PPE Utilized (Specify in PPE Section)
- Fall Protection
- Proper Tool Inspection
- First-Aid Kit Readily Available
- Sufficient Drinking Water
- Extra Rest Breaks Due to Weather/Elements
- Proper Supervision
- Dress Appropriately
- Lockout/Tagout
- GFCI Protection
- Proper Communication
- Proper Equipment Inspection
- Using Correct Tools
- Using Correct Equipment
- Proper Planning
- Use of a Spotter / Buddy / Watch
- Proper Lifting Techniques/Stretching
- Good Housekeeping
- SDS Sheets Readily Available
- Respiratory Protection (dusk mask or respirator)
- Proper Excavation/Trenching Procedures (Sloping, Trench Box, etc.)
- Other
-
Additional Mitigations:
-
Set-Up Equipment
-
Potential Hazards
- Vehicle Operation
- Equipment Operation
- Heavy Equipment
- Fire Hazards
- Invasive Wounds
- Air Quality
- Hand/Arm Injuries
- Eye/Facial Injuries
- Lifting Hazards
- Body Strain
- Tripping
- Ladder/Stilt Use
- Chemical Exposure
- Electrocution/Shock
- Arc Flash
- Heat/Cold Stress
- Falling From Heights (over 6')
- Overhead Hazards/Falling Debris
- Pinch Points
- Burns
- Loud Noise/Hearing Loss
- Cave-In
- Confined Space
- Other
-
Please describe additional hazards:
-
Mitigations
- Proper PPE Utilized (Specify in PPE Section)
- Fall Protection
- Proper Tool Inspection
- First-Aid Kit Readily Available
- Sufficient Drinking Water
- Extra Rest Breaks Due to Weather/Elements
- Proper Supervision
- Dress Appropriately
- Lockout/Tagout
- GFCI Protection
- Proper Communication
- Proper Equipment Inspection
- Using Correct Tools
- Using Correct Equipment
- Proper Planning
- Use of a Spotter / Buddy / Watch
- Proper Lifting Techniques/Stretching
- Good Housekeeping
- SDS Sheets Readily Available
- Respiratory Protection (dusk mask or respirator)
- Proper Excavation/Trenching Procedures (Sloping, Trench Box, etc.)
- Other
-
Additional Mitigations:
-
Run Conduit
-
Potential Hazards
- Vehicle Operation
- Equipment Operation
- Heavy Equipment
- Fire Hazards
- Invasive Wounds
- Air Quality
- Hand/Arm Injuries
- Eye/Facial Injuries
- Lifting Hazards
- Body Strain
- Tripping
- Ladder/Stilt Use
- Chemical Exposure
- Electrocution/Shock
- Arc Flash
- Heat/Cold Stress
- Falling From Heights (over 6')
- Overhead Hazards/Falling Debris
- Pinch Points
- Burns
- Loud Noise/Hearing Loss
- Cave-In
- Confined Space
- Other
-
Please describe additional hazards:
-
Mitigations
- Proper PPE Utilized (Specify in PPE Section)
- Fall Protection
- Proper Tool Inspection
- First-Aid Kit Readily Available
- Sufficient Drinking Water
- Extra Rest Breaks Due to Weather/Elements
- Proper Supervision
- Dress Appropriately
- Lockout/Tagout
- GFCI Protection
- Proper Communication
- Proper Equipment Inspection
- Using Correct Tools
- Using Correct Equipment
- Proper Planning
- Use of a Spotter / Buddy / Watch
- Proper Lifting Techniques/Stretching
- Good Housekeeping
- SDS Sheets Readily Available
- Respiratory Protection (dusk mask or respirator)
- Proper Excavation/Trenching Procedures (Sloping, Trench Box, etc.)
- Other
-
Additional Mitigations:
-
Terminate Devices
-
Potential Hazards
- Vehicle Operation
- Equipment Operation
- Heavy Equipment
- Fire Hazards
- Invasive Wounds
- Air Quality
- Hand/Arm Injuries
- Eye/Facial Injuries
- Lifting Hazards
- Body Strain
- Tripping
- Ladder/Stilt Use
- Chemical Exposure
- Electrocution/Shock
- Arc Flash
- Heat/Cold Stress
- Falling From Heights (over 6')
- Overhead Hazards/Falling Debris
- Pinch Points
- Burns
- Loud Noise/Hearing Loss
- Cave-In
- Confined Space
- Other
-
Please describe additional hazards:
-
Mitigations
- Proper PPE Utilized (Specify in PPE Section)
- Fall Protection
- Proper Tool Inspection
- First-Aid Kit Readily Available
- Sufficient Drinking Water
- Extra Rest Breaks Due to Weather/Elements
- Proper Supervision
- Dress Appropriately
- Lockout/Tagout
- GFCI Protection
- Proper Communication
- Proper Equipment Inspection
- Using Correct Tools
- Using Correct Equipment
- Proper Planning
- Use of a Spotter / Buddy / Watch
- Proper Lifting Techniques/Stretching
- Good Housekeeping
- SDS Sheets Readily Available
- Respiratory Protection (dusk mask or respirator)
- Proper Excavation/Trenching Procedures (Sloping, Trench Box, etc.)
- Other
-
Additional Mitigations:
-
Install Light Fixtures
-
Potential Hazards
- Vehicle Operation
- Equipment Operation
- Heavy Equipment
- Fire Hazards
- Invasive Wounds
- Air Quality
- Hand/Arm Injuries
- Eye/Facial Injuries
- Lifting Hazards
- Body Strain
- Tripping
- Ladder/Stilt Use
- Chemical Exposure
- Electrocution/Shock
- Arc Flash
- Heat/Cold Stress
- Falling From Heights (over 6')
- Overhead Hazards/Falling Debris
- Pinch Points
- Burns
- Loud Noise/Hearing Loss
- Cave-In
- Confined Space
- Other
-
Please describe additional hazards:
-
Mitigations
- Proper PPE Utilized (Specify in PPE Section)
- Fall Protection
- Proper Tool Inspection
- First-Aid Kit Readily Available
- Sufficient Drinking Water
- Extra Rest Breaks Due to Weather/Elements
- Proper Supervision
- Dress Appropriately
- Lockout/Tagout
- GFCI Protection
- Proper Communication
- Proper Equipment Inspection
- Using Correct Tools
- Using Correct Equipment
- Proper Planning
- Use of a Spotter / Buddy / Watch
- Proper Lifting Techniques/Stretching
- Good Housekeeping
- SDS Sheets Readily Available
- Respiratory Protection (dusk mask or respirator)
- Proper Excavation/Trenching Procedures (Sloping, Trench Box, etc.)
- Other
-
Additional Mitigations:
-
Test Equipment
-
Potential Hazards
- Vehicle Operation
- Equipment Operation
- Heavy Equipment
- Fire Hazards
- Invasive Wounds
- Air Quality
- Hand/Arm Injuries
- Eye/Facial Injuries
- Lifting Hazards
- Body Strain
- Tripping
- Ladder/Stilt Use
- Chemical Exposure
- Electrocution/Shock
- Arc Flash
- Heat/Cold Stress
- Falling From Heights (over 6')
- Overhead Hazards/Falling Debris
- Pinch Points
- Burns
- Loud Noise/Hearing Loss
- Cave-In
- Confined Space
- Other
-
Please describe additional hazards:
-
Mitigations
- Proper PPE Utilized (Specify in PPE Section)
- Fall Protection
- Proper Tool Inspection
- First-Aid Kit Readily Available
- Sufficient Drinking Water
- Extra Rest Breaks Due to Weather/Elements
- Proper Supervision
- Dress Appropriately
- Lockout/Tagout
- GFCI Protection
- Proper Communication
- Proper Equipment Inspection
- Using Correct Tools
- Using Correct Equipment
- Proper Planning
- Use of a Spotter / Buddy / Watch
- Proper Lifting Techniques/Stretching
- Good Housekeeping
- SDS Sheets Readily Available
- Respiratory Protection (dusk mask or respirator)
- Proper Excavation/Trenching Procedures (Sloping, Trench Box, etc.)
- Other
-
Additional Mitigations:
-
Underground Work
-
Potential Hazards
- Vehicle Operation
- Equipment Operation
- Heavy Equipment
- Fire Hazards
- Invasive Wounds
- Air Quality
- Hand/Arm Injuries
- Eye/Facial Injuries
- Lifting Hazards
- Body Strain
- Tripping
- Ladder/Stilt Use
- Chemical Exposure
- Electrocution/Shock
- Arc Flash
- Heat/Cold Stress
- Falling From Heights (over 6')
- Overhead Hazards/Falling Debris
- Pinch Points
- Burns
- Loud Noise/Hearing Loss
- Cave-In
- Confined Space
- Other
-
Please describe additional hazards:
-
Mitigations
- Proper PPE Utilized (Specify in PPE Section)
- Fall Protection
- Proper Tool Inspection
- First-Aid Kit Readily Available
- Sufficient Drinking Water
- Extra Rest Breaks Due to Weather/Elements
- Proper Supervision
- Dress Appropriately
- Lockout/Tagout
- GFCI Protection
- Proper Communication
- Proper Equipment Inspection
- Using Correct Tools
- Using Correct Equipment
- Proper Planning
- Use of a Spotter / Buddy / Watch
- Proper Lifting Techniques/Stretching
- Good Housekeeping
- SDS Sheets Readily Available
- Respiratory Protection (dusk mask or respirator)
- Proper Excavation/Trenching Procedures (Sloping, Trench Box, etc.)
- Other
-
Additional Mitigations:
-
Trenching
-
Potential Hazards
- Vehicle Operation
- Equipment Operation
- Heavy Equipment
- Fire Hazards
- Invasive Wounds
- Air Quality
- Hand/Arm Injuries
- Eye/Facial Injuries
- Lifting Hazards
- Body Strain
- Tripping
- Ladder/Stilt Use
- Chemical Exposure
- Electrocution/Shock
- Arc Flash
- Heat/Cold Stress
- Falling From Heights (over 6')
- Overhead Hazards/Falling Debris
- Pinch Points
- Burns
- Loud Noise/Hearing Loss
- Cave-In
- Confined Space
- Other
-
Please describe additional hazards:
-
Mitigations
- Proper PPE Utilized (Specify in PPE Section)
- Fall Protection
- Proper Tool Inspection
- First-Aid Kit Readily Available
- Sufficient Drinking Water
- Extra Rest Breaks Due to Weather/Elements
- Proper Supervision
- Dress Appropriately
- Lockout/Tagout
- GFCI Protection
- Proper Communication
- Proper Equipment Inspection
- Using Correct Tools
- Using Correct Equipment
- Proper Planning
- Use of a Spotter / Buddy / Watch
- Proper Lifting Techniques/Stretching
- Good Housekeeping
- SDS Sheets Readily Available
- Respiratory Protection (dusk mask or respirator)
- Proper Excavation/Trenching Procedures (Sloping, Trench Box, etc.)
- Other
-
Additional Mitigations:
-
Terminate Panels/Switchgear
-
Potential Hazards
- Vehicle Operation
- Equipment Operation
- Heavy Equipment
- Fire Hazards
- Invasive Wounds
- Air Quality
- Hand/Arm Injuries
- Eye/Facial Injuries
- Lifting Hazards
- Body Strain
- Tripping
- Ladder/Stilt Use
- Chemical Exposure
- Electrocution/Shock
- Arc Flash
- Heat/Cold Stress
- Falling From Heights (over 6')
- Overhead Hazards/Falling Debris
- Pinch Points
- Burns
- Loud Noise/Hearing Loss
- Cave-In
- Confined Space
- Other
-
Please describe additional hazards:
-
Mitigations
- Proper PPE Utilized (Specify in PPE Section)
- Fall Protection
- Proper Tool Inspection
- First-Aid Kit Readily Available
- Sufficient Drinking Water
- Extra Rest Breaks Due to Weather/Elements
- Proper Supervision
- Dress Appropriately
- Lockout/Tagout
- GFCI Protection
- Proper Communication
- Proper Equipment Inspection
- Using Correct Tools
- Using Correct Equipment
- Proper Planning
- Use of a Spotter / Buddy / Watch
- Proper Lifting Techniques/Stretching
- Good Housekeeping
- SDS Sheets Readily Available
- Respiratory Protection (dusk mask or respirator)
- Proper Excavation/Trenching Procedures (Sloping, Trench Box, etc.)
- Other
-
Additional Mitigations:
-
Operate Machinery
-
Potential Hazards
- Vehicle Operation
- Equipment Operation
- Heavy Equipment
- Fire Hazards
- Invasive Wounds
- Air Quality
- Hand/Arm Injuries
- Eye/Facial Injuries
- Lifting Hazards
- Body Strain
- Tripping
- Ladder/Stilt Use
- Chemical Exposure
- Electrocution/Shock
- Arc Flash
- Heat/Cold Stress
- Falling From Heights (over 6')
- Overhead Hazards/Falling Debris
- Pinch Points
- Burns
- Loud Noise/Hearing Loss
- Cave-In
- Confined Space
- Other
-
Please describe additional hazards:
-
Mitigations
- Proper PPE Utilized (Specify in PPE Section)
- Fall Protection
- Proper Tool Inspection
- First-Aid Kit Readily Available
- Sufficient Drinking Water
- Extra Rest Breaks Due to Weather/Elements
- Proper Supervision
- Dress Appropriately
- Lockout/Tagout
- GFCI Protection
- Proper Communication
- Proper Equipment Inspection
- Using Correct Tools
- Using Correct Equipment
- Proper Planning
- Use of a Spotter / Buddy / Watch
- Proper Lifting Techniques/Stretching
- Good Housekeeping
- SDS Sheets Readily Available
- Respiratory Protection (dusk mask or respirator)
- Proper Excavation/Trenching Procedures (Sloping, Trench Box, etc.)
- Other
-
Additional Mitigations:
-
Splicing Junction Boxes
-
Potential Hazards
- Vehicle Operation
- Equipment Operation
- Heavy Equipment
- Fire Hazards
- Invasive Wounds
- Air Quality
- Hand/Arm Injuries
- Eye/Facial Injuries
- Lifting Hazards
- Body Strain
- Tripping
- Ladder/Stilt Use
- Chemical Exposure
- Electrocution/Shock
- Arc Flash
- Heat/Cold Stress
- Falling From Heights (over 6')
- Overhead Hazards/Falling Debris
- Pinch Points
- Burns
- Loud Noise/Hearing Loss
- Cave-In
- Confined Space
- Other
-
Please describe additional hazards:
-
Mitigations
- Proper PPE Utilized (Specify in PPE Section)
- Fall Protection
- Proper Tool Inspection
- First-Aid Kit Readily Available
- Sufficient Drinking Water
- Extra Rest Breaks Due to Weather/Elements
- Proper Supervision
- Dress Appropriately
- Lockout/Tagout
- GFCI Protection
- Proper Communication
- Proper Equipment Inspection
- Using Correct Tools
- Using Correct Equipment
- Proper Planning
- Use of a Spotter / Buddy / Watch
- Proper Lifting Techniques/Stretching
- Good Housekeeping
- SDS Sheets Readily Available
- Respiratory Protection (dusk mask or respirator)
- Proper Excavation/Trenching Procedures (Sloping, Trench Box, etc.)
- Other
-
Additional Mitigations:
-
Other Task 1
-
Task:
-
Potential Hazards
- Vehicle Operation
- Equipment Operation
- Heavy Equipment
- Fire Hazards
- Invasive Wounds
- Air Quality
- Hand/Arm Injuries
- Eye/Facial Injuries
- Lifting Hazards
- Body Strain
- Tripping
- Ladder/Stilt Use
- Chemical Exposure
- Electrocution/Shock
- Arc Flash
- Heat/Cold Stress
- Falling From Heights (over 6')
- Overhead Hazards/Falling Debris
- Pinch Points
- Burns
- Loud Noise/Hearing Loss
- Cave-In
- Confined Space
- Other
-
Please describe additional hazards:
-
Mitigations
- Proper PPE Utilized (Specify in PPE Section)
- Fall Protection
- Proper Tool Inspection
- First-Aid Kit Readily Available
- Sufficient Drinking Water
- Extra Rest Breaks Due to Weather/Elements
- Proper Supervision
- Dress Appropriately
- Lockout/Tagout
- GFCI Protection
- Proper Communication
- Proper Equipment Inspection
- Using Correct Tools
- Using Correct Equipment
- Proper Planning
- Use of a Spotter / Buddy / Watch
- Proper Lifting Techniques/Stretching
- Good Housekeeping
- SDS Sheets Readily Available
- Respiratory Protection (dusk mask or respirator)
- Proper Excavation/Trenching Procedures (Sloping, Trench Box, etc.)
- Other
-
Additional Mitigations:
-
Other Task 2
-
Task:
-
Potential Hazards
- Vehicle Operation
- Equipment Operation
- Heavy Equipment
- Fire Hazards
- Invasive Wounds
- Air Quality
- Hand/Arm Injuries
- Eye/Facial Injuries
- Lifting Hazards
- Body Strain
- Tripping
- Ladder/Stilt Use
- Chemical Exposure
- Electrocution/Shock
- Arc Flash
- Heat/Cold Stress
- Falling From Heights (over 6')
- Overhead Hazards/Falling Debris
- Pinch Points
- Burns
- Loud Noise/Hearing Loss
- Cave-In
- Confined Space
- Other
-
Please describe additional hazards:
-
Mitigations
- Proper PPE Utilized (Specify in PPE Section)
- Fall Protection
- Proper Tool Inspection
- First-Aid Kit Readily Available
- Sufficient Drinking Water
- Extra Rest Breaks Due to Weather/Elements
- Proper Supervision
- Dress Appropriately
- Lockout/Tagout
- GFCI Protection
- Proper Communication
- Proper Equipment Inspection
- Using Correct Tools
- Using Correct Equipment
- Proper Planning
- Use of a Spotter / Buddy / Watch
- Proper Lifting Techniques/Stretching
- Good Housekeeping
- SDS Sheets Readily Available
- Respiratory Protection (dusk mask or respirator)
- Proper Excavation/Trenching Procedures (Sloping, Trench Box, etc.)
- Other
-
Additional Mitigations:
PPE Required and Utilized
-
What PPE is required and being utilized?
- Hard Hat (Class C, G & E)
- Safety Glasses (ANSI Z-87)
- AR Clothing
- Ear Protection (Inserts)
- AR Faceshield
- Leather or AR Gloves
- Leather Boots
- Respiratory Protection
- Personal Fall Arrest System
- Class II Safety Vest
- Other
-
Additional PPE Required/Utilized:
-
Has all PPE been inspected prior to use?
Permits Required and Completed
-
Lockout/Tagout
-
Confined Space Entry
-
Energized Electrical Work (EEW)
-
Excavation and Trenching (anything over 5' deep)
-
Hot Work
Are All Necessary Inspections Complete Prior to Use?
-
Fall Protection (harness, etc.)
-
Motorized Equipment
-
Ladders
-
Man/Scissor Lifts
-
Electrical/GFCI
-
Fire Extinguishers (Monthly)
-
Housekeeping
HAZCOM
-
Are Safety Data Sheets readily available for all chemicals being used?
Signatures
-
Foreman/Supervisor Signature: I affirm that I have shared this JHA with everyone on my crew and advised them of all hazards and mitigations of work assigned to them:
-
Crew Signatures:
By signing below, I affirm that my foreman/supervisor has shared this JHA with me and I am aware of all hazards and mitigations of the job duties assigned to me:
Signatures
-
Signatures
