Information
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Jobsite Name
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Conducted on
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Foreman
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Location
JHA
Site Information
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Job Name
Personal Protective Equipment Checked
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Personal Protective Equipment Checked
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Hard Hat
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Safety Glasses
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Cutting Goggles
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Face Shield
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Respirator
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Hand Protection
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Ear Plugs
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Fall Protection
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Tie Off Cables
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Full Body Harness Inspected
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Lanyard Inspected
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Date
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Site Number/ Name
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General Contractor
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Project Lead
Ensure all hazards identified are addressed in the JHA below.
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1. Potential Hazards. (Ex. site conditions, falls, cuts, slips trips, housekeeping)
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1. Sequence of basic job step in order
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1. Safety Controls used to reduce or eliminate hazards
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2. Potential Hazards. (Ex. site conditions, falls, cuts, slips trips, housekeeping)
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2. Sequence of basic job step in order
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2. Safety Controls used to reduce or eliminate hazards
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3. Potential Hazards. (Ex. site conditions, falls, cuts, slips trips, housekeeping)
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3. Sequence of basic job step in order
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3. Safety Controls used to reduce or eliminate hazards
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4. Potential Hazards. (Ex. site conditions, falls, cuts, slips trips, housekeeping)
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4. Sequence of basic job step in order
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4. Safety Controls used to reduce or eliminate hazards
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5. Potential Hazards. (Ex. site conditions, falls, cuts, slips trips, housekeeping)
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5.Sequence of basic job step in order
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5. Safety Controls used to reduce or eliminate hazards
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6. Potential Hazards. (Ex. site conditions, falls, cuts, slips trips, housekeeping)
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6. Sequence of basic job step in order
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6. Safety Controls used to reduce or eliminate hazards
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7. Potential Hazards. (Ex. site conditions, falls, cuts, slips trips, housekeeping)
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7. Sequence of basic job step in order
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7. Safety Controls used to reduce or eliminate hazards
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Prepared By
Attendees
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Reviewed By
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Reviewed By
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Reviewed By
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Date