Pima County Job Hazard Analysis

• Site conducted

  Select

• Conducted on:

  Date

• Job/ Task:

• Location:
  Address

• Prepared by:

• Department Personnel and Title:

• Severity of Hazards Explanation:

• 

Job Step:

• Sequence of Basic Job Steps:

• Potential Hazards of Each Step:

• Plan of Action or Eliminate any Hazard

• Severity of Hazards:

  1

  2

  3

Personal Protective Equipment:

• List All PPE Required:

Media

• Add media

  Media

SIGNATURES

• Participating Employee:

  Sign

• Participating Employee:

  Sign

• Participating Employee:

  Sign

• Participating Employee:

  Sign

• Participating Facilities Management LCO:

  Sign