Information
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Document No.
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Segment
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Conducted on
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Prepared by
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Location
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Foreman and Superintendent
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Crew members
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If the question does not apply consider it an excellent (5) so the percentage takes it into account. Please be brutally hosed when assessing the hazard analysis. We are looking at the quality of the document as well as the execution of the document with the crews. Improvement is our ultimate goal.
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What type of JHA?
- MAJOR JHA
- MINOR JHA
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Supervisor (foreman/super) conducted JHA review with feedback/input from workers?
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All members of the crew participate in the JHA review prior to starting work? (Applies to new workers to the crew as well)
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Was approached by someone on the crew to review the operations JHA upon approaching the work zone?<br>
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JHA visible and appropriately maintained at the job location?
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Includes ALL steps for the operation being completed?
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Identifies specific hazards and mitigation measures to control those hazards? (NOT GENERIC)
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JHA was conducted at the operations location?
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Operation is following and not deviating from the JHA?
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JHA is being updated or a mini is being conducted when changes to the operation occur?
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Foreman and Superintendent signed off on the JHA?
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Workers are knowledgable of the JHA process?
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General comments
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Supervisor signature
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Auditor signature
