Information
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Conducted On
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Client / Site
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JHA Title
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Document No.
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Specific Job Location
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Originator
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Personnel in attendance
Risk Rating & Identification Of Controls
HAZARDS AND CONTROLS IDENTIFIED
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HAZARD IDENTIFIED
HAZARD
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Hazard Description
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Hazards and controls identified on which drawings and documents?
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Support Media (if available)
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Identify Hazard (refer Energy Source)
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Existing Risk Score (refer Matrix)
- 1VL - Improbable (1st Aid)
- 1L - Annual Occurrence (1st Aid)
- 1M - Weekly Occurrence (1st Aid)
- 2L - Improbable (Recordable)
- 2M - Annual Occurrence (Recordable)
- 2H - Weekly Occurrence (Recordable)
- 3M - Improbable (Fatal)
- 3H - Annual Occurrence (Fatal)
- 3H - Weekly Occurrence (Fatal)
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Control Measure
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Residual Risk Score (refer Matrix)
- 1VL - Improbable (1st Aid)
- 1L - Annual Occurrence (1st Aid)
- 1M - Weekly Occurrence (1st Aid)
- 2L - Improbable (Recordable)
- 2M - Annual Occurrence (Recordable)
- 2H - Weekly Occurrence (Recordable)
- 3M - Improbable (Fatal)
- 3H - Annual Occurrence (Fatal)
- 3H - Weekly Occurrence (Fatal)
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:::: THIS RESULT IS UNACCEPTABLE! ::::
Please reconsider your solution to the problem. -
To Be Actioned By
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Hazard Action Completed By
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Hazard Action Completion Date
Summary Check List
THINK THROUGH THE DESIGN
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Do you understand the design scope?
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Do you have the relevant study/scope definition documents?
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Have you reviewed the relevant standards applicable to this design?
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Do you understand the applicable site practices/procedures?
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Have you consulted with the relevant subject matter experts applicable to this design? ( Construction/Operations/Maintenance)
HAZARD IDENTIFICATION
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Are there hazards related to construction of the item?
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Are there hazards related to operating/maintaining the item?
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Are there hazards associated with the control system?
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Are there any personnel/plant/equipment hazards?
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Are there any vehicle/personnel/equipment interaction hazards?
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Are there any access hazards for vehicles/personnel/equipment?
CONTROL IDENTIFICATION
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Have the correct personnel been consulted regarding controls?
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Have existing procedures been considered/reviewed?
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Are there any cost/schedule implications relevant to controls?
JHA Contribution
MEETING CONTRIBUTORS
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By signing below, I acknowledge that I have contributed to the development of this JHA and have reviewed the Hazid Worksheet and Work Method Statement (as applicable) to ensure the necessary hazards and controls are included.
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LIST OF JHA CONTRIBUTORS
JHA Contributor
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Name & Signature
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Date Of Signing
