Information
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Audit Title
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Client / Site/ Project
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Conducted on
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Prepared by
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Location
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Document No.
Information
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Task or equipment I.D.
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Equipment or Task Photo
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Location
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Date and Time JHA Started
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General Description of Task/s
Sequence of steps
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Step 1
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Photo of task
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Description of task
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Step Catagory
- Engineering controls
- Administrative controls
- PPE Required
- Job rotation
- Machine guarding
- Stretching - Pre shift
- Shielding
- Workspace re-design
- Adjust work surface to worker
- Develop Safe work procedure
- Training
- Use lifting aids
- Team lift
- Use pullbacks
- Ergonomic Mats
- Lockout tagout
- Use adjustable work station
- Use work lift tabel
- Substitution
- Limit exposure
- Increase lighting
- Use sound absorbing barriers
- Use chip guards
- Install protective barriers
- Paint safe work zones
- Chain off area
- Post warning signage
- Apply warning or danger stickers
- Install ventilation
- Restrict access to area
- Stage work properly
-
Hazards associated with task
- Struck by an object
- Caught between
- Pinch or crush hazard
- Awkward position
- Repetitive motion
- Hot surface
- Slip or Fall
- Tripping hazard
- Respiratory hazard - Dust
- Respiratory hazard - Fumes
- Electrical shock hazard
- Poor workspace design
- Vibration
- Excessive noise levels
- Back strain
- Flying chips or particles
- Extended periods of standing or sitting
- High traffic area - forklifts
- Confined space hazard
- Hot surface
- Lighting - poor visibility
- Danger of falling objects
- Fire or explosion hazard
- Environment - Heat illness
- Rotating parts
- Exposed cutting blades
- Slippery surface
- High pressure
- Laceration
- Excessive vibration
- Low clearance
- Chemical hazard
- Poor workspace design
- Moving parts
- Belt or Gear exposure
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PPE Required
- Safety Glasses
- Goggles
- Face Shield
- Gloves - Chemical Resistant
- Cut Resistant Gloves
- Ear Protection
- Foot Protection
- Head protection
- Back belts
- Wrist brace - down movement restrictive
- Wrist brace - up movement restrictive
- Dust mask
- Respirators
- Fall protection
- Non slip shoes
- Knee pads
- Aprons
- Flame retardant overalls
- Arc rated gloves
- Arc rated tools
-
Controls
- Safety Glasses
- Goggles
- Face Shield
- Gloves - Chemical Resistant
- Cut Resistant Gloves
- Ear Protection
- Foot Protection
- Head protection
- Back belts
- Wrist brace - down movement restrictive
- Wrist brace - up movement restrictive
- Dust mask
- Respirators
- Fall protection
- Non slip shoes
- Knee pads
- Aprons
- Flame retardant overalls
- Arc rated gloves
- Arc rated tools
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Summary of controls to reduce or eliminate hazards
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Step 2
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Photo of task
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Description of task
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Step Catagory
- Setup
- Operation
- Loading
- Unloading
- Support
- Service or Maintenance
- Adjusting
- Material Supply
- Material handling
- Packing
- Assembly
- Filling
- Changing blade
-
Hazards associated with task
- Struck by an object
- Caught between
- Pinch or crush hazard
- Awkward position
- Repetitive motion
- Hot surface
- Slip or Fall
- Tripping hazard
- Respiratory hazard - Dust
- Respiratory hazard - Fumes
- Electrical shock hazard
- Poor workspace design
- Vibration
- Excessive noise levels
- Back strain
- Flying chips or particles
- Extended periods of standing or sitting
- High traffic area - forklifts
- Confined space hazard
- Hot surface
- Lighting - poor visibility
- Danger of falling objects
- Fire or explosion hazard
- Environment - Heat illness
- Rotating parts
- Exposed cutting blades
- Slippery surface
- High pressure
- Laceration
- Excessive vibration
- Low clearance
- Chemical hazard
- Poor workspace design
- Moving parts
- Belt or Gear exposure
-
PPE Required
- Safety Glasses
- Goggles
- Face Shield
- Gloves - Chemical Resistant
- Cut Resistant Gloves
- Ear Protection
- Foot Protection
- Head protection
- Back belts
- Wrist brace - down movement restrictive
- Wrist brace - up movement restrictive
- Dust mask
- Respirators
- Fall protection
- Non slip shoes
- Knee pads
- Aprons
- Flame retardant overalls
- Arc rated gloves
- Arc rated tools
-
Controls
- Engineering controls
- Administrative controls
- PPE Required
- Job rotation
- Machine guarding
- Stretching - Pre shift
- Shielding
- Workspace re-design
- Adjust work surface to worker
- Develop Safe work procedure
- Training
- Use lifting aids
- Team lift
- Use pullbacks
- Ergonomic Mats
- Lockout tagout
- Use adjustable work station
- Use work lift tabel
- Substitution
- Limit exposure
- Increase lighting
- Use sound absorbing barriers
- Use chip guards
- Install protective barriers
- Paint safe work zones
- Chain off area
- Post warning signage
- Apply warning or danger stickers
- Install ventilation
- Restrict access to area
- Stage work properly
-
Summary of controls to reduce or eliminate hazards
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Step 3
-
Photo of task
-
Description of task
-
Step Catagory
- Setup
- Operation
- Loading
- Unloading
- Support
- Service or Maintenance
- Adjusting
- Material Supply
- Material handling
- Packing
- Assembly
- Filling
- Changing blade
-
Hazards associated with task
- Struck by an object
- Caught between
- Pinch or crush hazard
- Awkward position
- Repetitive motion
- Hot surface
- Slip or Fall
- Tripping hazard
- Respiratory hazard - Dust
- Respiratory hazard - Fumes
- Electrical shock hazard
- Poor workspace design
- Vibration
- Excessive noise levels
- Back strain
- Flying chips or particles
- Extended periods of standing or sitting
- High traffic area - forklifts
- Confined space hazard
- Hot surface
- Lighting - poor visibility
- Danger of falling objects
- Fire or explosion hazard
- Environment - Heat illness
- Rotating parts
- Exposed cutting blades
- Slippery surface
- High pressure
- Laceration
- Excessive vibration
- Low clearance
- Chemical hazard
- Poor workspace design
- Moving parts
- Belt or Gear exposure
-
PPE Required
- Safety Glasses
- Goggles
- Face Shield
- Gloves - Chemical Resistant
- Cut Resistant Gloves
- Ear Protection
- Foot Protection
- Head protection
- Back belts
- Wrist brace - down movement restrictive
- Wrist brace - up movement restrictive
- Dust mask
- Respirators
- Fall protection
- Non slip shoes
- Knee pads
- Aprons
- Flame retardant overalls
- Arc rated gloves
- Arc rated tools
-
Controls
- Engineering controls
- Administrative controls
- PPE Required
- Job rotation
- Machine guarding
- Stretching - Pre shift
- Shielding
- Workspace re-design
- Adjust work surface to worker
- Develop Safe work procedure
- Training
- Use lifting aids
- Team lift
- Use pullbacks
- Ergonomic Mats
- Lockout tagout
- Use adjustable work station
- Use work lift tabel
- Substitution
- Limit exposure
- Increase lighting
- Use sound absorbing barriers
- Use chip guards
- Install protective barriers
- Paint safe work zones
- Chain off area
- Post warning signage
- Apply warning or danger stickers
- Install ventilation
- Restrict access to area
- Stage work properly
-
Summary of controls to reduce or eliminate hazards
-
Step 4
-
Photo of task
-
Description of task
-
Step Catagory
- Setup
- Operation
- Loading
- Unloading
- Support
- Service or Maintenance
- Adjusting
- Material Supply
- Material handling
- Packing
- Assembly
- Filling
- Changing blade
-
Hazards associated with task
- Struck by an object
- Caught between
- Pinch or crush hazard
- Awkward position
- Repetitive motion
- Hot surface
- Slip or Fall
- Tripping hazard
- Respiratory hazard - Dust
- Respiratory hazard - Fumes
- Electrical shock hazard
- Poor workspace design
- Vibration
- Excessive noise levels
- Back strain
- Flying chips or particles
- Extended periods of standing or sitting
- High traffic area - forklifts
- Confined space hazard
- Hot surface
- Lighting - poor visibility
- Danger of falling objects
- Fire or explosion hazard
- Environment - Heat illness
- Rotating parts
- Exposed cutting blades
- Slippery surface
- High pressure
- Laceration
- Excessive vibration
- Low clearance
- Chemical hazard
- Poor workspace design
- Moving parts
- Belt or Gear exposure
-
PPE Required
- Safety Glasses
- Goggles
- Face Shield
- Gloves - Chemical Resistant
- Cut Resistant Gloves
- Ear Protection
- Foot Protection
- Head protection
- Back belts
- Wrist brace - down movement restrictive
- Wrist brace - up movement restrictive
- Dust mask
- Respirators
- Fall protection
- Non slip shoes
- Knee pads
- Aprons
- Flame retardant overalls
- Arc rated gloves
- Arc rated tools
-
Controls
- Engineering controls
- Administrative controls
- PPE Required
- Job rotation
- Machine guarding
- Stretching - Pre shift
- Shielding
- Workspace re-design
- Adjust work surface to worker
- Develop Safe work procedure
- Training
- Use lifting aids
- Team lift
- Use pullbacks
- Ergonomic Mats
- Lockout tagout
- Use adjustable work station
- Use work lift tabel
- Substitution
- Limit exposure
- Increase lighting
- Use sound absorbing barriers
- Use chip guards
- Install protective barriers
- Paint safe work zones
- Chain off area
- Post warning signage
- Apply warning or danger stickers
- Install ventilation
- Restrict access to area
- Stage work properly
-
Summary of controls to reduce or eliminate hazards
-
Step 5
-
Photo of task
-
Description of task
-
Step Catagory
- Setup
- Operation
- Loading
- Unloading
- Support
- Service or Maintenance
- Adjusting
- Material Supply
- Material handling
- Packing
- Assembly
- Filling
- Changing blade
-
Hazards associated with task
- Struck by an object
- Caught between
- Pinch or crush hazard
- Awkward position
- Repetitive motion
- Hot surface
- Slip or Fall
- Tripping hazard
- Respiratory hazard - Dust
- Respiratory hazard - Fumes
- Electrical shock hazard
- Poor workspace design
- Vibration
- Excessive noise levels
- Back strain
- Flying chips or particles
- Extended periods of standing or sitting
- High traffic area - forklifts
- Confined space hazard
- Hot surface
- Lighting - poor visibility
- Danger of falling objects
- Fire or explosion hazard
- Environment - Heat illness
- Rotating parts
- Exposed cutting blades
- Slippery surface
- High pressure
- Laceration
- Excessive vibration
- Low clearance
- Chemical hazard
- Poor workspace design
- Moving parts
- Belt or Gear exposure
-
PPE Required
- Safety Glasses
- Goggles
- Face Shield
- Gloves - Chemical Resistant
- Cut Resistant Gloves
- Ear Protection
- Foot Protection
- Head protection
- Back belts
- Wrist brace - down movement restrictive
- Wrist brace - up movement restrictive
- Dust mask
- Respirators
- Fall protection
- Non slip shoes
- Knee pads
- Aprons
- Flame retardant overalls
- Arc rated gloves
- Arc rated tools
-
Controls
- Engineering controls
- Administrative controls
- PPE Required
- Job rotation
- Machine guarding
- Stretching - Pre shift
- Shielding
- Workspace re-design
- Adjust work surface to worker
- Develop Safe work procedure
- Training
- Use lifting aids
- Team lift
- Use pullbacks
- Ergonomic Mats
- Lockout tagout
- Use adjustable work station
- Use work lift tabel
- Substitution
- Limit exposure
- Increase lighting
- Use sound absorbing barriers
- Use chip guards
- Install protective barriers
- Paint safe work zones
- Chain off area
- Post warning signage
- Apply warning or danger stickers
- Install ventilation
- Restrict access to area
- Stage work properly
-
Summary of controls to reduce or eliminate hazards
-
Step 6
-
Photo of task
-
Description of task
-
Step Catagory
- Setup
- Operation
- Loading
- Unloading
- Support
- Service or Maintenance
- Adjusting
- Material Supply
- Material handling
- Packing
- Assembly
- Filling
- Changing blade
-
Hazards associated with task
- Struck by an object
- Caught between
- Pinch or crush hazard
- Awkward position
- Repetitive motion
- Hot surface
- Slip or Fall
- Tripping hazard
- Respiratory hazard - Dust
- Respiratory hazard - Fumes
- Electrical shock hazard
- Poor workspace design
- Vibration
- Excessive noise levels
- Back strain
- Flying chips or particles
- Extended periods of standing or sitting
- High traffic area - forklifts
- Confined space hazard
- Hot surface
- Lighting - poor visibility
- Danger of falling objects
- Fire or explosion hazard
- Environment - Heat illness
- Rotating parts
- Exposed cutting blades
- Slippery surface
- High pressure
- Laceration
- Excessive vibration
- Low clearance
- Chemical hazard
- Poor workspace design
- Moving parts
- Belt or Gear exposure
-
PPE Required
- Safety Glasses
- Goggles
- Face Shield
- Gloves - Chemical Resistant
- Cut Resistant Gloves
- Ear Protection
- Foot Protection
- Head protection
- Back belts
- Wrist brace - down movement restrictive
- Wrist brace - up movement restrictive
- Dust mask
- Respirators
- Fall protection
- Non slip shoes
- Knee pads
- Aprons
- Flame retardant overalls
- Arc rated gloves
- Arc rated tools
-
Controls
- Engineering controls
- Administrative controls
- PPE Required
- Job rotation
- Machine guarding
- Stretching - Pre shift
- Shielding
- Workspace re-design
- Adjust work surface to worker
- Develop Safe work procedure
- Training
- Use lifting aids
- Team lift
- Use pullbacks
- Ergonomic Mats
- Lockout tagout
- Use adjustable work station
- Use work lift tabel
- Substitution
- Limit exposure
- Increase lighting
- Use sound absorbing barriers
- Use chip guards
- Install protective barriers
- Paint safe work zones
- Chain off area
- Post warning signage
- Apply warning or danger stickers
- Install ventilation
- Restrict access to area
- Stage work properly
-
Summary of controls to reduce or eliminate hazards
-
Step 7
-
Photo of task
-
Description of task
-
Step Catagory
- Setup
- Operation
- Loading
- Unloading
- Support
- Service or Maintenance
- Adjusting
- Material Supply
- Material handling
- Packing
- Assembly
- Filling
- Changing blade
-
Hazards associated with task
- Struck by an object
- Caught between
- Pinch or crush hazard
- Awkward position
- Repetitive motion
- Hot surface
- Slip or Fall
- Tripping hazard
- Respiratory hazard - Dust
- Respiratory hazard - Fumes
- Electrical shock hazard
- Poor workspace design
- Vibration
- Excessive noise levels
- Back strain
- Flying chips or particles
- Extended periods of standing or sitting
- High traffic area - forklifts
- Confined space hazard
- Hot surface
- Lighting - poor visibility
- Danger of falling objects
- Fire or explosion hazard
- Environment - Heat illness
- Rotating parts
- Exposed cutting blades
- Slippery surface
- High pressure
- Laceration
- Excessive vibration
- Low clearance
- Chemical hazard
- Poor workspace design
- Moving parts
- Belt or Gear exposure
-
PPE Required
- Safety Glasses
- Goggles
- Face Shield
- Gloves - Chemical Resistant
- Cut Resistant Gloves
- Ear Protection
- Foot Protection
- Head protection
- Back belts
- Wrist brace - down movement restrictive
- Wrist brace - up movement restrictive
- Dust mask
- Respirators
- Fall protection
- Non slip shoes
- Knee pads
- Aprons
- Flame retardant overalls
- Arc rated gloves
- Arc rated tools
-
Controls
- Engineering controls
- Administrative controls
- PPE Required
- Job rotation
- Machine guarding
- Stretching - Pre shift
- Shielding
- Workspace re-design
- Adjust work surface to worker
- Develop Safe work procedure
- Training
- Use lifting aids
- Team lift
- Use pullbacks
- Ergonomic Mats
- Lockout tagout
- Use adjustable work station
- Use work lift tabel
- Substitution
- Limit exposure
- Increase lighting
- Use sound absorbing barriers
- Use chip guards
- Install protective barriers
- Paint safe work zones
- Chain off area
- Post warning signage
- Apply warning or danger stickers
- Install ventilation
- Restrict access to area
- Stage work properly
-
Summary of controls to reduce or eliminate hazards
-
Step 8
-
Photo of task
-
Description of task
-
Step Catagory
- Setup
- Operation
- Loading
- Unloading
- Support
- Service or Maintenance
- Adjusting
- Material Supply
- Material handling
- Packing
- Assembly
- Filling
- Changing blade
-
Hazards associated with task
- Struck by an object
- Caught between
- Pinch or crush hazard
- Awkward position
- Repetitive motion
- Hot surface
- Slip or Fall
- Tripping hazard
- Respiratory hazard - Dust
- Respiratory hazard - Fumes
- Electrical shock hazard
- Poor workspace design
- Vibration
- Excessive noise levels
- Back strain
- Flying chips or particles
- Extended periods of standing or sitting
- High traffic area - forklifts
- Confined space hazard
- Hot surface
- Lighting - poor visibility
- Danger of falling objects
- Fire or explosion hazard
- Environment - Heat illness
- Rotating parts
- Exposed cutting blades
- Slippery surface
- High pressure
- Laceration
- Excessive vibration
- Low clearance
- Chemical hazard
- Poor workspace design
- Moving parts
- Belt or Gear exposure
-
PPE Required
- Safety Glasses
- Goggles
- Face Shield
- Gloves - Chemical Resistant
- Cut Resistant Gloves
- Ear Protection
- Foot Protection
- Head protection
- Back belts
- Wrist brace - down movement restrictive
- Wrist brace - up movement restrictive
- Dust mask
- Respirators
- Fall protection
- Non slip shoes
- Knee pads
- Aprons
- Flame retardant overalls
- Arc rated gloves
- Arc rated tools
-
Controls
- Engineering controls
- Administrative controls
- PPE Required
- Job rotation
- Machine guarding
- Stretching - Pre shift
- Shielding
- Workspace re-design
- Adjust work surface to worker
- Develop Safe work procedure
- Training
- Use lifting aids
- Team lift
- Use pullbacks
- Ergonomic Mats
- Lockout tagout
- Use adjustable work station
- Use work lift tabel
- Substitution
- Limit exposure
- Increase lighting
- Use sound absorbing barriers
- Use chip guards
- Install protective barriers
- Paint safe work zones
- Chain off area
- Post warning signage
- Apply warning or danger stickers
- Install ventilation
- Restrict access to area
- Stage work properly
-
Summary of controls to reduce or eliminate hazards
Jobsite and Task Summary of Analysis
-
Additional Recommendations
Signatures
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Supervisor
-
Date approved
-
Reviewed
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EHS Manager
-
Date approved
-
Reviewed
-
Worker
-
Worker
-
Worker
-
Worker
Comments/Discussion
-
General Comments/Discussion
-
Add media