TFOME Contract JHA Review

• JHA Task Reviewed

• Reviewed By

• Review Date

  Date

• Building and/ or Facility Work Took Place

Page 2 (Administration)

• Does the JHA Clearly define the task to take place?

  Yes

  No

  N/A

• Was the JHA reviewed and Singed off on?

  Yes

  No

  N/A

• Were all other applicable NASA permits/ forms required for the task, that you know of, checked off?

  Yes

  No

  N/A

• What is missing?

• Were all known specific chemicals used, that you know of, listed?

  Yes

  No

  N/A

• What chemicals are missing?

Page 3 (Steps, Hazards, Controls, References)

• Do the STEPS of job/ task listed seem to adequately cover the entire task

  Yes

  No

  N/A

• Do you feel there are STEPS that could be added to make the JHA more complete?

  Yes

  No

  N/A

• Suggested STEPS to add

• Do you feel the HAZARDS listed are applicable for the STEPS they coincide with?

  Yes

  No

  N/A

• Why not or what should be added? Too basic?

• Do you feel the HAZARD CONTROLS adequately address mitigation measures, and follow the heirchy of controls, for the HAZARDS they coincide with?

  Yes

  No

  N/A

• Why not or what is missing? Too generic?

• Are references availabe as necessary?

  Yes

  No

  N/A

Pages 4-6 (Check boxes/ Guidance)

• Was the CHECK BOX section used?

  Yes

  No

  N/A

• Why not? Follow-up on this as necessary.

• Are applicable are applicable Engineering and/ Administrative controls checked off?

  Yes

  No

  N/A

• Is required PPE checked off and applicable?

  Yes

  No

  N/A

Final

• Any other Thoughts or Comments to share

• Completed By

  Sign