JHA - NOAO
|JOB HAZARD ANALYSIS (JHA) FORM |
|For more details please see Job Hazard Analysis Guide.pdf - |
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|Title of Job or Task: |JHA Number: |
|Date Completed: |Revision: |
|Person Completing this JHA: |Person(s) Assisting with this JHA: |
|Location/Facility: |
|Recommended Personal Protective Equipment (PPE) |
|Use the personal protective equipment hazard assessment form as a guide - |
|Head Protection |Eye Protection |Hand and Body Protection |Other PPE |
|Foot Protection |Hearing Protection |Respiratory Protection | |
|Things to consider |
|Do employees know how to do the job? |What are the hazards? Include people and equipment. |
|How can injuries or accidents occur? |How can injuries or accidents be prevented? |
|Are there obvious unsafe conditions? |Are special tools needed? |
|Do people need personal protective equipment? |How would we rescue people if something went wrong? |
|Do we have the equipment to rescue? | |
|Use these designations in the “Hazards Present” column: |
|SB – Struck By |CI - Caught In |FB – Fall to Below |CBY – Contacted By |
|SA – Struck Against |CB – Caught Between |FS – Fall at the Same Level |CO – Caught On |
|CW – Contact With |O – Overexertion or Repetitive Motion |E – Exposure to Chemicals, Noise, Vibration, Radiation |
|BASIC JOB STEPS |HAZARDS PRESENT IN |CORRECT AND SAFE PROCEDURES |
| |EACH JOB STEP | |
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|JOB HAZARD ANALYSIS (JHA) FORM (cont.) |
|Title of Job or Task: |JHA Number: |
|BASIC JOB STEPS |HAZARDS PRESENT IN |CORRECT AND SAFE PROCEDURES |
| |EACH JOB STEP | |
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WORKERS PERFORMING THIS JHA
|N° |NAME |ID NUMBER |CHARGE NUMBER |AREA / COMPANY |SIGNATURE |
|1 | | | | | |
|2 | | | | | |
|3 | | | | | |
|4 | | | | | |
|5 | | | | | |
|6 | | | | | |
|7 | | | | | |
|8 | | | | | |
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|15 | | | | | |
SUPERVISOR IN CHARGE
|N° |NAME |ID NUMBER |CHARGE NUMBER |AREA/ |SIGNATURE |
| | | | |COMPANY | |
|1 | | | | | |
KEY PERSONNEL IF LIFTING
| |NAME |SIGNATURE |
|SPOTTER | | |
|CRANE OPERATOR | | |
|LEAD RIGGER | | |
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