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JOB HAZARD ANALYSIS WORKSHEET

Job/Task: Job Location: Contractor:

THIS DOCUMENT IS REQUIRED DAILY


Date: Completed By: Supervisor / Foreman: KM epresentative:

!ersonal !rotective "#uipment re#uired:

Sequence of Basic Job Steps


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otentia! Ha"a#$s of Eac% Job Step


!an of Action to &ont#o! o# E!i'inate an( Ha"a#$)s*

Si+natu#es of E'p!o(ees ,e#if(in+ t%e Re-ie. of otentia! Ha"a#$s #int Na'e


Si+natu#e

#int Na'e

Si+natu#e

IDENTI/Y HAZARDS0 otentia! E1a'p!es0 strikin/ a/ainst0 bein/ struck by0 or makin/ 1arm2ul contact 3it1 an ob4ect5 bein/ cau/1t in0 by or bet3een ob4ects5 slippin/0 trippin/ or 2allin/5 developin/ a strain 2rom pus1in/0 pullin/0 li2tin/0 bendin/ or t3istin/5 comin/ in contact 3it1 electricity or ot1er po3er source5 receivin/ a t1ermal or c1emical burn5 bein/ e6posed to a 1a7ardous environment

Dist#ibution0

KM onsite epresentative KM Job File

!a/e $ o2 &

CSM8..( */.-

INSTR2&TIONS /OR &O3 LETIN4 JOB SA/ETY ANALYSIS WORKSHEET

Sequence of Basic Job Steps


Break t1e 4ob do3n into steps% "ac1 o2 t1e steps o2 a 4ob s1ould accomplis1 some ma4or task% T1e task 3ill consist o2 a set o2 movements% Look at t1e 2irst set o2 movements used to per2orm a task0 and t1en determine t1e ne6t lo/ical set o2 movements% For e6ample0 t1e 4ob mi/1t be to move a bo6 2rom a truck in t1e receivin/ area to a s1el2 in t1e stora/e area% 9o3 does t1at break do3n into 4ob steps: !ickin/ up t1e bo6 2rom t1e truck and puttin/ it on a 1and truck is one lo/ical set o2 movements0 so it is one 4ob step% "veryt1in/ related to t1at one lo/ical set o2 movements is part o2 t1at 4ob step% T1e ne6t lo/ical set o2 movements mi/1t be pus1in/ t1e loaded 1and truck to t1e storeroom% emovin/ t1e bo6es 2rom t1e truck and placin/ t1em on t1e s1el2 is anot1er lo/ical set o2 movements% ;nd 2inally0 returnin/ t1e 1and truck to t1e receivin/ are mi/1t be t1e 2inal step in t1is type o2 4ob% Be sure to list all t1e steps in a 4ob% Some steps mi/1t not be done eac1 time 8 c1eckin/ t1e casters on a 1and truck0 2or e6ample% 9o3ever0 t1at task is a part o2 t1e 4ob as a 31ole0 and s1ould be listed and analy7ed% <umber t1e steps% T1e number 3ill provide a re2erence point 2or t1e 1a7ards and procedures developed%

otentia! Ha"a#$s of Eac% Job Step


=denti2y t1e 1a7ards associated 3it1 eac1 step% "6amine eac1 step to 2ind and identi2y 1a7ards 8 actions0 conditions and possibilities t1at could lead to an accident% <umber 1a7ard list to correspond 3it1 your steps% =t is not enou/1 to look at t1e obvious 1a7ards% =t>s also important to look at t1e entire environment and discover every conceivable 1a7ard t1at mi/1t e6ist% Be sure to list 1ealt1 1a7ards as 3ell0 even t1ou/1 t1e 1arm2ul e22ect may not be immediate% "6: t1e 1arm2ul e22ect o2 in1alin/ a solvent or c1emical dust over a lon/ period o2 time% =t>s important to list all 1a7ards% 9a7ards contribute to accidents0 in4uries and occupational illnesses% =n order to do !art ' o2 a J9; e22ectively0 you must identi2y potential and e6istin/ 1a7ards% T1at>s 31y it>s important to distin/uis1 bet3een a 1a7ard0 an accident and an in4ury% "ac1 o2 t1ese terms 1as a speci2ic meanin/: 9;?; D: 1a7ard% ; potential dan/er% @il on t1e 2loor is a

!an of Action to &ont#o! o# E!i'inate t%e Ha"a#$)s*


Asin/ t1e 2irst t3o columns as a /uide0 decide 31at actions are necessary to eliminate0 minimi7e or monitor t1e 1a7ards t1at could lead to an accident0 in4ury or occupational illness% <umber t1e actions to correspond 3it1 t1e steps and identi2ied 1a7ards% ;mon/ t1e actions t1at can be taken are: C$D en/ineerin/ t1e 1a7ard out C&D providin/ personal protective e#uipment C'D 4ob instruction trainin/ C(D /ood 1ousekeepin/ C)D /ood er/onomics Cpositionin/ t1e person in relation to t1e mac1ine or ot1er elements in t1e environment in suc1 a 3ay as to eliminate stresses and strainsD List recommended sa2e operatin/ procedures on t1e 2orm0 and also list re#uired or recommended personal protective e#uipment 2or eac1 step o2 t1e 4ob% Be speci2ic% Say e6actly 31at needs to be done to correct t1e 1a7ard0 suc1 as Eli2t0 usin/ your le/ musclesF% ;void /eneral statements like0 Ebe care2ulF% Give a recommended action or procedure 2or every 1a7ard% =2 t1e 1a7ard is a serious one0 it s1ould be corrected immediately% T1e J9; s1ould t1en be c1an/ed to re2lect t1e ne3 conditions%

;CC=D"<T: ;n unintended 1appenin/ t1at may result in in4ury0 loss or dama/e% Slippin/ on t1e oil is an accident% =<JA B: T1e result o2 an accident% ; sprained 3rist 2rom t1e 2all 3ould be an in4ury% Some people 2ind it easier to identi2y possible accidents and illnesses and 3ork back 2rom t1em to t1e 1a7ards% =2 you do t1at0 you can list t1e accident and illness types in parent1eses 2ollo3in/ t1e 1a7ard% But be sure you 2ocus on t1e 1a7ard 2or developin/ recommended actions and sa2e 3ork procedures%

Dist#ibution0

KM onsite epresentative KM Job File

!a/e & o2 &

CSM8..( */.-

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