Job Hazard Analysis (JHA) Template

Permit to work (PTW) or contract

Site / location:
number:
Prepared by: Date prepared:

Job description:
Environment Energy (Hazard) Groups
Targets Aspects Impact Energy Explanation Energy Explanation
Air Dust, fumes Air pollution Manual handling Lifting a chain or sling Radiation Welding, NDT testing, Sun
Water Spills of Oil, chemicals Water pollution Machinery & tools Unguarded bench grinder Heat & cold Oxy Cutting, hot work
Land/Soil Erosion, spills Soil pollution Vehicles & mobile equip Impact from vehicle, forklift, Chemicals Solvents, fumes, dust
Flora & Fauna Damage Cultural crane Fire & explosion Gases in confined spaces
Heritage Pressure Compressed Air Biological organisms Hepatitis B, cooling towers
Waste disposal Location, Falling objects/people Welding rod, people, open pit Psychological/Social stress Witness a death,
recycling Resource usage Sound & vibration Noise/vibration from excessive hours
Noise Equipment noise, operations Noise jackhammer Physical environment Weather, confined space
pollution Electricity Extension cord, overhead lines
Fire Hot work Bush fire
CONSEQUENCE (Impact)
LIKELIHOO 1. 2. 3. 4. 5. 6.
Insignificant Minor Moderate Major Disaster Extreme
D
A.
Almost High High Extreme Extreme Extreme Extreme
certain
B.
Moderate High High Extreme Extreme Extreme
Likely
C.
Low Moderate High High Extreme Extreme
Possible
D.
Low Moderate High High Extreme Extreme
Unlikely
E.
Low Low Moderate High High Extreme
Rare
F.
Extremely Low Low Low Moderate Moderate High
rare
Company Procedures PPE Required

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 Job Hazard Analysis (JHA) Template

Asbestos management SWP 10.1 Hydraulic Spanner SWP 11.5

Mask Dust P1 P2 Respirator
Chemical Cleaning SWP 10.6 Lead/ Mercury SWP 10.6
Concealed Services SWP 7.3 Manual Handling SWP 10.3 Safety Glasses Face Shield Goggles Chemical
Confined Spaces SWP 7.5 Oil transfer SWP 10.6
Cranes and Lifting SWP 11.5 Painting SWP 11.2 Safety Helmet Hair net Welding
Diving Permit SWP 7.6 Permit to Work/Lockout Tag-out SWP 7.1 Helmet
Electrical Safety SWP 12.2 Personal Protective Equipment SWP 10.2 Boots Steel caps
Gumboots
Emergency Planning EMPLIA-05 Portable Electrical Equipment SWP 12.2
Gloves Riggers Rubber
First Aid SWP 5.5 Scaffolding, Ladders, Mobile Platforms SWP Welding
Flammable Liquids 12.1 Fume Fans
Gas Storage and Transport SWP 11.4 Transport Plan SWP 13.5 Extraction Heaters
Hazardous Chemical Control SWP 10.6 Working at Heights SWP 12.1 Welding Chemical
Hot work SWP 7.4 Clothing Jacket/Hood Disposable Overalls
Overalls

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 Job Hazard Analysis (JHA) Template

CONSEQUENCE (impact) - The most likely result of contact with the hazard Hierarchy of Controls
Production
Consequence Injury to Financial loss on
Environmental impact Control Examples
(impact) people loss system or to
client
1. First-aid Negligible or no environmental harm or environmental Up to $5k Level 1 1.
Repair damaged equipment; replace a
Insignificant treatment - nuisance, e.g. Eliminate
chemical process with a mechanical or
minor cuts, - contained oil spill <20 litres
physical one. If this is not practical
bruises, bumps - possible incidental and local impact on flora and fauna
then:
2. Medical Material environmental harm or an environmental nuisance, $5k - $50k Level 2 2.
With a safer alternative. Break larger
Minor treatment but prosecution unlikely, local publicity only, local nuisance Substitute
loads into smaller, lighter loads; use a
injury impacts on community, e.g.
less toxic material. If this is not
- technical breaches of legal requirements regardless of harm
practical, then:
or nuisance
- spills to waterways <200 litres where dispersal/cleanup is
simple
3. Serious injury - Serious environmental harm, possible prosecution, local state $50K - $500k Level 3 3.
Install barriers to restrict access to
Moderate permanent publicity eg Isolate
hazardous work areas, electrical
disability, - significant loss of oil (4000L to land, several 100L to water)
isolation and permit systems. If this is
amputation - ecosystem impact such as fish kill that requires follow up
not practical, then:
monitoring and recovery with expert input and control
4. Fatality Serious environmental harm, prosecution probable, national Over $500K Level 4 4.
Place a guard on dangerous parts;
Major publicity, reputation impacts, political and licence implications Engineering
extract fumes, dust, use a lifting device
e.g.
to do all lifting in workplace. If this is
- Significant ecosystem impact with residual effects likely after
not practical, then:
follow up
- large loss to waterways eg 8,000 litres, esp. if drinking water
affected
5. 2 - 4 fatalities Serious environmental harm, prosecution certain, severely n/a n/a 5.
Rotate jobs to reduce time spent on a
Disaster affected reputation, international attention possible, probable Administrate
single task, train staff in safe work
licence restrictions e.g.
procedures, documented procedures,
- loss of 20,000L oil to water, or to sensitive land area
rules. If this is not practical, then:
- significant impact on regional ecosystem, with significant
residual effects likely
6. 5 or more Serious environmental harm, prosecution certain with jail n/a n/a 6.
Use safety footwear, helmets, earmuffs
Extreme fatalities terms, licence restrictions, severe reputation impact, PPE
etc. These rely on appropriate human
international attention e.g.
behaviour to minimise the risk
- significant impact on regional ecosystem with eventual
recovery impossible
- catastrophic dam failure

LIKELIHOOD - The probability that the identified consequence will occur, taking into account proximity and exposure to the hazard
A. Almost certain The most likely and expected result. Up to 1 in 10 chance.
B. Likely Would not be unusual. Up to 1 in 100 chance.
C. Possible Unusual but possible sequence or coincidence. Up to a 1 in 1,000 chance.
D. Unlikely Has happened somewhere. Up to a 1 in 10,000 chance.
E. Rare Has never occurred after many years of exposure, but is conceivably possible. Up to a 1 in 100,000 chance.
F. Extremely rare Has never happened before. Up to a 1 in 1,000,000 chance

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 Job Hazard Analysis (JHA) Template

Controlled Risk Level Action Table

Level Low JHA Moderate JHA High JHA Extreme JHA
1. People
2. Plant, Environment Proceed. Ensure identified control (Competent) Accountable person Do not proceed. Manager approval Do not proceed. Responsible officer to address
3. Production measures are applied as required approval required to proceed required the problem

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 Job Hazard Analysis (JHA) Template

Uncontrolle Controlled
Job Steps Hazard and Risk Descriptions Control Measures
d Risk Level Risk Level

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 Job Hazard Analysis (JHA) Template

Additional Hazards Identified on Site

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 Job Hazard Analysis (JHA) Template

Uncontrolle Controlled
Job Steps Hazard and Risk Descriptions Control Measures
d Risk Level Risk Level

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 Job Hazard Analysis (JHA) Template

All foreseeable hazards have been identified, risks evaluated and appropriate control measures will be applied as per this JHA worksheet -
Team member sign-off that JHA has been reviewed, and understood prior to starting work
Team member
name
Signature
Date
Team member
name
Signature
Date
Team member
name
Signature
Date

Change of work methodology - Team member sign-off that JHA has been reviewed, and understood prior to starting work
Team member
name
Signature
Date
Team member
name
Signature
Date
Team member
name
Signature
Date

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 Job Hazard Analysis (JHA) Template

Authorisation sign off for this JHA - *Line management approval required for moderate or high level risks after controls
Site Manager/Supervisor Signature,
Approval date
Signature,
Accountable person for job
date

Authorisation sign off for this JHA - *Line management approval required for moderate or high level risks after controls
Site Manager/Supervisor Signature,
Approval date
Signature,
Accountable person for job
date

Authorisation sign off for this JHA - *Line management approval required for moderate or high level risks after controls
Site Manager/Supervisor Signature,
Approval date
Signature,
Accountable person for job
date

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