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WORK AREA: TASK NAME: DATE:

 NEW
 REVISED

PREPARED BY: (List all members of the assessment team)


JOB HAZARD ANALYSIS

FREQUENCY/ DURATION:  ROUTINE ITEMS/ PROCEDURE TO BE ISSUED WITH THIS JHA;


 NON-ROUTINE
 EMERGENCY SITUATION

REVIEWED BY (Contractor Manager/ Safety Representative): APPROVED BY (SEC Facilities Engineer/ Safety Engineer):

SEQUENCE OF BASIC JOB STEPS EXISTING OR POTENTIAL CONTROLS TO MINIMIZE/


(Break a specific job/task down into a series of HAZARDS/ IMPACTS ELIMINATE HAZARDS
steps or smaller tasks). (List ALL hazards – both those produced by the (By using the Elimination, Substitution, Engineering, Administrative &
environment or conditions and those connected Personal Protective Equipment control methods)
with the job procedure).
Using Tools Eye Injury, Foot Injury, Hand Injury Use proper PPE
Chemical (Pouring/Handling) Eye Injury, Contact irritation, burn or absorption, Ingestion, Face Use proper PPE, Wear respirator if needed, Apron
Lifting/Carrying objects Foot injury Wear safety shoes/boots
Sewer Snake Electrical shock, Hand/eye injury, Noise Follow manufacturer instructions, proper grounding, and use proper PPE
Valves (operating) Eye/foot injury Wear proper PPE

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