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