MJD PHA

Daily Pre-Job Hazard Assessment (PHA)

Assess the Risk!

1. Identify Hazard	2. Assess Risk
3. Work Safely	4. Introduce Controls

Project*
Company*
Date*

YearMonthDay
Date
Time*

Hour Minutes

AM/PM Option
Trade*
Specific Task Location*
First Aider*
Location of First Aid Kit*

Site Permits*

	Yes	No
Concrete Cutting/Coring
Confined Space Entry
Hot Work
Lockout/Tagout
Fire Suppression/Alarm Shutdown
Other (write below)

Input your other permit(s) above.

Worker/Work Area/Equipment*

	Yes	No
Inspect work area for possible hazards before commencing with tasks? Reassessment may need to occur after inspection.
Am I physically prepared and mentally focused?
Do workers have copies of all MSDS for products used or stored?
Do workers have copies of all up to date mandatory and task specific training on their person?
Have all equipment and PPE inspections been completed? Equipment inspection sheets must be kept on the equipment.

PPE Requirements (All PPE Must Be Inspected Prior To Use Each Shift at a Minimum)*

	Yes	No
CSA Approved Hard Hat
Gloves
Hearing Protection
CSA Approved Minimum 6" Green Work Boots
Safety Glasses/Full Face Shield
Dust Mask/Respirator
Safety Vest/Jacket/Shirt
Fall Protection
Other

Additional Information

	Tasks	Hazards	Controls
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10.

Team PHA and Evacuation Acknowledgement*

	Team Members
1.
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30.

Team Lead*

First NameLast Name
Phone Number*
Email*
example@example.com
Team Lead Signature*

Clear
Date Signed*

MonthDayYear
Date
Should be Empty: