JOB HAZARD ANALYSIS
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FACILITY
*
Email
*
example@example.com
DATE
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
JOB DESCRIPTION
SITE SUPERVISOR
Nearest Hospital
Emergency Contact Numbers
Emergency Contact Numbers
Permit Required
Yes
No
If yes, Type of Permit
If yes, Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Utility Locates:
Yes
No
If yes, Date Clear
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
JOB TASKS
Rows
JOB TASKS
List the steps required to perform this job in the order they are to be carried out.
POTENTIAL RISKS
For each task, list the hazard(s) that could cause injury when the task is performed.
RISK MITIGATION TACTICS
For each task, list the control measures required to eliminate or minimize the risk from the identified hazard.
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WORK CREW SIGNATURES
Signature
1.
*
2.
3.
4.
5.
6.
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12.
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