JHA - Job Site Hazard Analysis
Date
*
-
Month
-
Day
Year
Date
Company
*
Job site address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work area location?
*
Emergency contact?
On-site emergency - Hospital location or 911
Who is onsite?
First names are fine
Inspection checklist. Check all of these items daily before use.
Anchors
PPE
Ropes
Structure
Housekeeping
Ronin Climbers
Lifts -Swing Stages
Electrical hazards
Equipment
Other
If anything does not pass inspection please set the item aside and mark as non compliant.
Type ok for compliance
What are the tasks of the day?
Climbing
Pressure wash
Scraping rust or old paint
Mixing paint
Rigging
Cutting
Power tools
Access methods
Lifting
Spray painting
Driving
Other
What hazards do our tasks present?
Falls
Trauma
Slips and trips
Hitting head
Cutting skin
Debris in eyes
Heat or cold stress
Pulled muscles
Burns
Injection into skin
Pressurized line problems
Other
How can we control these hazards?
*
Use proper lifting techniques
Cut away from body
Electrical is grounded
Wear eye protection
Wear a helmet
Keep items off floor
Be cautious
Drink liquids and stay warm
Wear proper clothing
100% tie off at all times
Good housekeeping
Make sure all pressurized lines are secure
Two rope system
Follow road rules
Other
Rigging plan for fall protection and rope access
Each rope/person on a separate anchor
Each anchor to withstand marked 5000lbs
100% tie off
Two independent line systems for Rope Access
Horizontal lifelines to maintain safety factor of at least two (OSHA 1926.502(d)(8))
Other
Rescue plan - Site lead will delegate tasks to non injured to secure the injured ASAP, within 20 minutes. The use of 4:1 or Milan to lower person to safe space. Keep either item in designated place close to work area. Site lead or delegated person calls 911
Type Ok or any deviations
Emergency / evacuation meeting area:
Evacuation Plan - 1. Emergency declared 2. Airwaves cleared 3. All personnel rendezvous to Emergency designated location 4. Area is assessed and cleared 5. Take roll call 6. Immediately move to designated meeting area 7. Call 911
Type Ok or any deviations
First aid kit and rescue kit location area:
*
Other Information
Signature
*
Signature
Signature
Signature
Signature
Signature
Print
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Submit JSA
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