Gulfstar Job Hazard Analysis (JHA) Form

Date

MonthDayYear
Date
Your Name*

First NameLast Name
Your Email Address*
You will receive an editable copy of this JHA upon submission
Company Name*
Project Site*
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JHA Form

If you fill out your own JHA form please take a picture using the above widget and then scroll to bottom of this page and click 'Submit'. If you do not have an in-house JHA form please continue using this form.
Construction Manager

First NameLast Name
Contact Phone Number

Area CodePhone Number
Muster Area
Permit/s to be Performed*

NoneHot WorkExcavationLock Out/ Tag OutROW ClearanceCritical LiftConfined SpaceOther
Job to be Performed
Steps to todays Jobs
Hazards associated with the jobs listed above
How will we mitigate the hazards above?
Do you have a COVID-19 Plan on your jobsite?*

YesNo (If "No" why?)
Have you reviewed the COVID-19 Plan with your crew?*

YesNo (If "No" why?)
If no why?
Tasks Associated With Job
Job Hazards & Controls

Check all that apply and give details as needed in the Tasks, Hazards and Controls section of this form
The Following Hazards and Controls were Identified and Discussed
Stop Work*

The obligation of every person to stop work if something is not rightOther
Work Area Hazards*

Confined space concernsMoving equipment or vehiclesLighting levels too high/ lowExtreme heat or coldH2SSevere weatherExcessive winds (high profile structures, flying dust & debris)Uneven, wet, slippery, or muddy ground (unstable footing)Ignition sources, static, grounding (Hotwork)overhead utilities (clearance restrictions)Working under energized lines requires access permission (Clearance)N/A or outlined in attached JHAOther
If working in Confined Space, Who Granted Access Permission
First & Last Name
Housekeeping*

Job location clean and free of hazardsClutter on job siteGarbage on groundSignage present as necessaryAre tools and equipment clean and orderlyN/A or outlined in attached JHAOther
Task Hazards*

Ergonomic concerns (bending, lifting, etc.)Potential for slips, trips and fallsCaught between hazardsHand tool inspectionFire hazardsOthers working overhead or belowOther jobs in area (SIMOPS)N/A or outlined in attached JHAOther
Personal Protective Equipment (PPE)*

Hardhat, safety glasses, safety-toed boots, high visibility clothing/ vestFace shield, goggles or spoggelsHearing protectionGlovesRespiratory protectionEyewash station- location identifiedProper attire for the job (welding, snakes, etc)N/A or outlined in attached JHAOther
Emergency & Communication*

Communication resources available to call emergency respondersEmergency Action Plan presentCall 911 for all Medical EmergenciesN/A or outlined in attached JHA
Electrical Safety*

Grounding and bondingGFCI for electric power toolsSafe distance of energized lines and equipmentClearance requirementsN/A or outlined in attached JHAOther
Confined Space Safety

All entrants have the required Confined Space TrainingConfined Space is ventilated and adequate atmospheric testing is being conducted with an approved air quality monitorConfined Space written work permit is filled outAll sources containing a hazardous substance leading to the confined space are safely and completely blocked off or disconnectedCompetent watch person is present with effective emergency response planN/A or outlined in attached JHAOther
Personnel Concerns*

New employees/ inexperienced workersWorkers fit for duty (medications, sleep, physical limitations, distractions, etc.)Workers clean and sharp with buttoned and zipped outer attireLanguage barriers addressedN/A or outlined in attached JHAOther
Heavy Equipment or Cranes*

Permit requiredCurrent operator certification on fileEquipment daily inspections completedEquipment swing radius clearPositioning and outrigger location addressedOverhead power lines, utilities, etc.Equipment Horn is operableAir horn or other communicationSignal man or spotterPinch locationsSoft, hard, muddy, wet, sloped groundArea cordoned offN/A or outlined in attached JHAOther
Daily Rigging Sheet Information

This is a daily inspection of the rigging used by each foreman on the jobsite.

Lift: This is the lift or reason why the rigging is being used.

Crane Used: The crane or equipment performing the operation with use of rigging.

Specification: Engineer Specifications or Shop Drawings.

Rigging Used: All rigging used to include the type and serial numbers on tag.

Size: Length of rigging

Capacity: Weight limit on rigging

Condition: The inspection of the rigging for any defects and state if it is ok or defective.

Notes:If any rigging is defective be sure to note damage and that the equipment has been replaced

Daily Rigging Report

Rows	Size	Capacity	Condition	Any thoughts?
Rigging Used
Sling
Shackles
Round Sling
Block Weight
Four Way

Driving Motorized Equipment*

Seat belts used at all timesCondition of road or routeSpotter/ safety watch requiredUnattended operationVehicle inspectionAll loads securedN/A or outlined in attached JHAOther
Working at Heights*

Man lift inspectedFall protection plan reviewedProper tie-off points identifiedFull body harness and lanyard/ lifelineFall protection equipment inspectedLadder safety addressedOverhead walking and working surfaces restricted, narrow, wet, slippery or icyScaffolding weight capacity identifiedscaffolding shift inspection completeArea cordoned off below workRescue personnel & procedure in placeN/A or outlined in attached JHAOther
Hot Work

Fire extinguisher/ equipment at job locationFire watchFlammables, Combustibles or LEL in the areaFire blanketGround rod for welding machineGround lead as close to weld as possibleProper work attireN/A or outlined in attached JHAOther
Excavations and Trenching*

Utility locate performedLines located, marked and drawings reviewedConfined space concernsApproved shoring in useProper slopingProper barricading around open holesProper egress providedCompetent person reviewPermit requirementsN/A or outlined in attached JHAOther
Energy Isolation*

LOTO Training verifiedWalk through and discussion of LOTOIsolated and locked outBreaker open and lockedMechanical energy releasedAssured groundingRisk of trapped or non-isolated energyN/A or outlined in attached JHAOther
Environmental Issues*

Spill mitigation, containment, or kitRight To know Center location identifiedSDS reviewedN/A or outlined in attached JHAOther
Additional Hazards
Additional Controls
List Workers Present at Time of JHA (save between each worker noted)
Signature of Workers Performing the Work
Customer Representative (first and Last Name)
Signature of Customer Representative
Visitors (first and Last Name)
Signature of Visitors That Could be Affected by This Job
Job Hazard Analysis (JHA) Form

Each job is required to complete a Job Hazard Analysis. All subcontractors must complete a Job Hazard Analysis with all crew members and visitors who enter the work area.
Should be Empty:

JHA Form

Job Hazards & Controls

The Following Hazards and Controls were Identified and Discussed

Job Hazard Analysis (JHA) Form