JHA Audit Form
Name of the Contractor
*
Auditor's Name
*
Project Name
*
Please Select
BCH Cranbrook substation-2222415
BCH SCQ Access Floor - 2222414
OC FOOD WINE & TOURISM CENTRE
CF PC Dunsmuir Upgrades
CF PC Ceiling Replacement
Lions Gate Hospital
New St. Paul's Hospital
CSRC
Project #
*
Please Select
2222415
2222414
2270012
2222405
2222411
2220061
2220059
2220074
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Date JHA was created
*
/
Month
/
Day
Year
Date
Date of Audit
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/
Month
/
Day
Year
Date
Work Activity being audited
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All significant task steps identified?
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Yes
No
Comments
Hazards correctly identified and assessed?
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Yes
No
Comments
Workers familiar with hazards associated with the task?
*
Yes
No
Comments
Workers understood their individual responsibilities to ensure hazards are controlled?
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Yes
No
Comments
Appropriate controls identified?
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Yes
No
Comments
Required controls in place at time of audit?
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Yes
No
Comments
Workers observed following task steps correctly?
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Yes
No
Comments
All identified and required equipment is available and in use?
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Yes
No
Comments
All workers involved with task have signed off on the JHA?
*
Yes
No
Comments
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