Job Hazard Analysis
Project Name:
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Location:
Date of Analysis:
Project Number:
Department:
Performed By:
Job Title:
Description of Scope
Emergency Numbers
Sheriff / Police:
Highway Patrol / State Trooper:
Fire Department:
Ambulance:
Medivac Helicopter Services:
Closest Hospital
Closest Hospital Name:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone:
GPS - Longitude:
GPS - Latitude:
Cotton Numbers
Cotton Watch:
Project Coordinator:
Project Manager:
APM:
Safety Officer:
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Initial Safety Review
Workplace Overview
Please Review the Following
Any "NO" answer will stop work activity - Contact your PC/PM/APM before proceeding
Workplace Overview
Rows
YES
NO
NA
Job procedures discussed with work team?
First Aid Kit on-Site?
Required PPE identified & used?
Simultaneous work requirements met?
Crew(s) qualified to do this job?
Adequate number of personnel?
Hazardous Materials identified and reviewed?
Spill/gas release prevention requirements met?
Overhead Powerlines/Electrical hazards assessed?
Adequate lighting?
Overhead Hoisting/Lifting hazards reviewed?
Adequate lighting?
Overhead Hoisting/Lifting hazards reviewed?
Tripping/Slipping hazards identified?
Ariel Lift (e.g. boom lift, scissor lift) hazards reviewed?
Lockout/Tagout requirements met?
Driving safety requirements met?
Congested work area(s) assessed?
Fall protection requirements met?
Heavy equipment hazards identified?
Pinch Points identified?
Ground Disturbance requirements met?
Management of Change completed?
Hazardous atmospheres identified? (ex. Flammable, Toxic, H2S)
Other site hazards reviewed? (ex. animals and insects)
Hazardous weather conditions identified? (ex. Low/high temp)
Permit to Work requirements met?
Confined Space Entry requirements met?
Potential H&S Hazards
Potential H&S Hazards: Including Chemical, Physical, Safety, Biological, and Environmental
Potential H&S Hazards
Chemical burns/contact
Pressurized lines/Equipment
Thermal burns
Electrical
Weather Conditions
Heights/Fall>6'
Noise>85dBA
Explosion/Fire
Confined space
Aerial lifts
Bloodborne pathogens
Trench, Excavation, Cave-ins
Overexertion
Pinch points
Cuts/Abrasions
Spills
Overhead Electrical Hazards
Elevated Loads
Slips, Trips, and Falls
Welding Cutting
Manual Lifting
Mold
Ergonomics
Chemical Splash
Poisonous Plants/Insects
Eye Hazards/Flying Projectile
Inhalation
Skin Contact
Strike Against/Struck By
Water/Drowning Hazard
Heavy Equipment
Demolition
Heat/Cold Stress
Other
Notes:
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Potential Workplace Hazards:
Potential Workplace Hazards
Gravity
Gravity
Heights/Fall>6’
Elevated Loads
Excavation
Falling object
Open holes
Overhead work
Slips, Trips, and Falls
Elevated/Uneven work surface
Collapsing roof/equipment
Other
Motion
Motion
Aerial Lifts
Body positioning/Ergonomics
Limited mobility (confined space)
Manual Lifting
Material movement
Pinch Points
Strike Against/Struck By
Vehicle/Equipment movement
Water/Wind movement
Other
Chemical
Chemical
Carcinogen Compound
Chemical burns/contact
Chemical Splash
Corrosive Compound
Explosive/Flammable vapors
Inhalation
Loss of Primary Containment (Spill)
Reactive Compounds
Toxic Compounds
Other
Temperature
Temperature
Heat/Cold Stress
Hot/Cold gases
Hot/Cold liquids
Hot/Cold surfaces
Hot/Cold weather conditions
Thermal Burns
Other
Mechanical
Mechanical
Compressed springs
Drive belts and conveyors
Motors
Power/Hand tools
Rotating equipment
Other
Biological
Biological
Bacteria/Viruses
Bloodborne Pathogens
Contaminated food/water
Mold
Poisonous Plants/Insects
Skin Contact
Other
Electrical
Electrical
Batteries
Electrical Hazards (Overhead/below)
Energized equipment
Static charges
Wiring
Other
Radiation
Radiation
Lighting
NORM scale
Sunlight
Welding arc/flash
X-rays
Other
Sound
Sound
Communication (Language)
Communication (SimOps)
Equipment noise
Impact noise
Noise>85 dBA
Other
Permit to Work
Permit to Work
Cold Work
Confined Space
Electrical
Hot Work
Ignition source
Pressurized Lines/Equipment
Trench, Excavation, Cave-ins
Welding Cutting
Other
Work Site
Work Site
Ergonomics
Eye Hazards/Flying Projectile
Overexertion
Water/Drowning Hazard
Other
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Protective Measures
Protective Measures
PPE
PPE
Eye
Face Shield
Foot
Hand
Head
Hearing Protection
Reflective Vest
Respiratory Protection
Rubber Boots
Tyvek Suits
Other
Protective System
Protective System
Barricades
Caution/Danger Tape
Competent Person
Cones
Daily Inspections
Locate Buried Utilities
Shoring
Sloping
Trench Box
Other
Safety Equipment
Safety Equipment
Caution tape
Fire Extinguisher
Fire Watch
Gas detectors
Grounding/Bonding
Intrinsically Safe Equipment
Non-Spark Tools
Safety Barricade
Safety cable
Other
Fall Protection
Fall Protection
Adequate Anchorage
Covered Opening
Fixed Barricades
Guardrail System
Hardness/Lanyard
Life Line
Safety Net
Warning Systems
Other
Air Monitoring
Air Monitoring
Air Monitoring
CO
CO2
H2S
LEL
Oxygen (O2)
Personal air monitoring
Other
Proper Equipment
Proper Equipment
Aerial Lift
Backup Alarms
Cranes w/Current Inspection
Forklift/Heavy Equipment
Hand/Power Tools
Ladders/Scaffolds
Operator Qualified
Proper Rigging
Other
Confined Space Entry
Confined Space Entry
Air Monitoring
Isolation
Permit Completed
Rescue
Trained Personnel
Other
Medical/ER
Medical/ER
Emergency Shower
Eye Wash
FA-CPR Trained
First Aid Kit
Route to Hospital
Other
Heat/Cold Stress
Heat/Cold Stress
Work/Rest Regime
Rest Area
Liquids Available
Monitoring
Training
Other
Permits
Permits
Confined Space
Demolition
Energized Work
Excavation
Hot Work
Lockout/Tag-out
Other
Demolition
Demolition
Competent Person
Hazmat Present
Isolate Area/Utilities
Pre-Demolition
Structure Condition
Other
Inspections
Inspections
Aerial Lifts (boom, scissor, etc.)
Cranes and Rigging
Heavy Equipment
Ladder
Lanyard/Harness
Scaffolds
Other
Electrical
Electrical
GFCI/Extension Cords
Grounded
Lighting
Lockout/Tagout
Panels Covered
Power Tools/Cord Inspected
Other
Welding/Cutting
Welding/Cutting
Appropriate Goggles
Cylinders Secured/Capped
Cylinders Separated/Upright
Flame Retardant Clothing
Flash-Back Arrestors
No Cylinders in CSE
Other
Vehicle/Traffic
Vehicle/Traffic
Traffic Control
Barricades
Flags
Cones
Signs
Flagger
Other
End of Section
Notes/Observations:
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List of Job Tasks
List of Job Tasks
Signatures
Safety Officer #1
Signature
Signature
Print Name
Safety Officer #2
Signature (2)
Signature (2)
Print Name (2)
Safety Officer #3
Signature (3)
Signature (3)
Print Name (3)
Safety Officer #4
Signature (4)
Signature (4)
Print Name (4)
Safety Officer #5
Signature (5)
Signature (5)
Print Name (5)
Safety Officer #6
Signature (6)
Signature (6)
Print Name (6)
Safety Officer #7
Signature (7)
Signature (7)
Print Name (7)
Safety Officer #8
Signature (8)
Signature (8)
Print Name (8)
Safety Officer #9
Signature (9)
Signature (9)
Print Name (9)
Safety Officer #10
Signature (10)
Signature (10)
Print Name (10)
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