Pfeiffer and Son Job Hazard Analysis

Pfeiffer and Son Job Hazard Analysis
Date*

MonthDayYear
Date
Supervisor*

Chris PettisCody ZimmermanEric OdonelJoe PerezJosh DiGulioKris GardnerMichael KovalPaul SchaiderSean SesherZach McCoyOther
Chris Pettis Projects
Cody Zimmerman Projects
Eric O' Donel Projects
Joe Perez Projects
Josh DiGulio Projects
Kris Gardner Projects
Michael Koval Projects
Paul Schaider Projects
Sean Sesher Projects
Zach McCoy Projects
Other Project (jobs that may not appear in the drop down menu above)
General Contractor/Customer*
If this JHA needs to sent to the Customer, enter their email address in the field below:
example@example.com
Other than the Foreman, how many P&S Employees are working on this project today:*

123456789101112131415
Select the employees that are on site:*
Other Employees on-site
Equipment On-site*
Major Tasks

Complete the following for the major tasks that will be completed today.
How many Major Tasks will there be on this project today:*

123456
Task #1
Task Description
Briefly describe the task.
Hazard Description
List what could go wrong.
Hazard Controls
List what can be done to prevent the Hazard.
Task #2
Task Description
Briefly describe the task.
Hazard Description
List what could go wrong.
Hazard Controls
List what can be done to prevent the Hazard.
Task #3
Task Description
Briefly describe the task.
Hazard Description
List what could go wrong.
Hazard Controls
List what can be done to prevent the Hazard.
Task #4
Task Description
Briefly describe the task.
Hazard Description
List what could go wrong.
Hazard Controls
List what can be done to prevent the Hazard.
Task #5
Task Description
Briefly describe the task.
Hazard Description
List what could go wrong.
Hazard Controls
List what can be done to prevent the Hazard.
Task #6
Task Description
Briefly describe the task.
Hazard Description
List what could go wrong.
Hazard Controls
List what can be done to prevent the Hazard.
Site Safety
PPE - Do you have the proper PPE avaible and ready to be used?

YesNo - Corrective Action Req'd
What PPE is not being used properly:
First Aid Kits - Are first aid kits available on site (i.e. in the truck or job box)? Are they adequately filled?

YesNo - Corrective Action Req'dN/A
What trucks (or job boxes) are missing first aid kits? What first aid supplies are missing?
SDS Book - Are SDS books on site and readily available?

YesNo - Corrective Action Req'dN/A
What trucks (or job boxes) are missing SDS books?
HAZCOM Labeling - Are containers properly labelled?

YesNo - Corrective Action Req'dN/A
What HAZCOM labels are missing?
Fire Extinguishers - Are fire extinguishers readily available? Are they properly serviced?

YesNo - Corrective Action Req'dN/A
What trucks (or job boxes) are missing Fire Extinguishers? Which extinguishers need to be serviced/replaced?
Housekeeping - Is the work area clean and orderly? Is the job site free from slip, trip and fall hazards? Are the cab, bed, and tool bins of the trucks clean and organized?

YesNo - Corrective Action Req'dN/A
What housekeeping issues need to be addressed? What trucks need to be cleaned off?
Tools, Machinery, and Equipment - Are tools, machines, and equipment in safe operating condition?

YesNo - Corrective Action Req'dN/A
What tools, machinery, and/or equipment issues need to be addressed?
Hand Tools - Are the crews using the correct tools for the job? Are the tools in good working condition?

YesNo - Corrective Action Req'dN/A
What tools are needed so that the crew can do the job correctly? What tool repairs need to be addressed?
Assured Grounding - Are all of the power cords and grounds in the proper condition? Have the cords had their quarterly Assured Grounding inspection?

YesNo - Corrective Action Req'dN/A
What assured grounding issues need to be addressed?
Are GFCIs being used where required? Have the GFCIs been tested?

YesNo - Corrective Action Req'dN/A
What GFCI issues need to be addressed?
Are all ladders, scaffolds, equipment and/or materials more than 10 feet from any electrical power lines?

YesNo - Corrective Action Req'dN/A
What items are within 10' of overhead electrical power lines? What has been done to immediately resolve the issue?
Training and Certifications - Are the operators trained in use of the equipment they are operating?

YesNo - Corrective Action Req'dN/A
Who is operating equipment without the proper training?
Fall Protection - Do you have the proper fall protection equipment on site?

YesNo - Corrective Action Req'dN/A
What fall protection issues need to be addressed?
Ladders
Are Ladders being used on this project?

YesNo
Do you have the correct ladders on site for the intended use?

YesNo - Corrective Action Req'dN/A
Do you have ladders that are the correct size needed?

YesNo - Corrective Action Req'dN/A
Are you able to properly tie off extension ladders off?

YesNo - Corrective Action Req'dN/A
On extension ladders, are they tall enough so that the side rails can extend 36" above the top landing?

YesNo - Corrective Action Req'dN/A
Are the ladders in good physical condition?

YesNo - Corrective Action Req'dN/A
Are the annual inspections current on all of the ladders?

YesNo - Corrective Action Req'dN/A
Please provide further comments, if any of the previous answers from this section are "No." Also, please provide any corrective measures that need to be taken.
Hoist, Cranes, and Derricks
Are there activities on site that involve hoists, cranes, and/or Digger Derricks?

YesNo
Are the annual inspection completed on the crane?

YesNo - Corrective Action Req'dN/A
Is the operator certified for the lifting equipment?

YesNo - Corrective Action Req'dN/A
Has the daily inspection been completed by the operator?

YesNo - Corrective Action Req'dN/A
Do you have the proper pads for the outriggers?

YesNo - Corrective Action Req'dN/A
Are all power lines deactivated, removed, or at least 10' away from the lifting activities?

YesNo - Corrective Action Req'dN/A
Is the lift within the proper loading capacity for the lifting radius?

YesNo - Corrective Action Req'dN/A
Do you have a tag line for the lift?

YesNo - Corrective Action Req'dN/A
Is there a signal person on site?

YesNo - Corrective Action Req'dN/A
Please provide further comments, if any of the previous answers from this section are "No." Also, please provide any corrective measures that need to be taken.
Work Zone Safety
Does this project involve working in or near traffic?

YesNo
Are the proper work zones and barricading set up?

YesNo - Corrective Action Req'dN/A
Do you have a certified flagmen on site?

YesNo - Corrective Action Req'dN/A
Do the workers have the proper reflective vests on?

YesNo - Corrective Action Req'dN/A
Please provide further comments, if any of the previous answers from this section are "No." Also, please provide any corrective measures that need to be taken.
Excavations
Are there excavation activities?

YesNo
Who is the Competent Person on site?

First NameLast Name
Do you have ladders in order to provide Safe exits for excavations greater than 4 ft. deep?

YesNo - Corrective Action Req'dN/A
Do you have shoring for excavations greater than 5 ft. deep?

YesNo - Corrective Action Req'dN/A
Fall protection or guardrails for excavations greater than 6 ft. deep?

YesNo - Corrective Action Req'dN/A
Will you make sure spoils are stored at least 2 ft. from the edge of the cut?

YesNo - Corrective Action Req'dN/A
Does the excavation equipment have ROPS and seat belts in place?

YesNo - Corrective Action Req'dN/A
Does the excavation equipment have the proper back up alarms?

YesNo - Corrective Action Req'dN/A
Excavation - Has a utility locate been called in?

YesNo - Corrective Action Req'dN/A
What is the transmittal number?
When was the locate called in?
Please provide further comments, if any of the previous answers from this section are "No." Also, please provide any corrective measures that need to be taken.
Aerial Equipment
Does this project involve manlifts or bucket trucks?

YesNo
Aerial Equipment (bucket trucks) - Is fall protection being used?

YesNo - Corrective Action Req'dN/A
Please provide further comments, if any of the previous answers from this section are "No." Also, please provide any corrective measures that need to be taken.
Lock Out Tag Out
Are the employees working on items that have potential Stored Energy Hazards? Are there items that need to be Locked Out and Tagged Out?

YesNo
Are the properly LOTO procedures and devices being used?

YesNo - Corrective Action Req'dN/A
Please provide further comments, if any of the previous answers from this section are "No." Also, please provide any corrective measures that need to be taken.
Electrical Hot Work/Arc Flash
Is there electrical hot work being done?

YesNo
Why can't the circuit be de-energized? Why can't an outage be scheduled?
Is there a restrictive boundary set up to limit unqualified personel from entering the work area?

YesNo - Corrective Action Req'dN/A
How is the boundry set up?
What is the Hazard Risk Category number?
Who is the lead Qualified Person on site?

First NameLast Name
Please provide further comments if necessary. Also, please provide any corrective measures that need to be taken.
Confined Spaces
Are there potential Confined Space issues on the project?

YesNo
Test #1 - Does the space have the potential to contain a hazardous atmosphere?

YesNo
Test #2 - Does the space contain material with the potential to engulf someone who enters the space?

YesNo
Test #3 - Does the internal configuration of the space have inwardly converging walls or a floor that slopes downward and tapers to a smaller cross section?

YesNo
Test #4 - Does the space contain any other recognized serious safety or health hazards?

YesNo
THIS IS A PERMIT REQUIRED SPACE - Are the proper steps being done for a Permit Required Entry

YesNo - Corrective Action Req'd
The Alternative Entry Procedure is acceptable - Is the atmosphere being continuously tested while employees are within the space

YesNo - Corrective Action Req'd
Are the blowers adequately sized to provide the proper air exchange

YesNo - Corrective Action Req'dN/A
Please provide further comments if necessary. Also, please provide any corrective measures that need to be taken.
Silica Containment
Does this project involve activities that could result in silica dust exposure?

YesNo
Are the crews using proper dust control methods and/or Table 1 compliant tools?

YesNo - Corrective Action Req'dN/A
Please provide further comments, if any of the previous answers from this section are "No." Also, please provide any corrective measures that need to be taken.
Signatures
Foreman/Leadman*

First NameLast Name
Foreman/Leadman Signature*

Clear
Employee Signature*

Clear
Employee Signature*

Clear
Employee Signature*

Clear
Employee Signature*

Clear
Employee Signature*

Clear
Employee Signature*

Clear
Employee Signature*

Clear
Employee Signature*

Clear
Employee Signature*

Clear
Employee Signature*

Clear
Employee Signature*

Clear
Employee Signature*

Clear
Employee Signature*

Clear
Employee Signature*

Clear
Employee Signature*

Clear
Should be Empty:

Pfeiffer and Son Job Hazard Analysis

Major Tasks

Site Safety

Ladders

Hoist, Cranes, and Derricks

Work Zone Safety

Excavations

Aerial Equipment

Lock Out Tag Out

Electrical Hot Work/Arc Flash

Confined Spaces

Silica Containment

Signatures