JOB NUMBER:

JOB HAZARD ANALYSIS WORKSHEET

Project Name: Site:
Project Number: Bldg / Rm #:
General Contractor: Prepared By:
Contractor(s): Date:
Craft(s): Scheduled Start Date: Reviewed By:
Briefly Describe Task:
Required PPE:
Supplemental PPE:
Required Permits:
General Comments: If work changes beyond the scope of this JHA - STOP. Notify your supervisor. Re-evaluate for possible new hazards. Confirm this JHA already addresses all new hazards and that safe actions are adequate. If not, a new JHA is required.
WORK OPERATION POTENTIAL ACCIDENTS OR HAZARDS SAFE JOB ACTIONS NEEDED
Set up hot work areas adjacent to walls, equipment, and penetrations with weld blankets or small foil backed heat shields Slips trips falls, hand cuts, insufficient coverage of equipment or local area, flammable product containers, data com wires, cables, electrical Clear out the location of torch work and pathway to it before protection set up commences, wear cut resistant gloves, make sure all potentially affected equipment or local area is protected and debris is removed, remove flammable containers from work area, use electrical tape to contain messy wires and cables in ceilings above tee bar or connected to equipment that are in the affected heat zone areas of work.
Bottle set up for map gas and turbo torch Connections not fully engaged, cuts or punctures in hoses Double check all connections are tight, check hose and connections with wrench
Bottle set up for oxy acetylene Drop a bottle, connections not fully engaged, cuts or punctures in hoses Use an approved bottle cart, double check all connections are tight, inspect hose and connections with quick check pressure test method
Pre-light up safety check Break in procedure can cause employment termination, interruption to facility, company litigation Before lighting up double check with your foreman there is an approved daily hot work permit posted, fire alarm impairments, hot work on pre-task, ten pound fire extinguisher
Pre-light up PPE for map gas and turbo torch Body burns, clothes catch fire, hair catches on fire Long sleeve shirt, welding jacket, welding sleeves if deemed necessary by Therma Safety, welders cap to contain hair if necessary, clear glasses, shaded glasses, flex fit gloves or leather gloves depending on scope of work and size of material
Pre-light up PPE for oxy acetylene Ocular flash burn, body burns, clothes catch fire, hair catches on fire Fire resistant long sleeve jacket of various industry materials, welders cap to cover ears and contain hair, burning glasses with clear face shield, clear glasses with shaded face shield, welding hood, no frays on clothing, leather gloves
Working around sprinkler heads Flood the area, interruption to facility, company litigation, employment termination Cover sprinkler heads with wet rags if in range of heat affected zone
Break and Lunch Gas leaks, affect atmospheric conditions, explosion Turn off bottles at valve stem, regulator, or twist apart map gas before going to break and lunch
This JHA is to be reviewed and signed by all personnel at the jobsite. It is to be kept at each work site for the duration of this project.
Date Name (Print) Company Signature