# JOB HAZARD ANALYSIS

| JOB HAZARD ANALYSIS |  |  |  |
| --- | --- | --- | --- |
| 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 addresses all new hazards and safe actions are adequate. If not, revise as required. A copy of this JHA will be kept at the work site available for review upon request. This JHA will be reviewed by all workers prior to start of activities. |  |  |  |
| WORK OPERATION | POTENTIAL ACCIDENTS OR HAZARDS | SAFE JOB ACTIONS NEEDED |  |
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