Microsoft Word - JHA form.doc
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 | |
JHA Title:
JHA Number: PAGE___OF___
JHA Title:
JHA Number: PAGE___OF___