### 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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### JHA Title:

JHA Number: PAGE___OF___

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### JHA Title:

JHA Number: PAGE___OF___

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