JOB NUMBER:

JOB HAZARD ANALYSIS WORKSHEET

Project Name: ________________________________________________________ Site: ________________________________________________________
Project Number: ________________________________________________________ Bldg / Rm #: ________________________________________________________
General Contractor: ________________________________________________________ Prepared By: ________________________________________________________
Contractor(s): ________________________________________________________ Date: ________________________________________________________
Craft(s): Pipefitters, Plumbers, Sheetmetal Scheduled Start Date: Reviewed By: ________________________________________________________
Briefly Describe Task: Working from a ladder or an elevated work place
Required PPE: Hard Hat, Safety Glasses, Leather Work Boots, Task Specific Gloves, Reflective Vest
Supplemental PPE: Safety Harness, Retractable Lanyard, Cross-Arm Strap, I-Beam Anchor Device, 5K Climbers Cam Anchor
Required Permits: None
General Comments: 1. When a worker is standing at 6' or above they will wear personal fall protection if not on a ladder. 2. When fall protection is used a competent person shall verify means/methods of anchorage points. 3. Always inspect the ladder prior to use to ensure all rungs are in place, sides are secure, cleats in place, and no visible defects. 4. Ensure ladder is stable before climbing. 5. Use 3 points of contact on ladder when climbing. 6. Keep body in center of ladder; do not use extreme reach to sides of ladder; belt buckle rule. 7. Face ladder when working, do not work sideways or backwards from ladder. 8. Tools and material shall not be left unattended on top or on rungs of ladder, tool belts or buckets are preferred. 9. Ensure load rating is adequate for person using ladder. 10. Do not use metal ladders. 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 Unauthorized people in work area Barricade work area a safe distance from falling tools or material.
Blocking doorways / exits Barricade or use a spotter when ladder blocks doorway.
Accessing work area using extension ladder Improper setup When using extension ladder to access elevated work areas ladder must extend at least 3 feet (3 rungs) above landing
Do not use any rungs above the landing

JHA Title:

JHA Number:

Secure ladder at top and bottom before starting work. If ladder cannot be secured, a second worker must hold the ladder at the bottom. The worker holding the ladder must not leave their post until the worker on the ladder comes down or the ladder is secured at top and bottom. Extension ladders should be set at a ratio of 1:4 (bottom is 1 foot from wall for every 4 feet of height) respectively.
Accessing work area using "A" frame step ladder Improper setup Ladder must be fully opened and hinges locked straight. Only one worker may be on the ladder. Do not step or stand above the second to the top rung and do not straddle the ladder. Do not "walk" the ladder.
Working above 6 feet without a scaffold or ladder Falls Worker must use proper fall protection. Fall protection must be approved by competent person. Worker must tie-off to a 5K anchor point. If an anchor point is not available, workers must contact their supervisor to determine best fall protection option.
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.
JHA Title:
JHA Number:
Date Name(Print) Company Signature