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: LOTO Valves listed on the approved LOTO permit requested specifically for project needs. Bleed off remaining pressure to confirm zero energy after valve shut off. After work is performed and/or tie-in is complete, remove lock and turn on system to check for leaks.
Required PPE: Hard Hat, Reflective Vest, Safety Glasses, Work Boots, Task appropriate gloves.
Supplemental PPE:
Required Permits: LOTO
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
Locking and tagging out utilities	System being fed from more than 1 source	The system owner and facilities personnel along with the contractor shall walk the system and verify the valves to be shut down as well as checking current drawings.
	Wrong valves being shut and locked out	Genentech system owner and facilities as well as the contractor will agree that all of the proper valves have been shut off and locked and tagged out.
	Valves improperly locked and tagged out	Person attaching lock to the shut off valve will verify the correct lock device is used for type of valve being locked out. The lockout tag will have the name of the person, contractor, phone number, date, time, and reason for the lock out.
	Valves being opened prematurely	Every person who is working on the systems will have their own lock on the source valves. Genentech JLL/Subcontractor will be the primary lock/tag and all other workers will apply their lock/tag in addition while performing their work. Each individual whose lock is on the system will remove their lock only after they have verified that their work is complete. JLL will confirm with Therma all work is complete prior to removing final lock and device.
Locking and tagging out	Residual line pressure	Prior to cutting into system bleed off any residual system pressure from nearest valve.