# 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: |  |  |  |
| 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 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 hot work area with screens and/or blankets | Slips trips falls, hand cuts, insufficient coverage of equipment or local area, debris or landscape fires, flammable product containers | Clear out the location of torch work and pathway to it before screen and blanket setup commences, wear cut resistant gloves, make sure all potentially affected equipment or local area is protected and debris is removed, if adjacent landscape is a concern then fire watch attendant will have a water tank sprayer or water hose to wet down the area of landscape, remove flammable containers from work area |  |
| Bottle set up | Drop a bottle, connections not fully engaged, cuts or punctures in hoses | Use an approved bottle cart, double-check all connections are tight, inspect hose and connections with quick check pressure test method |  |
| Pre-light up safety check | Break in procedure can cause employment termination, interruption to facility, company litigation | Before lighting up double-check with your foreman there is an approved daily hot work permit posted, fire alarm impairments, hot work on pre-task, a fire watch attendant with a ten pound fire extinguisher |  |
| Pre-light up PPE | Ocular flash burn, body burns, clothes catch fire, hair catches on fire | Fire resistant long sleeve jacket of various industry materials, welders cap to cover ears and contain hair, burning glasses with clear face shield, clear glasses with shaded face shield, welding hood, no frays on clothing, no cuffs on pants, heavy duty welding gloves, full leather boots |  |
| Break and Lunch | Gas leaks, affect atmospheric conditions | Turn off bottles before going to break and lunch |  |

| WORK OPERATION | POTENTIAL ACCIDENTS OR HAZARDS | SAFE JOB ACTIONS NEEDED |  |
| --- | --- | --- | --- |
| Spark Containment | Uncontained sparks beyond set up zone | Fire watch attendant must be able to monitor the set up zone and modify if necessary to contain sparks. |  |
| Housekeeping | Slips trips and falls | Make sure the attendant has a broom and dust pan to clean up floor intermittently throughout the day and at the end of the day. Torch cutting creates slag chunks and slag BB's that need to be policed with clean up |  |

| 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. |  |  |  |  |  |
| Date | Name(Print) |  | Company |  | Signature |
|  |  |  |  |  |  |