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Job Hazard Analysis

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Section 1 – Work Information

Contract Owner: Facility/Equipment Description:
Contract/Work Order/Job Ticket #: Facility/Equipment Number:
Reference PTW Serial Number: Work to be done (Detailed work description; attach separate page if necessary):
Job Location & Work Boundaries (indicate specific work site and physical limits):

Section 2 – Job Hazard Analysis (attach additional pages when required)

Sequence of Job Steps Tools & Equipment Used For Job Step Potential Hazards Identified Recommended Control Measures

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 Job Hazard Analysis Page 2 of 2
Section 3 – Tool for Identifying the Primary Sources of Potential Job Hazards Section 4 – Categories for Control Measures
Hazard Analysis Consideration General Hazard Specific Hazards Pertinent to Category Example
Category Category
Can worker be struck by anything? Struck by (SB) Moving objects Elimination or Substitution Use of lead free, non-toxic paint
Flying objects Use a trolley instead of manual handling
Falling material Engineering controls Ventilation
Can worker strike against anything? Strike against (SA) Stationary or moving objects Barricades
Protruding objects Administrative controls No Smoking Policy
Sharp or jagged edges Rotating personnel
Can worker be caught between Caught between (CB) Moving and/or stationary objects Job frequency reduction
anything? Pinch points Safe work practice or procedure Confined Space Entry Procedure
Can worker come into contact with Contact with (CW) Electricity Lock Out/Tag Out Procedure
any energy source or hazardous Chemicals Gas Testing Procedure
material? Hazardous plants Personal protective equipment Hard hats; safety shoes; safety glasses
Extreme Heat/Cold Respirators
Can worker by contacted by any Contacted by (CBy) Splashing chemicals Chemical Protective Clothing
energy source or hazardous Animals and Insects Fall protection harness
material? Arcing electricity Section 5 – JHA Development Team
Can worker be caught on anything? Caught on (CO) Moving parts Print Name Signature Date Time
Sharp or jagged edges
Protruding objects
Can worker be caught in anything? Caught in (CI) Settling material
Falling material
Moving parts
Can worker fall to same level? Fall, same level (FS) Slip/trip/fall Section 6 – Stop Work Instructions
Poor footing 1. Permit Receiver shall return this JHA together with the Safe Work Permit and Associated
Wet surfaces Clearances to the Permit Issuer when work is stopped for whatever reason.
Can worker fall to level below? Fall to below (FB) Unstable footing
2. The work activity shall be stopped when:
Unprotected platforms  An alarm is sounded; or
Is there a possibility of overexertion? Overexertion (O) Lifting  An incident, accident or near miss occurs; or
Pulling / Pushing  The Scope of Work changes; or
Repetitive motion  New hazards develop; or
Is there a possibility of exposure to Exposure (E) Chemical vapors; toxic gases
hazardous chemicals or Oxygen Deficiency  The validity of the SWP expires
temperatures or other 3. When the Emergency Alarm sounds, all work shall stop and any motorized equipment
shutdown. All personnel will exit the work area in a safe manner and report to their
environmental conditions?
assigned assembly point unless instructed otherwise.
Excessive noise
Radiation
Section 7 – Approvals
Heat/Cold Print Name Signature Date Time
Weather conditions Area Owner
Is there a potential to spill, leak, or Release to (RT) Environmental issues Permit Receiver
discharge hazardous materials? Ground/Water contamination Permit Issuer
Public involvement