Job Safety and Environmental Analysis (JSEA) / Risk Assessment / Job Hazard Analysis (JHA)

Sample Co Ltd
Part 1: Project and Task Identification
Process Initiators of JHAs are responsible for consulting the Project Supervisor, Quality OSH Manager or other persons directly in charge of the work and other personnel involved in the execution of the task
(as appropriate) for input into the JHA. Other persons may be consulted for technical advice or review of the JHA to see that proposed measures are effective and workable. The task is to be broken up into
steps. For each step, the safety hazards are identified. For each of the hazards identified, corrective action, precautions, equipment are identified to reduce the hazard. All involved in the task must review and
sign this JHA form.

Client: TotalTrack LLC

Site: ABC Building, 1152 Fist Sample St Colorado Springs CO 80921 Job ID: 4
Contact Name Job Title Phone Mobile FAX Email
Scott LeBlanc Project Manger 719 309 0380 scott.leblanc@totaltrack.com
Will B. Watchin Supervisor 719 555 5555 will.b.watchin@totaltrack.com
B Safe Safety Manager 719 555 4444 b.safe@totaltrack.com

JHA Initiated By Rev: 0 Rev. Date: 12/08/2021

Date: JHA No. 1
Ben Workin

Work Locations/Areas:
Supervisor Review
Date: All
(Responsible for monitoring Sample Guy
JHA compliance)

Management Review Date:

Sample Guy

Description of Work Installing a Residential Sewer Line

to be Undertaken:

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JSEAsy JHA - Installing a Residential Sewer Line
 High Risk Construction Work covered in this SWMS
Risk of a person falling more than 2 metres Work on a telecommunication tower Demolition of load‐bearing structure
Likely to involve disturbing asbestos Temporary load‐bearing suport for structural alterations  Work in or near a confined space
or repairs
Work in or near a shaft or trench deeper than  Use of Explosives Work on or near pressurised gas mains or piping
1.5 m or a tunnel
Work on or near chemical, fuel or refrigerant  Work on, in or adjacent to a road, railway, shipping lane or  Work in any area that may have a contaminated or 
lines other traffic corridor in use by traffic other than pedestrians flammable atmosphere
Tilt‐up precast concrete elements Work on or near energised electrical installations or services Work in a area with movement of powered mobile plant
Work in areas with artificial extremes of  Work in or near water or other liquid that involves a risk of  Diving work
temperature drowning

Work Permits  Not Required Hot Work Confined space Isolation Excavation Coring

Work permits for this activity: Demolition Work at Heights Plant Setup Road Closure Other:

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JSEAsy JHA - Installing a Residential Sewer Line
 First, identify and assess the risks, then decide the best way to control them by applying the Hierarchy of Control as follows:

LEVEL CONTROL DEFINITION

Level 1 Elimination Controlling the Hazard at source
Level 2 Substitution Replacing one substance or Activity with a less hazardous one
Isolation Separating the hazard from the person
Engineering Installing Guards on machinery
Level 3 Administration Implementing policies and procedures for safe work practices
Personal Protective Equipment Use of safety glasses, hardhats, protective clothing, etc.

Hierarchy of Controls

Effectiveness
Eliminate the hazard

Substitute the hazard

Isolate the hazard

Use engineering controls

Use administrative
controls

Use PPE

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JSEAsy JHA - Installing a Residential Sewer Line
Part 2: Hazard Analysis, Control and Legislation Worksheet Sample Co Ltd

Job Safety and Environmental Analysis (JSEA) / Risk Assessment Job Hazard Analysis (JHA)
Process Steps Potential Hazard(s) / Risk Hazard Control Measures New
Risk
Step List the steps needed to do the job Rating
Risk Action By
Against each step list potential hazards that For each hazard, identify control measures
No. in the sequence to be done. Rating
could cause injury when the job is done. to eliminate or minimise the risk of injury.

1 Arrive at domestic site with truck and establish unloading area

1.1 Park truck on site of road Obstructing traffic 2 Check for clearways and bike lanes 1 Driver
Do not block people’s driveways 1 Driver
1.2 Set up unloading area Being hit by motor vehicles 19 Watch for oncoming traffic 3 All
Always wear Hi visibility clothing 1 All
Set up hi visibility temporary bollards or cones 1 Driver

2 Site Orientation/ Induction

2.1 Report to client’s reception Entering restricted areas 19 Follow posted signs and go directly to reception 1 All
2.2 Undertake a site induction Unfamiliarity with emergency procedures 14 Listen and ensure you obtain information and 1 All
site emergency and evacuation procedures
Unawareness of site specific hazards 14 Listen and ensure you obtain information about 1 All
any and all site hazards
Unawareness of restricted areas 18 Listen and ensure you obtain information about 1 All
any restricted areas
Unawareness of other operations or 9 Listen and ensure you obtain information about 5 All
hazardous activities being undertaken on site any other activities being undertaken on site
3 Claim Work Area
3.1 Access the site Breaching minimum site PPE requirements 13 HI visibility clothing must be worn at all times 1 All
whilst on site
Steel toe safety boots must be worn at all times 1 All
whilst on site
Safety glasses must either be worn or carried at 1 All
all times whilst on site
Breaching site rules or requirements 13 NO SMOKING on site-designated smoking area 1 All
will be available and ALL butts to be placed in bin
Progressive housekeeping clean as you go 1 All
3.2 Establish safe perimeter People entering work area 21 Controlled by Site Manager 5 Site Supervisor
Bunting or Caution tape shall define the work 3 All
area by providing a 3 meter barrier or denying
access whichever is more appropriate.
4 Working where there is movement of powered mobile plant
4.1 Enter the work area where powered Being hit or runover by powered mobile plant 22 All team members must wear Hi-Visibility vests 5 All
mobile plant is or will be operating or clothing
Ensure constant communication with all 5 Everyone working in

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JSEAsy JHA - Installing a Residential Sewer Line
 Job Safety and Environmental Analysis (JSEA) / Risk Assessment Job Hazard Analysis (JHA)
Process Steps Potential Hazard(s) / Risk Hazard Control Measures New
Risk
Step List the steps needed to do the job Rating
Risk Action By
Against each step list potential hazards that For each hazard, identify control measures
No. in the sequence to be done. Rating
could cause injury when the job is done. to eliminate or minimise the risk of injury.
personnel in the immediate area the area of the plant
Never assume the plant operator has seen you 5 Everyone working in
or knows where you are the area of the plant
Establish eye contact with the operator 3 Everyone working in
the area of the plant
Communicate your intentions with the plant 3 Everyone working in
operator via radio or hand or head signals and the area of the plant
ensure an appropriate response
Crushing 23 Never stand or traverse between the machine 3 Everyone working in
and a fixed structure at any time the area of the plant
Never assume others have seen or are aware of 6 Everyone working in
any impeding obstacle the area of the plant
Tripping hazard 12 Be aware of surroundings, risers and set downs 3 All

5 Unload skid steer excavator from trailer using aluminium ramps

5.1 Place ramps in position Muscle strain - musculoskeletal disorders 13 Ensure correct manual handling procedures 3 Installer
Keep Load close to body 5 All
Dropping components 17 Ensure a firm grip 2 All
Wear safety boots 3 All
Ramps may strike personnel 7 Ensure locating pins are securely in place 3 Operator
5.2 Release machine restraints Machine may move 4 Ensure machine is stable before tie down 1 Driver
tension is released
Ensure truck is parked on level hard surface 1 Driver
Due care by personnel 5 All
5.3 Board the Machine Falling from machine 14 Gain access and egress from the manufactured 2 Operator
entry/ exit opening only
Keep three points of contact during access and 2 Operator
egress
5.4 Unload and drive machine to ground Machine can tip, slip or fall down ramps 9 Ensure firm ground 3 Operator
Experienced and competent operator with VOC 5 Operator
to perform task
5.5 Moving or driving the machine Injury to people, damage to product or 13 Only trained and authorised employees with 3 Driver
equipment from running into or over VOC may operate this equipment
6 Safety check and operation of Excavator for trenching and excavations
6.1 Safety check of unit. Fill out Pre-trip/ Faulty equipment machine failure 14 Check for dents, cracks and faulty welds 3 Operator
Daily Inspection Check all hydraulic rams and lines, controls for 3 Driver
leaks
Check all safety devices 3 Operator

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JSEAsy JHA - Installing a Residential Sewer Line
 Job Safety and Environmental Analysis (JSEA) / Risk Assessment Job Hazard Analysis (JHA)
Process Steps Potential Hazard(s) / Risk Hazard Control Measures New
Risk
Step List the steps needed to do the job Rating
Risk Action By
Against each step list potential hazards that For each hazard, identify control measures
No. in the sequence to be done. Rating
could cause injury when the job is done. to eliminate or minimise the risk of injury.
Check for leaking Fuids 1 Operator
Check tracks for tightness and rollers, idlers, and 3 Plant Operator
sprockets for damage
6.2 Boarding the machine Falling from Ladder 23 Ensure 3 points of contact 3 All
6.3 Operating / traveling with or without Injury to people, damage to product or 13 Only trained and authorised employees with 3 Driver
a load equipment from running into or over VOC may operate this equipment
Thrown out of cab or against cab interior 13 Always wear seatbelt 1 Plant Operator
Personal Injury 20 Allow no one to ride outside of the cab 1 Plant Operator
Never use the basket or other attachments as a 1 Plant Operator
staging platform for workers
Tipping over 19 Be alert for trenches, open cuts, sump holes and 2 Driver
pits
Keep the machine as level as possible when 3 Operator
operating
Electrocution 25 Always check for overhead power lines 1 Driver
6.4 Dig Digging up underground services 18 Any suspected services should be uncovered by 2 Site Supervisor
hand digging and clearly marked so as to be
visible to plant operators on site
Obtain service location from property owner 3 Supervisor
Dial 811 before you dig 3 Site Manager
Ground collapse 22 All stockpile materials must be “put out of the 3 Operator
zone of influence”
If excavations exceed 5 feet (1.5m) no persons 2 All
should work in the trench without support
If excavations exceed 5 feet (1.5m) undertake 2 Site Manager
benching , battering or shoring
Plant is not to travel up to 3 feet (1m) from edge 2 Plant Operator
of trench unless the trench is only 3 feet (1m)
deep (zone of influence)
Environmental - Disturb Cultural Heritage Sites 9 Stop all works if sub-surface archaeological 1 All
deposits are discovered
Environmental - Spreading of Weeds and 4 Contain weeds if present for disposal 3 All
pests
Environmental - Dust 16 Wet down area in dry dusty conditions 1 All
6.5 Load the truck Running over someone 15 Be aware of everyone’s location in the work area 5 Plant Operator
Dropping material on cab and driver 9 Do not move bucket near cab of truck. 3 Plat Operator
Uneven loading may affect control of truck 13 Load truck evenly 5 Plat Operator

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JSEAsy JHA - Installing a Residential Sewer Line
 Job Safety and Environmental Analysis (JSEA) / Risk Assessment Job Hazard Analysis (JHA)
Process Steps Potential Hazard(s) / Risk Hazard Control Measures New
Risk
Step List the steps needed to do the job Rating
Risk Action By
Against each step list potential hazards that For each hazard, identify control measures
No. in the sequence to be done. Rating
could cause injury when the job is done. to eliminate or minimise the risk of injury.
6.6 Backing up Reversing/ Running over people and 22 Make sure that your back up alarm is working 5 Plant Operator
equipment and not very good visual
7 Working in open trench
7.1 Gain access to trench via a ladder Ground collapse 22 Inspect excavation daily for water, ground 3 All trench workers
movement, undermining collapses and any other
changes from previous day.
Ensure all team members have read and 6 Site Manager
understand the Trench and Excavations Incident
Emergency Response Procedure
If excavations exceed 5 feet (1.5m) no persons 2 All
should work in the trench without support
If excavations exceed 1.5m undertake benching , 2 Site Manager
battering or shoring
Falling from Ladder 23 Ensure firm ground support 3 Installer
Ensure correct slope of ladder (4m up - 1m out) 1 All
Do not face away from the ladder when going up 6 User
or down
Materials or tools must not be carried while 3 User
climbing the ladder—use a tool belt or side pouch
7.2 Working in trench Restricted entry or exit 22 Provide ladder access points required every 32 2 Site Manager
feet (10m)
Unauthorized access 18 Remove ladder if no one is working in excavation 1 All persons working
on or in trench
8 Dig/ clean trench by hand
8.1 Dig into ground with Shovel Digging up underground services 18 Dial 1100 before you dig 5 Supervisor
Obtain service location from facillity manager 5 Supervisor
Muscle strain - musculoskeletal disorders 13 Do not over reach with shovel 3 Operator
Stand firmly in braced position before exerting 5 Laborer
force
Environmental - Disturbance to Plants or 17 Ensure fragile vegetation is removed carefully for 1 All
animals - removal of vegitation reinstatement
Environmental - Dust 16 Wet down area in dry dusty conditions 1 All
Environmental - Spreading of Weeds and 4 Contain weeds if present for disposal 3 All
pests
8.2 Check gradient by laying pipe into Moving Machinery 21 Ensure constant communication with co-workers 5 Operator
trench and setting level Wear Hi visibility clothing 1 All
Falling into trench 13 Be aware of loose edges 2 All

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JSEAsy JHA - Installing a Residential Sewer Line
 Job Safety and Environmental Analysis (JSEA) / Risk Assessment Job Hazard Analysis (JHA)
Process Steps Potential Hazard(s) / Risk Hazard Control Measures New
Risk
Step List the steps needed to do the job Rating
Risk Action By
Against each step list potential hazards that For each hazard, identify control measures
No. in the sequence to be done. Rating
could cause injury when the job is done. to eliminate or minimise the risk of injury.

9 Installation of UPVC Pipe

9.1 Cut pipe to length with hand saw Cut through body parts 18 Ensure the user has been inducted with SOP 2 Site Supervisor
Ensure opposite hand is well clear of cutting area 5 Plumber
Environmental - Waste Generation 11 Measure twice and cut once 3 All
9.2 Apply Cleaning Fuid to Pipes Inhalation of toxic and noxious fumes 25 Provide adequate fan forced ventilation 3 Operator
Read SDS to know the specific hazards of the 1 All
substance you are using
Skin irritation 7 Wash hands immediately if contact with skin 1 All
occurs
9.3 Apply glue to pipe ends Inhalation of toxic and noxious fumes 25 Ensure adequate ventilation 1 All
Read SDS to know the specific hazards of the 1 All
substance you are using
Skin irritation 7 Refer to manufacturers Safety Data Sheet (SDS) 1 All
prior to commencement
Wash hands immediately if contact with skin 1 All
occurs
Environmental - Spills to land contamination 8 Immediately clean up any spillage 1 All
9.4 Fit pipes together Skin irritation 7 Wash hands immediately if contact with skin 1 All
occurs
10 Back Fill trench using excavator with sand and original spoil
10.1 Boarding the machine Falling from Ladder 23 Ensure 3 points of contact 3 All
10.2 Operating / traveling with or without Injury to people, damage to product or 13 Only trained and authorised employees with 3 Driver
a load equipment from running into or over VOC may operate this equipment
Thrown out of cab or against cab interior 13 Always wear seatbelt 1 Plat Operator
Personal Injury 20 Allow no one to ride outside of the cab 1 Plant Operator
Never use the basket or other attachments as a 1 Plant Operator
staging platform for workers
Tipping over 19 Be alert for trenches, open cuts, sump holes and 2 Driver
pits
Keep the machine as level as possible when 3 Operator
operating
Electrocution 25 Always check for overhead power lines 1 Driver
10.3 Fill the trench Running over someone 15 Be aware of everyone’s location in the work area 5 Plant Operator
Stop work immediately if the exclusion zone has 5 Plant Operator
been breached
Crushing 23 Check for services (tap stands, stormwater pipes 1 All

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JSEAsy JHA - Installing a Residential Sewer Line
 Job Safety and Environmental Analysis (JSEA) / Risk Assessment Job Hazard Analysis (JHA)
Process Steps Potential Hazard(s) / Risk Hazard Control Measures New
Risk
Step List the steps needed to do the job Rating
Risk Action By
Against each step list potential hazards that For each hazard, identify control measures
No. in the sequence to be done. Rating
could cause injury when the job is done. to eliminate or minimise the risk of injury.
etc)
Ensure rocks and sharp objects are not in 2 Plant Operator
contact with pipes
Digging up underground services 18 Ensure warnng tape is placed in the trench when 2 Plant Operator
it is halfway back filled
10.4 Backing up Reversing/ Running over people and 22 Make sure that your back up alarm is working 5 Driver
equipment and not very good visual
11 Spreading soil with Shovel and Rake
11.1 Spread with rake or shovel Faulty or unsafe hand tools 13 Inspect rake or shovel for defects or damage 3 All
(e.g., splintered, loose, bent, or cracked tool
handles, loose connections, and damaged tines
or blade)
If a rake or shovel fails your inspection, remove it 3 All
from use
Muscle strain - musculoskeletal disorders 13 Do not over reach 3 Operator
Use a rake or shovel that is comfortable for your 3 Operator
height and strength
Do not use a rake or shovel that is too long or 3 Operator
heavy for you
Never twist your trunk when raking or moving a 3 All
shovel load. Always turn your feet and body in
the direction where you wish to pile leaves or
spread or drop the shovel load.
Never overextend your arms or shoulders to load 3 All
a shovel
Shovel loads should not be thrown above about 3 All
1200mm or further than about 900mm
Injury from using hand tools 13 All personnel are to be trained in the safe 3 All
operating procedure of hand tools
Be on the lookout for signs of repetitive stress. 6 All
Early detection might prevent a serious injury
When raking, stand upright and use the rake to 3 Operator
pull leaves or dirt towards you
Before shoveling, inspect the area for 3 Operator
obstructions such as cables and pipes
When shoveling, stand upright and bend your 2 Operator
knees so your legs carry most of the load
Push the shovel blade into the soil or material to 3 Operator
obtain a shovel load
Keep your arms and elbows close to your body 3 All
when handling a shovel load

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JSEAsy JHA - Installing a Residential Sewer Line
 Job Safety and Environmental Analysis (JSEA) / Risk Assessment Job Hazard Analysis (JHA)
Process Steps Potential Hazard(s) / Risk Hazard Control Measures New
Risk
Step List the steps needed to do the job Rating
Risk Action By
Against each step list potential hazards that For each hazard, identify control measures
No. in the sequence to be done. Rating
could cause injury when the job is done. to eliminate or minimise the risk of injury.
When digging, use the ball of your foot to push 3 All
the shovel blade into the ground
When raking or shoveling for long periods, vary 6 All
your arm and leg positions and movements
Never lay a garden rake down with the teeth 3 All
pointing up – the teeth should always be pointing
down
Back injury 13 Lift the shovel load by straightening your legs 5 All
hand injury 18 Wear gloves 1 All
Striking foot 8 Wear safety boots 1 All

12 Compact area using a gasoline powered leg rammer

12.1 Carry the machine to the work area Muscle strain - musculoskeletal disorders 13 Ensure correct manual handling procedures 3 Installer
Ensure adequate personnel is utilised to 3 All
distribute the load
12.2 Perform prestart inspection Faulty equipment machine failure 14 Check for dents, cracks and faulty welds 3 Operator
Check and top up fuel levels 1 Operator
Check all hoses for cracks and leaks 1 Operator
Check for leaking Fuids 1 Operator
Check oil levels 1 Operator
Do not operate unit that has faulty parts or 2 Operator
equipment. If a problem is found, contact
supervisor to initiate repairs of any damage or
abnormalities
12.3 Start the machine Inhalation of toxic and noxious fumes 25 Ensure adequate ventilation 1 All
Never start the machine indoors. Exhaust fumes 1 Operator
can be dangerous if inhaled.
Damage to machinery and personal injury 21 The operator must have received instruction and 1 Operator
from incorrect operation training in the safe operation of the equipment
Hearing damage 18 Use correct PPE - Ear Muffs / Ear Plugs 2 Operator
12.4 Operate the machine Runaway machinery 13 Do not let go of the handle 1 Operator
Striking foot 8 Wear safety boots 1 All
Vibration 13 Do not exceed the maximum hours of daily 1 Operator
exposure as per the manufacturers
recommendations

13 Monitoring and review of JHA

13.1 Monitor the JHA Ineffective JHA 13 Review the JHA at a minimum of 3 monthly 2 Supervisor
intervals
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JSEAsy JHA - Installing a Residential Sewer Line
 Job Safety and Environmental Analysis (JSEA) / Risk Assessment Job Hazard Analysis (JHA)
Process Steps Potential Hazard(s) / Risk Hazard Control Measures New
Risk
Step List the steps needed to do the job Rating
Risk Action By
Against each step list potential hazards that For each hazard, identify control measures
No. in the sequence to be done. Rating
could cause injury when the job is done. to eliminate or minimise the risk of injury.
Monitor and complete an inspection of a 3 Supervisor
minimum of 2 task observations
JHA Failure 18 Stop Work 1 All
In conjunction with workers and all involved, 1 Supervisor
review and formulate a new JHA
Implement new controls 1 All
Conduct a toolbox meeting with all personnel 1 Supervisor
involved with work activity

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JSEAsy JHA - Installing a Residential Sewer Line
 Sample Co Ltd
Part 3: Hazard Analysis, Control and Legislation Worksheet - Site modifications, additions or alterations

Job Safety and Environmental Analysis (JSEA) / Risk Assessment Job Hazard Analysis (JHA)
Process Steps Potential Hazard(s) / Risk Hazard Control Measures New
Risk
Step List the steps needed to do the job Rating
Risk Action By
Against each step list potential hazards that For each hazard, identify control measures
No. in the sequence to be done. Rating
could cause injury when the job is done. to eliminate or minimise the risk of injury.

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JSEAsy JHA - Installing a Residential Sewer Line
 Part 4: Worker Qualifications and Induction Record Sample Co Ltd

Personal Qualifications and Experience Duties and Responsibilities of Personnel Formal or Specialized Training or
Required To Carry Out the Works: Completing the Task: Licenses Required to Complete Work or
Operate Specific Plant or Equipment:
The ability to work unsupervised and part of a team Maintain adequate house-keeping on site Commercial Drivers License
Plant Operator Reporting of any injuries / incidents to your Project
Plumber (Preferred) or a competency level of working Supervisor
with UPVC and allied materials Take reasonable care for your own health and safety
Take reasonable care for the health and safety of
others
Operate safely and perform daily pre-shift inspections
Adherence to company's and the site's OSH policies
and procedures
JHA Sign Off – Your signature below indicates that you have been consulted in development of
the JHA and accept and will implement the requirements of the JHA and control measures
No. Name Classification Employed By Signature Date
1
2
3
4
5
6

Reference and Detail Applicable Sections of: Legislation Codes Of Practice Project WHS Site WHS Manufacturer Or Supplier Recommendations

ANSI/ASSP A10.12-1998 Safety Requirements For Excavation

Code of Federal Regulations (CFR): 1926 For Construction Subpart C - General Safety and Health Provisions
Code of Federal Regulations (CFR): 1926 For Construction Subpart P - Excavations
Occupational Safety and Health Regulation under the US Occupational Safety and Health Act of 1970

Plant and Equipment to be used for task: Plant, Equipment and Area Safety Inspections:
Hi-visibility temporary bollards or cones Excavator Pre Operational Checks
Warning signs and bunting as required Gasoline Powered Tools Pre- Operational Checks
Excavator Hand Tools Pre Operation Check
Ladder Hand Tools Pre- Operational Checks
Shovel Skid Steer Pre Operational Checks

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Hand Tools
Shovel and Rake
Gasoline powered Leg Rammer

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JSEAsy JHA - Installing a Residential Sewer Line
PPE Requirements for Task: Sample Co Ltd

Electrical Tool Tag Colors
Gloves Red Dec‐Feb Orange Jan‐Jun
Green Mar‐May White Jul‐Dec
Blue Jun‐Aug Black Annual
Hearing Protection Yellow Sep‐Nov

Hi Visibility Vests or Clothing

Safety Boots

Acronyms and Abbreviations:

LTI - Lost Time Injury
PPE - Personal Protection Equipment
PTD - Permanent and Total Disability

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