DATE:

JOB HAZARD ANALYSIS FOR

JHA No:
CONTRACTOR NAME:
PROJECT: WORK LOCATION:
JOB DESCRIPTION:

EMERGECY PLAN (include First Response):

Make the area safe, Inform Company Emergency response team, Follow site emergency protocol.

PERMITS
Confined Space Excavation Floor/Wall opening Hot Work
HV Access
Isolation (LOTO) Lift Study NDT Workbox Working at heights
PLANNED HIGH RISK CONSTRUCTION ACTIVITIES
Confined Space Entry Excavation <1.2m Isolation (LOTO) Road Work Work at Heights
Crane Activities Flammable / Contaminated atmosphere Mobile Plant Movement Tilt Up / Precast Installation NDT
Energised Electrical Work Gas / Chemical Fuel Line Work Pressure testing Vertical Rebar Other:

ADDITIONAL PPE PLANT, TOOLS & EQUIPMENT BARRICADE / SIGNS

Goggles Sun Screen Compactor Hand Tools Forklift Barrier Mesh
Face Shield Welding Jacket Drill Stair ladder Backhoe Yellow & Black Chain
Hearing Protection Welding Helmet Extension Leads Scaffold Crane Concrete Barriers
Safety Harness Other-Helmet Fans Power Source EWP / Scissor Lift Hard Barricade
Respirator Other-Safety Shoes Fire Extinguisher Welding Machine Shade Red & White
Hand Protection Other-Reflective vest Grinder Other Vehicles Other – Other –
JHA DEVELOPED BY: JHA APPROVAL:
No Name Signature Position Date No Name Signature Position Date
1 1
 RISK SCORE CALCULATOR
CONSEQUENCES
1 2 3 4 5
Minor Medium Serious Major Catastrophic
Medical Treatment Multiple Fatalities or
RISK CRITERIA Single Fatality or
`1C1 First Aid Injury Injury or restricted Lost Time Injury Multiple Permanent
Permanent Impairment
work day case Impairment
Low level
Major environmental Catastrophic
environmental Minor effects on Moderate short-term
event, e.g., pollution - environmental event,
impact, e.g., biological or physical environmental impact,
impact that is e.g., pollution – impact
Pollution– environment, e.g., e.g., pollution – near
unconfined &requiring that is widespread,
Environment near source pollution – near source source confined &
long term recovery, unconfined &requiring
confined & confined &short-term medium-term recovery
leaving residual long term recovery,
promptly reversible impact. impact.
damage. leaving major residual
reversible impact.
damage.
Minor damage to Major damage; loss of Serious problems with
Easily fixed up Loss of less than one
Operational/Economic equipment; no loss of less than six months future operation of the
straight away week’s production
Impact production production facility
<$10k $100k - $1M
$10k - $100k $1M - $10M >$10M
Occurs several times per
year at similar
Very projects/reasonably
A Moderate High High High High
likely expected to occur under
normal operating
conditions
Has occurred several
times / likely to occur at
B Likely some time under normal
Moderate Moderate High High High
operating conditions
LIKELIHOOD

Has occurred/may occur

C Possible under normal operating Low Moderate Moderate High High
conditions
Known to have occurred
in the construction
D Rare industry/unlikely to occur Low Low Moderate Moderate High
under normal operating
conditions
Moderate
Unheard of/not known to
E Unlikely have occurred
Low Low Low Moderate
 Hazard Inherent Control Methods & Monitoring Residua
Step Risk l Risk Action By
What control measures will be used?
Describe the job step by step
Score How will the effectiveness of the controls be determined? Score
 JHA SIGN OFF REGISTER
I have read and understood this JHA …
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