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A
gtegra Cooperative
JHA: Job Hazard Analysis
Location & Date:
Job:
Involved Employees:
Does a JHA exist for this task to Utilize/Review?
Complete
J
ob Hazard Ana
lysis for any job that is unfamiliar (non-routine) to ensure a safe job plan is utilized.
Complete
Job Hazard Analysis for all maintenance jobs.
If the need for additional PPE is identified from the Job Analysis below, contact your supervisor or safety administrator.
Comments or
Explanations:
Hot Work: Does the job involve Hot Work?
Status
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Yes
No
Lockout/Electrical Lockout: Does the job involve energy, or live energy?
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Yes
No
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Yes
No
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No
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Yes
No
Mechanical Hazards: Does the job involve other Moving Equipment?
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No
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No
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No
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Yes
No
Hazcom: Is there potential for Exposure to Chemicals or a Harmful Substance & a need for SDS or eye wash or shower?
Status
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Yes
No
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Yes
No
If YES – State Elimination or Control Method
Strains/Sprains/Fatigue: Is there a potential for Overexertion, Back Injury, Repetitive Motion?
Status
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Yes
No
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Yes
No
Slips/Trips/Falls: Is there potential for Slips (slick surface), Trips. Falls/or Holes?
Status
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Yes
No
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Yes
No
Elevated Work: Does this job involve Elevated Work (Ladder, Fall Protection, Scaffolding)?
Status
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Yes
No
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Yes
No
Falling/Flying Objects: Is there overhead work with potential for Falling/Flying objects?
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Yes
No
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Yes
No
Other Potential Hazards:
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Yes
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Make it Personal: Protect people!
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