Construction Activity Safety Planning Job Hazard Analysis: Date: SL Project/Task: Supervisor: Const. BSD Company: Supervisor: Phone#: Job Site: Location: Job Activity: Date of Task to be performed: Personal Protective Equipment to be used JHA Completed by (Name): Safety Glasses Hard Hat Approved by: Goggles Safety Vest Face Shield Reflective Vest Welding Helmet PFAS (Harness) Potential Hazards created by task Welding Safety Nets Clothng Personal Floatation Eye Falls Life Ring Buoy Caught Between Ear Plugs/Muffs Skiff Respiratory Crushed by Leather Gloves Chaps Face/Neck Electrical Rubber Gloves Protective Footwear Cave in Apron Foot Slips/Trips Respirator Hands Confined Space Burns Fire/Explosion Back Heat/Cold Pinch Points Falling Object Training Completed and Records on File Head Chemical Exposure 30 Hour Competent Person Abrasion/Laceration 10 Hour Competent Person Certified Fall Protection Equipment to be used and Inspected Forklift Excavation and Trenching Scissor Lift Aerial Lift Scaffolding Competent Person Scaffolding Cable Jack Crane Forklift Scaffolding Employee Awareness Fire Extinguisher Helicopter Emergency Evacuation Chain Hoist Confined Space Extended Reach Forklift Hazardous Communication St. Luke’s Contractor Training List Tools needed for task Inspected If you have checked a hazard on the first page, describe the task, hazard and the solution to eliminate. Task Hazard Solution
Construction Activity Safety Planning Job Hazard Analysis: Date: SL Project/Task: Supervisor: Const. BSD Company: Supervisor: Phone#: Job Site: Location: Job Activity: Date of Task to be performed: JHA Completed by (Name): Approved by: Potential Hazards created by task Eye Respiratory Face/Neck Foot Hands Burns Back Pinch Points Head Falls Caught Between Crushed by Electrical Cave in Slips/Trips Confined Space Fire/Explosion Heat/Cold Falling Object Chemical Exposure Abrasion/Laceration Equipment to be used and Inspected Scissor Lift Scaffolding Crane Fire Extinguisher Aerial Lift Cable Jack Forklift Helicopter Chain Hoist Extended Reach Forklift List Tools needed for task Inspected Personal Protective Equipment to be used Safety Glasses Goggles Face Shield Welding Helmet Welding Clothng Ear Plugs/Muffs Leather Gloves Rubber Gloves Apron Respirator Hard Hat Safety Vest Reflective Vest PFAS (Harness) Safety Nets Personal Floatation Life Ring Buoy Skiff Chaps Protective Footwear Training Completed and Records on File 30 Hour Competent Person 10 Hour Competent Person Certified Fall Protection Forklift Excavation and Trenching Scaffolding Competent Person Scaffolding Employee Awareness Emergency Evacuation Confined Space Hazardous Communication St. Luke’s Contractor Training If you have checked a hazard on the first page, describe the task, hazard and the solution to eliminate. Task Hazard Solution
JobHazardAnalysis_001.docx