Job Hazard Analysis Form
Saf ety He lme t | Saf ety Sh oes | Vis ibi lit y V est | Dus t M ask | Saf ety Gl ove s(D epe ndi ng on tas k) | Ear Pr ote cti on | Eye Pr ote cti on | Ove ral l | |
|---|---|---|---|---|---|---|---|---|
Sit e s et out an d e xca vat ion | ||||||||
Bac kfi lli ng | ||||||||
Con str uct ion of pl int hs and pe rim ete r w all | ||||||||
Cab lin g | ||||||||
Mov ing Eq uip men t | ||||||||
Loa din g & Off loa din g m ate ria l | ||||||||
Ele ctr ica l W ork s | ||||||||
Wel din g/G rin din g a n H ot wor ks | ||||||||
Saf ety He lme t | Saf ety Sh oes | Vis ibi lit y V est | Dus t M ask | Saf ety Gl ove s(D epe ndi ng on tas k) | Ear Pr ote cti on | Eye Pr ote cti on | Ove ral l | |
Use of Po wer to ols | ||||||||
Sit e c omp let ion wo rks | ||||||||
Sit e C lea n u p | ||||||||
Thr ead ing |
Yes | No | N/A | |
|---|---|---|---|
Exact s cope of work d iscusse d assoc iated r isks an d mitig ation m easures | |||
Absolut e site rules a nd EHS commitm ent | |||
Equipme nt Insp ection | |||
Yes | No | N/A | |
PPE Ins pection | |||
Results of ris k asses sment a nd fall protec tion pl an | |||
Emergen cy resc ue proc edures, evacua tion pr ocedure s and f irst ai d brief ing | |||
Plant,E xacavat ions,Ba ckfilli ng,Towe r riggi ng and electri cals wo rks dis cussed | |||
Safety moment Topic | |||
Others |
COMMITMENT
''We have participated in todays safety meeting and agree with the topics discussed and the way necessary safety measures have been taken into consideration in the planning of activities.''
Yes | No | N/A | |
|---|---|---|---|
Are the window s in go od cond ition a nd do t hey ope n prope rly? | |||
Do the doors o pen and close properl y? | |||
Are the windsc reen an d the r ear win dow in a good conditi on? | |||
Do the wipers front a nd rear operat e prope rly and are th e blade s in go od cond ition? | |||
Yes | No | N/A | |
Is the rear vi ew mirr or in p lace an d in go od cond ition | |||
Is the side mi rrors i n place and in good c onditio n? | |||
All the four t ires in good c onditio n inclu ding a spare t ire | |||
Are the airbag s intac t? | |||
Is the air con ditioni ng func tional? | |||
Vehicle fluid levels okay?(o il,brak e fluid , power steeri ng flui d coola nt) | |||
Are the door l ocks fu nctiona l? | |||
Do all sits ha ve seat belt? A re the seatbel ts func tioning proper ly? | |||
Does th e horn operate proper ly? | |||
Is the battery in goo d condi tion? | |||
Do the brake l ights i llumina te when the br ake ped al is d epresse d? | |||
Does th e headl ights o perate properl y? | |||
Yes | No | N/A | |
Does th e parki ng /han d brake work p roperly when e ngaged? | |||
Do the turn si gnal in dicator s blink front and rea r | |||
Do the headlig ht oper ate pro perly? | |||
Are the chevro n refle ctors i n place and in good c onditio n? | |||
Does th e vehic les hav e any d ents or scratc hes? |
Yes | No | N/A | |
|---|---|---|---|
is ther s an ad equate and wel l suppl ied fir t aid k it? | |||
Is fire exting uishers in pla ce, pro perly c harged and cur rently inspect ed? | |||
SIs the re a wh eel spa nner in a good condit ion? | |||
Is ther e a whe el jack in a g ood con dition? | |||
Are the life s avers i n place and in a good condit ion? |
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