JOB HAZARD ANALYSIS [JHA] WORKSHEET

JHA NO.

PTW NO

WORK PERMIT TYPE

FACILITY

LOCATION

SPECIFIC
WORKSTATION

EQUIPMENT NO.

WORK
DESCRIPTION

HOT/ COLD

NOTE
1. JHA shall be applicable for all work activities which requires PTW.
2. The pre-prepared JHA and JHA prompters will be used as a reference/guide during the development of JHA.
3. Personnel carrying out the work shall be fully familiar with the written Work/Operating Procedures developed for the job. The Work/Operating Procedures shall describe, in step-by-step instructions, the correct method of
executing the specified work.
4. Prior to commencement of work (after PTW has been approved), the task-specific JHA shall be discussed amongst all personnel involved in the execution; and requirements contained therein shall be fully understood and
agreed by all involved personnel.

JOB
STEP

DESCRIPTION OF JOB STEP

1.

CHECK AND VERIFY LOCATIONS

POTENTIAL
HAZARD

POTENTIAL
CONSEQUENCES

OVERHEARD,FALL
ING
OBJECT,WORKING
AT HEIGHT AND
HAND TOOLS

ACCIDENTLY
KNOCK,
BONE FRACTURE,RISK OF
FALLING
INTO
PERSONNEL

MANUAL
HANDLING
,PROTRUDED
MATERIALS,
FALLING
OBJECT,PULLING
CABLES AND
HOSES

BODY INJURIES, DAMAGE AWARE,VIGILANT OF SURROUNDING

TO FACILLITIES
AREA
ESP,SHARP
OBJECT,OVERHEARD,USING
PROPER
PULLING
TECHNIGUE,USE
WHIP
CHECK,SAFETY
PIN
TO
SECURE
CONNECTIONS

ALL CONNECTIONS WERE

SECURED,WORK
AREA
SURVEYED AND MARKED
FOR OBSTACLES

USING FIRE WATCHER

FOR
OVERHEARD
WORKING,SUPERVISOR
AND TECHNICION
TO
MADE
AWARE
OF
WORKING CONDITIONS

CONTROL BARRIERS

P.A.U.S.E

ACTION PARTY

RECOVERY BARRIERS

ALL P.P.E WER,E IN GOOD

CONDITIONS,
SAFETY
PROCEDURE
IN
PLACE,TOOL
BOX
MEETING ATTENDED

2.

PREPACE AND CHECK HABITAT

EQUIPMENTS ON SITE

3.

ERECTING HABITAT,SHIELD AND WORKING AT

INSTALL FIRE BLANKET AND HEIGHT, LIMITED
SUCURE POSSIBLE LEAKS
WORK
SPACE,WIND
SPEED,SLIPPERY
FLOOR

FALL
FROM
BODY
DROWNING

4.

CHECK
ALL
CONNECTION, IGNITION SOURCE
PERFORM GAS TESTING AND ,OPEN FLAME
MONITORING
,PRESSURISED
HOSES

ELECTRIC
SHORK,FIRE
DAMAGE,HIT
OTHER
PERSONNEL

REPLACE
ALL
DAMAGES
EQUIPMENT,TAKE
A
BREAK
IF
EXPOSED
TO
OPEN
FLAME,USE
PROPER P.P.E,LEATHER GLOVES

TEST
ELECTRICAL
CONNECTION
BEFORE
USE,CHECK
HOSES
CONNECTION,WEAR
APPROPRIATE P.P.E

5.

DISMANTLING
HOUSEKEEPING HABITAT

FALLING DOWN
INJURY,LIMITED
VISIBILITY

USE
CERTIFIED
SCAFFOLDING
PLATTFORM,USE SAFETYHARNESS TO
STRONG POINT

ENSURE ALL HARNESS

SECURED
BEFORE
PROCEED ,BEWARE OF
WORKING AREA ACTIVITY

Page 1

AND WORKING AT
HEIGHT,OVER
WATER,LIMITED
WORK
SPARE,NIGHT

HEIGHT, USE SAFETY HARNESS AND HOOK TO

INJURIES, STRONG
POINT,USE
CERTIFIED
SCAFFOLDING WORKING PLATFORM,
DEPLOY LIFE RING BUOY TO SEA
ADJACENT TO WORK AREA,STOP
WORK IF WIND SPEED OVER 20
KNOTS

,BODY

ACTION PARTY

JOB
STEP

DESCRIPTION OF JOB STEP

POTENTIAL
HAZARD

POTENTIAL
CONSEQUENCES

CONTROL BARRIERS

ACTION PARTY

RECOVERY BARRIERS

ACTION PARTY

POTENTIAL
CONSEQUENCES

CONTROL BARRIERS

ACTION PARTY

RECOVERY BARRIERS

ACTION PARTY

ACTIVITY

JOB
STEP

Page 2

DESCRIPTION OF JOB STEP

POTENTIAL
HAZARD

JOB
STEP

Page 3

DESCRIPTION OF JOB STEP

POTENTIAL
HAZARD

POTENTIAL
CONSEQUENCES

CONTROL BARRIERS

ACTION PARTY

RECOVERY BARRIERS

ACTION PARTY

JHA APPROVAL DURING PTW APPLICATION

REVIEWED BY

APPROVED BY

NAME

NAME

DESIGNATION

WORK LEADER

DESIGNATION

SIGNATURE

SIGNATURE

DATE

DATE

PRODUCTION SUPERVISOR / MAINTENANCE SUPERVISOR

AFTER PTW HAS BEEN APPROVED

WORK TEAM (CONFIRMATION THAT JHA HAS BEEN COMMUNICATED TO WORK TEAM AS PART OF PRE-JOB/TOOLBOX MEETING - AFTER PTW HAS BEEN APPROVED)
Name(s)

Page 4

Designation

Signature

Name(s)

Designation

Signature