ATTACHMENT 03 JHA Template.xlsx

XLSX spreadsheet 40 KB Posted

Attached to
WWV/WWVB UPS Battery Replacement and Annual Preventative Maintenance Federal contract opportunity
Solicitation number
1333ND24QNB190380
Issued by
Department of Commerce National Institute of Standards and Technology

About this file

The provided document is an ATTACHMENT 03 JHA Template, which is a Pre-Job Hazard Analysis form used at the National Institute of Standards and Technology (NIST) to identify potential hazards and control measures prior to performing work. The template covers various environmental, ergonomic, work-at-height, and activity-related hazards, as well as required permits and personal protective equipment (PPE). Employees are required to complete this form before starting each task or when conditions change. The related federal contract opportunity is for the WWV/WWVB UPS Battery Replacement and Annual Preventative Maintenance at the NIST Fort Collins site. This is a solicitation for ongoing UPS preventative maintenance and battery replacement services at the facility.

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Other files for this federal contract opportunity

Other files attached to WWV/WWVB UPS Battery Replacement and Annual Preventative Maintenance, newest first.
File Type Posted
1333ND24QNB190380 AMD 0002 WD and RFIs.pdf PDF
1333ND24QNB19038 00001 Reschedule Site Visit and Due date.pdf PDF
1333ND24QNB190380 UPS PM Fort Collins.pdf PDF

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Text version

Sheet1

Safety is Everyone’s Responsibility!
OFPM
Pre-Job Hazard Analysis
Please complete this Pre-JHA prior to start of each task or change in conditions.
BMSS
Shop/GroupDateTimeWork order #
Grounds Shop MaintenanceNIST
ProjectTask location
Prior to performing the job, identify tasks and hazards. Use the checklist to help find hazards or list hazards
not identified in the checklist and record results in the Table.
Environmental HazardsErgonomic HazardsPermits Required
1. Spill potential26. Working in a tight areaConfined space # _________
2. Weather conditions27. Parts of body in line of fireExcavation
3. MSDS (chemical handling)28. Working above your headImpairment
4. Ventilation required29. Pinch points identifiedHot Work/Burn
5. Heat stress/cold exposure30. Repetitive motionPenetration
6. Other workers in areaWork at Height HazardsRadiation Work
7. Lighting levels too low31. Barricades, flagging, and signsRoof Access
8. Housekeeping32. Floor holesScaffold
9. PACM-Possible asbestos containing material33. Protect from falling itemsPPE Requirements
10. Radiation34. Powered platforms/Arial LiftsMonogoggles/face shield
11. Lead paint35. Others working overhead/belowgloves (Kevlar, leather or specialty)
12. Fume hood exhaust36. Fall arrestArc Flash clothing/coveralls
Activity Hazards37. Ladders/scaffolding(fire retardant)
13. Operational lasers38. Leading edge workHearing protection
14. Welding/grindingPersonal Limitations/HazardsRespirator protection
15. Burn/heat sources39. Clear instructions providedSafety Glasses / or safety glasses
16. Compressed gasses40. Trained to use tool and perform taskw/side shields/face shield
17. Energized equipment in area41. Distractions in work areaAdditional PPE required:
18. Electrical shock from cords/tools42. Working alone (communication)Hard Hats
19. Equipment/tools inspected43. Lift too heavy/awkward positionSafety Vest
20. Critical lift required44. External noise levelsChaps
21. Lock out/Tag out required45. Physical limitationsSafety Shoes
22. Airborne particles46. Other HazardsDosimeters
23. Flammable liquidsOther: ___________________
24. Slips, trips & falls
25. Standing water

Describe the tasks, hazard(s) and the related controls in the following table.

TASK HAZARD CONTROL

Employee/Crew Members (printed):
Supervisor/Work Group Leader Signature:
OFPM Safety Office Signature:5/1/13

Sheet2

Sheet3

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