Attachment_8_-_JHA.pdf

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Attached to
Anderson Ditch Maintenance
Solicitation number
SB1341-16-RQ-0952
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Attachment 8 - JHA Submittal Form

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Attachment 06b

Job Hazard Analysis

Contract Number: Contractor Name: COR:

Principal Activity: Job Location Written By: Approved By: Date:

PRINCIPAL STEPS POTENTIAL HAZARDS RECOMMENDED CONTROLS

TOOLS AND EQUIPMENT

TO BE USED INSPECTION REQUIRED TRAINING REQUIRED

Are there any additional hazards associated with this task?

YES_____ NO____

If “YES” please describe:

Are there any weather conditions present that could affect this task?

YES_____ NO____

If “YES” please describe:

Are any permits required and have they been issued?

YES_____ NO____

If “YES” please describe:

Was anyone injured, or did a close call occur during this task?

YES_____ NO____

If “YES” please describe:

Are there any required certifications needed for this task?

YES_____ NO____

If “YES” please describe:

JOB HAZARD ANAYLISYS WILL BE DISSCUSSED AND SIGNED BY ALL PARTICIPANTS PRIOR TO WORK ACTIVITY.

If there is a need to deviate from planned safe work practices or procedures, work must be stopped and discussed with appropriate personnel

Employee Acknowledgement

Job Title Name Certifications

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