Professional Documents
Culture Documents
Reviewed:
Rev 1/2013
Building & Room(s):
Contractor/Subcontractor Name:
Project:
Date:
Scope of Work:
Please list the scope of work to be completed (example: use a wet method walk behind machine to saw cut trench for the installation of electrical conduit)
Ensure there has been a Penetration Permit briefing & permit is signed & on site & follow LBNL Penetration Permit.
Proper PPE shall be worn by adjacent personnel, as required by their proximity to the work task.
Work area should be delineated off from Un-Authorized personnel & signs posted
Ensure all Areas to be saw cut have been scanned.
Employee Signatures:
Date:
Employee Signatures:
Date:
Employee Signatures:
Date:
A signed copy of this JHA must be posted while the applicable subcontractor is working on-site and be available to any LBNL employee upon request.
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