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JOB HAZARD ANALYSIS [JHA] WORKSHEET

JHA NO.

PTW NO

e.g. 1234

FACILITY

e.g. 1234/JHA (JHA No. shall follow PTW No. followed by


/JHA)
(as written in PTW)

LOCATION

(as written in PTW)

EQUIPMENT NO.

(as written in PTW)

WORK
DESCRIPTION

WORK PERMIT TYPE

SPECIFIC
WORKSTATION
Ruston Gas Turbine - Gas Turbine, Blow Off Valve Change-Out

HOT/ COLD
(as written in PTW)

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

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DESCRIPTION OF JOB STEP

UT Thickness measurement

Housekeeping

POTENTIAL
HAZARD

POTENTIAL CONSEQUENCES

CONTROL BARRIERS

ACTION PARTY

RECOVERY BARRIERS

ACTION PARTY

Hot Surface

Injured Person (burn)

Proper PPE
Proper Handgloves

Production

Medical treatment

Production

Slippery surface

Fall, trips

Careful step

Production

Medical treatment

Production

Work overboard

Man Overboard

Using body harness

Production

Medical treatment

Production

Manual handling

Personnel
injury
injury, body injuries)

Slippery surface

Slips and trips

(back

Correct equipment handling (to


indicate
specific
equipment
handling
depending
on
site
condition)
Assign enough man power

All

Medical Treatment

Site Medic

Barricade the area and put signage

All

First Aid / Medical


Treatment

First Aider/ Site


Medic

JHA NO.
PTW NO
WORK PERMIT TYPE
FACILITY
LOCATION
SPECIFIC
WORKSITE
EQUIPMENT NO.
WORK
DESCRIPTION

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

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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)

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Designation

Signature

Name(s)

Designation

Signature