Professional Documents
Culture Documents
JHA No.:
REV
1
Name
M 015
Company:
Shashank
08.04.15
Antony Rajesh
Date
Name
Signature
Prepared By:
Date:
08.04.15
G V Ajayan
Date
Name
Signature
Supervisor:
Vishwanath Kurup
08.04.15
Signature
Reviewed By:
08.04.15
Date
Name
Signature
Date
Approved By:
2.0
Permit(s) Required:
PPE Required:
4.0
Potential
Environmental
Hazards
5.0
Non-Destructive Test
Spills (wadi)
Highly Flammable
Toxic
Dust Mask
Face Shield
Welding Mask
Ear Plugs
Earmuffs
Multi-Gas Monitor
Gas Detective
Thermometer
Ventilation Fans
Retrieval Line
Gas Badge
Dosimeter
Lifeline
Air Horn
Noise
Whistle
Cartridge Respirator
Traffic Flags
Air Pollution (smoke)
Soil erosion
Hazardous Materials
(attach SHOC Cards)
Irritant
6.0
Other Potential
Hazards
Electrical
Light / Dark
Ignition Sources
Dust / Vapor
7.0
Additional
Instructions
Carcinogen
Night Work
Chemical Goggles
Hard Hat
Cotton Gloves
Coverall
3.0
Energy Isolation
Cutting Goggles
Light Meter
Anemometer
Air Blowers
Fire Extinguisher
Traffic Cones
Spill Kits
Explosive
Temperature ()
Welding Aprons
Escape Respirator
Rubber Gloves
Hi-viz Vest / jacket
Welding Leggings
SCBA
Rubberized Cotton
Safety Shoes
Ergonomics
Suffocation
Other Trades
Dust Control Measures to be arranged. All equipments to be inspected before engaging on work by DPJV HSSE inspectors.
People
No injury or health effect
Slight injury or health effect
Minor injury or health effect
Major injury or health effect
Asset
No damage
Slight damage
Minor damage
Moderate damage
Environment
No effect
Slight effect
Minor effect
Moderate effect
Reputation
No impact
Slight impact
Minor impact
Moderate impact
Page 1 of 9
1.0
2.0
Permit(s) Required:
PPE Required:
JHA Title:
Step
1.
Dust Mask
Face Shield
Ear Plugs
Earmuffs
PTD or up to 3 fatalities
More than 3 fatalities
Non-Destructive Test
Hard Hat
Cotton Gloves
Coverall
4
5
Energy Isolation
Welding Mask
Cartridge Respirator
Major damage
Massive damage
Night Work
Welding Aprons
Escape Respirator
Rubber Gloves
Hi-viz Vest / jacket
Major effect
Massive effect
Hazards
Flying Objects
Dust
Pressured Hoses
Slip Trip and falls
High noise level
Operator Error
Fire Explosion
Lack of communication
Prevent Unauthorized Personnel
Risk
Rating
P3,E3
Cutting Goggles
Welding Leggings
SCBA
Rubberized Cotton
Safety Shoes
Major impact
Massive impact
JHA No.:
Activity
Chemical Goggles
Control Measures
1.1,Supervisor to conduct Tool box
meeting using this JHA make workers
aware of the specific hazards / risk related
to the activity and control measures to be
followed to employees before starting the
work daily basis.
1.2, PTW must be obtained and be at the
job site.
1.3 Job specific and mandatory PPE shall
be worn at all the time.
1.4 All power Tools and Pneumatic Power
Tools must be duly inspected and
checked by a competent person.
1.5 All connections from the air lines shall
be fitted with external clamps and whip
locks to prevent accidental release of air.
Air line must be isolated when not in use.
1.6 Only competent person to operate
equipment.
1.7 Buddy system should be followed at
all times.
1.8 Equipment and hoses should be
properly earthed (to prevent static
electricity)
1.9 Area to be properly barricaded and
provided with proper signage.
1.10 Ensure dip pan and fire extinguisher
M-015
Residual
Risk
P1,E1
Responsible Person
Supervisor /
Permit Holder
Page 2 of 9
1.0
2.0
Permit(s) Required:
PPE Required:
Non-Destructive Test
Hard Hat
Dust Mask
Face Shield
Ear Plugs
Cotton Gloves
Coverall
2.
Energy Isolation
Earmuffs
Chemicals
Contact Injury
High Pressure
Slip, Trip and falls
Fire & Explosion
Paint Spillage
Incompetent Workforce
Chronic Health effects
Welding Mask
Cartridge Respirator
Night Work
Chemical Goggles
Welding Aprons
Escape Respirator
P3, E3
Cutting Goggles
Welding Leggings
SCBA
Rubberized Cotton
Safety Shoes
P1, E1
Supervisor &
Permit Holder
Page 3 of 9
1.0
2.0
Permit(s) Required:
PPE Required:
Non-Destructive Test
Hard Hat
Dust Mask
Face Shield
Ear Plugs
Cotton Gloves
Coverall
Energy Isolation
Earmuffs
Welding Mask
Cartridge Respirator
Night Work
Chemical Goggles
Welding Aprons
Escape Respirator
Work at height/
Fall from height
Unsafe Storage of Paint & Thinner
P3,E2
Fire & Explosion
Cutting Goggles
Welding Leggings
SCBA
Rubberized Cotton
Safety Shoes
P1,E1
Supervisor /
Page 4 of 9
1.0
2.0
Permit(s) Required:
PPE Required:
Energy Isolation
Non-Destructive Test
Hard Hat
Dust Mask
Face Shield
Ear Plugs
Cotton Gloves
Coverall
Earmuffs
Contaminated Clothing
Welding Mask
Cartridge Respirator
Night Work
Chemical Goggles
Welding Aprons
Escape Respirator
Cutting Goggles
Welding Leggings
SCBA
Rubberized Cotton
Safety Shoes
Permit Holder
Site Supervisor
Personal Injury
Page 5 of 9
1.0
2.0
Permit(s) Required:
PPE Required:
Energy Isolation
Non-Destructive Test
Hard Hat
Dust Mask
Face Shield
Ear Plugs
Cotton Gloves
Coverall
Earmuffs
Welding Mask
Cartridge Respirator
Night Work
Chemical Goggles
Welding Aprons
Escape Respirator
Cutting Goggles
Welding Leggings
SCBA
Rubberized Cotton
Safety Shoes
Page 6 of 9
1.0
2.0
Permit(s) Required:
PPE Required:
Energy Isolation
Non-Destructive Test
Hard Hat
Dust Mask
Face Shield
Ear Plugs
Cotton Gloves
Coverall
Earmuffs
Welding Mask
Cartridge Respirator
Night Work
Chemical Goggles
Welding Aprons
Escape Respirator
Rubber Gloves
Hi-viz Vest / jacket
Cutting Goggles
Welding Leggings
SCBA
Rubberized Cotton
Safety Shoes
Page 7 of 9
1.0
2.0
Permit(s) Required:
PPE Required:
Non-Destructive Test
Hard Hat
Dust Mask
Face Shield
Ear Plugs
Cotton Gloves
Coverall
JHA Title:
Energy Isolation
Earmuffs
Welding Mask
Cartridge Respirator
Night Work
Chemical Goggles
Welding Aprons
Escape Respirator
Cutting Goggles
Welding Leggings
SCBA
Rubberized Cotton
Safety Shoes
JHA No.:
M-015
NOTE: As the worksite Supervisor, my signature (next column) confirms that I understand the hazards and control
measures on the previous page(s) and have communicated all requirements with my work crew and will abide by
all conditions and restrictions stated therein. List of names of work crew detailed below.
Name
Rubber Gloves
Hi-viz Vest / jacket
No.
Designation
______________________
__________________
Name
Signature
Company
Signature
____________
Date
Date
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Page 8 of 9
1.0
2.0
Permit(s) Required:
PPE Required:
Energy Isolation
Non-Destructive Test
Hard Hat
Dust Mask
Face Shield
Ear Plugs
Cotton Gloves
Coverall
Earmuffs
Welding Mask
Cartridge Respirator
Night Work
Chemical Goggles
Welding Aprons
Escape Respirator
Rubber Gloves
Hi-viz Vest / jacket
Cutting Goggles
Welding Leggings
SCBA
Rubberized Cotton
Safety Shoes
16.
17.
18.
19.
20.
Page 9 of 9