JOB HAZARD ANALYSIS [JHA] WORKSHEET

JHA NO. PTW NO WORK PERMIT TYPE COLD

FACILITY LOCATION SPECIFIC

WORKSTATION
EQUIPMENT NO. WORK GARDENING
DESCRIPTION
NOTE
1. JHA shall be applicable for all work activities which requires PTW.
2. 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.
3. Prior to commencement of work, 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
DESCRIPTION OF JOB STEP POTENTIAL HAZARD POTENTIAL CONSEQUENCES CONTROL BARRIERS ACTION PARTY RECOVERY BARRIERS ACTION PARTY
STEP

 ORGANIZE TOOLS AND  WORK

SHARP EDGE BODY INJURY FIRST AID TREATMENT MEDIC
MATERIAL LEADER
1 SITE PREPARATION
 TO HAVE SUFFICIENT REST
HEAVY LOAD BACK AND SHOULDER INJURY  WORK
 TO FOLLOW CORRECT LIFTING MEDICAL SERVICES MEDIC
FATIQUE LEADER
POSTURE

PINCH POINT  WEAR COATED GLOVE  WORK

2 SET UP TOOLS AND EQUIPMENT HAND & FINGER INJURY FIRST AID TREATMENT W/LEADER
SHARP OBJECT  HANDLE WITH CARE LEADER

 PRE-INSPECTION OF WORKING  WORK

BITTEN BY POISONOUS INSECT /
BIOLOGICAL HAZARD AREA LEADER MEDICAL SERVICES W/LEADER
ANIMALS
 WEAR CORRECT PPE  HSE
3 FLOWER TRIMMING
 WORK
SHARP OBJECT HAND & FINGER INJURY  WEAR COATED GLOVES FIRST AID TREATMENT W/LEADER
LEADER

 PRE-INSPECTION OF WORKING  WORK

BITTEN BY POISONOUS INSECT /
BIOLOGICAL HAZARD AREA LEADER MEDICAL SERVICES MEDIC
ANIMALS
 WEAR COATED GLOVES  HSE
4 SOIL LOOSENING
 TO HAVE SUFFICIENT REST
 WORK
REPETITIVE MOVEMENT (ERGONOMIC) BACK INJURY/FATIQUE  TO CHANGE BODY POSTURE MEDICAL SERVICES MEDIC
LEADER
ACCORDINGLY
 WEAR PROPER PPE (RUBBER
GLOVES, PROTECTIVE
 WORK
SKIN, LUNG AND EYE IRRITATION, CLOTHING, GOGGLES, MASK)
5 INSECTICIDE SPRAYING HAZARDOUS CHEMICAL LEADER MEDICAL SERVICES MEDIC
BREATHING DIFICULTIES, VOMITING  EATING, DRINKING OR
 HSE
SMOKING DURING WORK ARE
PROHIBITED
 WEAR PROPER PPE
 WORK
6 HOUSEKEEPING SLIP,TRIP AND FALL BODY INJURY  TO DO HOUSEKEEPING FIRST AID TREATMENT W/LEADER
LEADER
PROPERLY WITHOUT RUSH
 MOVE IN GROUP
 WOERK
7 DEMOBILIZATION OF WORKERS MOVING VEHICLE HIT/STRUCK BY MOVING VEHICLE  FOLLOW THE SPEED LIMIT MEDICAL SERVICES MEDIC
LEADER
20km/hr

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 JHA NO. PRE-PREPARED JHA PREPARED BY
PTW NO DATE

WORK PERMIT TYPE Name(s) Designation

FACILITY

LOCATION

SPECIFIC WORKSITE

EQUIPMENT NO.

WORK DESCRIPTION
HOUSEKEEPING

JHA APPROVAL DURING PTW APPLICATION

WORK LEADER APPROVED BY

NAME NAME

DESIGNATION DESIGNATION PRODUCTION SUPERVISOR / MAINTENANCE SUPERVISOR

SIGNATURE SIGNATURE

DATE DATE

WORK TEAM (CONFIRMATION THAT JHA HAS BEEN COMMUNICATED TO WORK TEAM AS PART OF PRE-JOB/TOOLBOX MEETING)
Name(s) Designation Signature Name(s) Designation Signature

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