CAN-EHS-F-05 Pre Job Hazard Assessment (PJHA) FORM Revision: 15/09/17

A. Identify task/job description B. Identify LIFEsavers involvement

PERMIT REQUIRED
Working at height Mobile powered equipment Electrical work Confined space entry

PERMIT REQUIRED PERMIT REQUIRED PERMIT REQUIRED

Hot work Hazardous materials Lifting and rigging Excavation and trench work
Work area Work date
Start time End time PERMIT REQUIRED
Lock Out Tag Out - Energy Bulk material handling and storage Motor vehicle-traffic safety Railcar safety
isolation
Dept./Contractor Task leader Other permits may apply, like: Electrical system change permit, Line-break permit, CSD by-pass permit

C: Step by step task breakdown and Identify critical task step D. Hazard identification (refer to 2nd page) E. Control measures (refer to 2nd page or permit)
Use additional sheet if this place is not enough to list all the task steps Add worst-case scenario, consequence and error traps to this column Refer hierarchy of control to eliminate SIF(p)&high risk, with STOP criteria

1.

2.

3.

4.

5.

6.

7.

8.

Please mark * behind the task step for indicating it as “CRITICAL TASK STEP” Worst-case scenario: ______________________________________________________________ Possible worst consequence ( ) fatality ( ) SIF Injury
STOP CRITERIA: If an unsafe activity/condition occurs may cause injury or property damage, or the job steps or sequence are not the same as identified in the PJHA, or task changes or the approved PJHA is not followed (e.g. job
STOP
scope, location, work method, duration, number of people working, local conditions) Others: ____________________________________________________________________________________________________________

F. Emergency preparedness for a worst-case scenario G. Sign off for approval (after validation) H. Sign off by any people expected to carry out the task
ERCT/Rescue team is required Yes or No On-site Off-site Roles & Positions Name + Signature Date
Location of nearest emergency shower Task leader

Location of fire alarm pull station Cargill Rep. / JLL/contractor

project Manager

Location of nearest Emergency devices 1 or 2 LIFEsavers involved Checked/validated

(Fire extinguisher, spill kit, first aid kit) 2nd pair of eyes: PJHA champion/ by Cargill/JLL Date
PMC EHS Officer Rep.

Our Safety pledge: We put Safety ahead of profits; No job is so important that it can’t be done Safely; Everyone has the obligation to stop an unsafe activity
Site emergency contact number: 3 or more LIFEsavers involved ALL WORKERS/EMPLOYEES ARE QUALIFIED TO PERFORM THE TASKS.
Nearest hospital contact number: One-up review: ROM/COM/POM

Instructions Scissors Lift - Man lift - JLG - Proper anchor 18. Sharp Objects
1. PJHA form has 2 pages and needs to be completed before performing Harness - Lanyard - Lifeline - Barricades Guarding - PPE, gloves, etc. - Positioning
the task. This second page is for guidance and reference only. Hand rails - Safety Chain 19. Electrical Shock
2. PJHA should not be used >1 shift and each crew member involved with 5. Slips, Wet Surfaces Isolation, LOTO - Testing - Grounding
the task had to be informed and sign off for acknowledgement. Clean surface - Barricade - Eyes on path - Use alternate route Shielding on equipment - GFCI - Electrically qualified
3. Post this PJHA in an obvious place during the length of the task. Voltage___ Procedure #___ Min Clearance:
6. Trips
4. Any questions, please contact your Cargill Rep., Supervisor, PJHA
Champion, EHS leads or Regional EHS manager. Relocate - Barricade - Use alternate route - Eyes on path 20. Airborne/Flying Material
7. Falls Cover/shield source - PPE, eye & face
Please use the following guidance as a checklist for identifying hazards, PPE, arms & body Positioning
Less than 4 feet - Move work to ground
Error traps, effective control measures and STOP criteria for your task.
More than 4 feet - Fall restraint, guardrails, short lanyard 21. Confined Space
1. Considering the Hierarchy of control for your risk management Access/Egress - Ladders, scaffold, steps Air monitoring - Ventilation needed - Attendant required
Construct platform - Tie-off Asphyxiation - Chemical hazard - Electrical hazard
8. Falling Objects Mechanical hazard
Secure objects - Guarding, covers - PPE - Barricade 22. Environmental spill
9. Hazards from others working in vicinity Containment - Waste plan - Waste containers - Other
Communication - Shielding - Barricade - Ventilation 22. Thermal Burns
10. Fire, Combustible Materials / Explosion Splash guard - Isolation, LOTO - Positioning
Remove materials - Relocate work - Shields Equipment covers - Additional PPE
Wet area - Fire watch - Isolation / LOTO 23. Hazardous Conditions, At-Risk Behaviors and some Error Traps
Air testing / monitoring - Fire extinguisher
floors, slipping and tripping housekeeping and orderliness
11. Housekeeping
Area kept clear of trash/debris - Tools organized temperature, humidity and other work groups in locality
Hoses/cords out of path /rolled weather (high or low) (above/below)
2. Hand Protection 12. Weather risk to the environment (air, water,
a) The hands/fingers could be exposed to: Possible wind shift - Consider stopping work in high winds noise/dust/gas/fumes/vapors
or waste)
- Abrasions caused by friction/moving part Secure materials /equipment
- Contusion caused by falling objects Line of fire, equipment and objects working alone risk to product safety
- Burns caused by extreme heat/cold Equipment erection - braced during construction
- Irritation caused by chemicals/flammables pinch, trapping, cutting, shearing
Design specs reviewed line of fire
- Shock by electricity points
13. Heat/Cold Stress
- Crushing injury caused by pinch points stress and time pressure body position/ergonomics
Ventilation - Cooling vests, etc.
- Punctures caused by sharp-pointed objects Task rotation, shared tasks - Work/rest regimen
b) Have you inspected materials for jagged edges, burns, slivers, departure from routine,
14. Lifting, Pulling, Pushing unexpected equipment condition
rough or slippery surfaces? unfamiliarity with the task
Get equipment designed for the job
c) Are you wearing jewelry or loose clothing that could be caught in
Proper technique - Smaller lighter loads distraction, unsafe attitude illness, fatigue, complacency
moving machinery parts?
Prepared for “unexpected” release - Move feet to turn with load
d) For this task, my hands/fingers will be protected by the following 24. Examples for “STOP” criteria
15. Repetitive Motion
type of glove: An unknown energy source is Full body harness is damaged or
Proper technique - Power tools rather than manual - take breaks
 Cloth – Leather - Metal Mesh - Electrician’s found Scaffold becomes deformed
 Rubber/PVC/etc. - Hot Work 16. Rotating Equipment
Isolation, LOTO - Guarding, barricading Steering wheel of a forklift does Capacity of a rope is not clearly
3. Hazard material usage
No loose clothing - Positioning not work identified before lifting
Chemical approved - SDS Available - Container Labeled
17. Pinch Point/Line of Fire
4. Lifting Equipment Electrical insulation of a welding
Guarding - Positioning Others e.g. Bad weather,
device is damaged
2
25. PPE Requirement
PPE for all tasks in the plant: Hard hat, safety glasses with side shields,
steel or composite toe footwear and high visibility shirts or vests
required for each worker on each job. Additional PPE may be needed
for certain tasks, such as:
a) Gloves b) Protective clothing
c) Face shield d) Mono goggles
e) Rubber boots f) Safety harness
g) Hearing protection
h) Respiratory protection
: Dust mask / Cartridge / PAPR / Supplied air / SCBA
i) Warning indicators
: Cones/posts, Caution tape, Danger tape