GP MARITIME PRIVATE LIMITED

SHIPBOARD OPERATION VER NO. :1/ 15/07/2023 PAGE 1 of 3

MANUAL REV NO. :0/ 15/07/2023 SECTION – SOM 1.1 D
JOB HAZARD ANALYSIS FORM PREPARED BY-DPA APPROVED BY- CEO

Title of Job or Task: JHA Number:

Date / Time Completed: Revision:
Person Completing this JHA: Person(s) Assisting with this JHA:
Location/Facility:
Recommended Personal Protective Equipment (PPE)
Use the personal protective equipment (PPE Matrix)
Head Protection Eye Protection Hand and Body Protection Other PPE
Foot Protection Hearing Protection Respiratory Protection
Things to consider
Do employees know how to do the job? What are the hazards? Include people and equipment.
How can injuries or accidents occur? How can injuries or accidents be prevented?
Are there obvious unsafe conditions? Are special tools needed?
Do people need personal protective equipment? How would we rescue people if something went wrong?
Do we have the equipment to rescue?
Use these designations in the “Hazards Present” column: Add abv if necessary
SB – Struck By CI - Caught In FB – Fall to Below CBY – Contacted By
SA – Struck Against CB – Caught Between FS – Fall at the Same Level CO – Caught On
CW – Contact With O – Overexertion or Repetitive Motion E – Exposure to Chemicals, Noise, Vibration, Radiation
HAZARDS PRESENT IN CORRECT AND SAFE
BASIC JOB STEPS
EACH JOB STEP PROCEDURES

This document is strictly CONTROLLED and part of the company SMS. Once printed, scanned or photocopied will be deemed as UNCONTROLLED
 GP MARITIME PRIVATE LIMITED
SHIPBOARD OPERATION VER NO. :1/ 15/07/2023 PAGE 2 of 3
MANUAL REV NO. :0/ 15/07/2023 SECTION – SOM 1.1 D
JOB HAZARD ANALYSIS FORM PREPARED BY-DPA APPROVED BY- CEO

JOB HAZARD ANALYSIS (JHA) FORM (cont.)

Title of Job or Task: JHA Number:
RA Reference :
HAZARDS PRESENT IN
BASIC JOB STEPS CORRECT AND SAFE PROCEDURES
EACH JOB STEP

This document is strictly CONTROLLED and part of the company SMS. Once printed, scanned or photocopied will be deemed as UNCONTROLLED
 GP MARITIME PRIVATE LIMITED
SHIPBOARD OPERATION VER NO. :1/ 15/07/2023 PAGE 3 of 3
MANUAL REV NO. :0/ 15/07/2023 SECTION – SOM 1.1 D
JOB HAZARD ANALYSIS FORM PREPARED BY-DPA APPROVED BY- CEO

WORKERS PERFORMING THIS JHA

N° NAME RANK DATE TIME SIGNATURE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

SUPERVISOR IN CHARGE

N° NAME ID NUMBER CHARGE AREA/ SIGNATURE

NUMBER COMPANY
1

KEY PERSONNEL IF WELDING CUTTING / ENCLOSED ENTRY / TANK INSPECTION / OTHERS

NAME SIGNATURE
OBSERVER
COMMINICATOR
ROVER

This document is strictly CONTROLLED and part of the company SMS. Once printed, scanned or photocopied will be deemed as UNCONTROLLED