Empire Automation Philippines

Hazard Analysis Form

JOB HAZARD ANALYSIS

Date of work: ________Control no. JHA_____

Time in: _________Time Out____________
IDENTIFY THE HAZARDOUS JOB:
Working at heights
Specific work area
__________________________________________________________________

SEQUENCE OF JOB STEPS OR POTENTIAL HAZARDS RECOMMENDED ACTIONS OR

ACTIVITIES
Working at heights by the use of
ladder
- Climbing to a ladder
- Setting up the ladder
Working at heights by the use of
scaffold
Working on roof, or edge of the
building
Other:
*Falling hazard, falling objects injuries to
self and others from losing control of
ladder
*Potential electrocution
*Scaffold failure due to damaged
structure/components
Fall from heights Slips, Trips, or Fall
Cuts/ Laceration
*Heat stress, fatigue, dehydration falling
hazards –falling debris
Trips/slips
Other:
PROCEDURE
*Ladder must be secured prior to use.
*Ladders shall be inspected for visible
defects on a daily basis
*Ladders shall be restricted to their
intended use
*Metal ladders are not used near
electrical lines
*Wear appropriate Personal Protective
equipment
*Maintain three points of contact while
on the ladder
*Secure inspection checklist and
scaffold tagging
*Wear appropriate Personal Protective
equipment
*Provide drinking station
*Wear appropriate Personal Protective
equipment
*Engineering controls (if applicable)
*Installation of Railings, life lines, debris
net, debris guards or canopy
Provide and define safe access
*Complied w/ the additional safety
requirements by the client or the
owner.
Watch for tripping hazards, especially
at edges
Other:

ANALYSIS DONE BY: APPROVED BY:

____________________________ ___________________________
COMPETENT PERSON EHS OFFICER