JOB HAZARD ANALYSIS (JHA) WORKSHEET

JOB HAZARD ANALYSIS [JHA] WORKSHEET

DATE
PTW
NO
JHA NO
WORK SPECIFIC
FACILITY /
PERMIT COLD BEKOK C WORKST CELLAR DECK
LOCATION
TYPE ATION
EQUIPME WORK
V-840 & V-890
NT NO. DESCRIPTION TO PERFORM RIG UP LIFTING GEAR ACTIVITY NEAR WORKING AREA
NOTE
1. JHA shall be applicable for all work activities which requires PTW.
2. The pre-prepared JHA and JHA prompters will be used as a reference/guide during the development of JHA.
3. 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.
4. Prior to commencement of work (after PTW has been approved), 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.

JO CONTROL ACTION PARTY MONITORING RECOVERY ACTION MONITORING

B DESCRIPTION OF POTENTIAL POTENTIAL BARRIERS REQUIREMEN BARRIERS PARTY REQUIREMEN
ST JOB STEP HAZARD Consequences T (Y/N) T (Y/N)
EP
1 Re-check and 25.01-Slip, - Personal - Use proper - Rigger Foreman - N - Medical Medic N
confirm work trip and fall injury PPE Treatment onboard
area suitable - Use - First aid
with lifting gears
handrail
when going
up/down
stairway
- Use body
hardness

2 Preparation work 25.01-Slip, - Personal - Beware of - Rigger - N - Medical Medic N

– transfer trip and fall injury tripping Foreman Treatment onboard
rigging/lifting - Equipment hazard - All team - First aid

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 JOB HAZARD ANALYSIS (JHA) WORKSHEET

gear and related 25.10-Drop damage - Use leather - Equipment re-

tools to work object - Can cause glove check
area death / body - Use safety
injury pin and
whip check
3 Pre-install rigging 25.01-Slip - Personal - Secure - Rigger - N - Medical Medic N
gears and trip injury equipment Foreman Treatment onboard
- Asset and during - All team - First aid
25.10-Drop equipment rigging - Equipment re-
object damage installation check
- Use safety
body
hardness
4 Install beam 25.10-Pinch - Finger injury - Wear rigger - Rigger - N - Medical Medic N
clamp point - Asset and hand gloves Foreman Treatment onboard
equipment - Use safety - All team - First aid
6.03-Fall damage body - Equipment re-
from height hardness check
drop object - Secure
equipment
during
rigging gear
installation
5 Hook the 25.01-Trip -Personal injury - Watch out - Rigger - N - Medical Medic N
webbing sling and fall -Finger injury of any Foreman Treatment onboard
and shackle at tripping - All team
chain block 25.01-Pinch hazard
point - Use safety
body
6.03-Fall hardness
from height - Use proper
rigger glove
6 Hook chain block 6.03-Falling - Personal injury - Hook the - Rigger - N - Medical Medic N
to beam clamp object equipment Foreman Treatment onboard
properly
- Fall from - Use safety

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 JOB HAZARD ANALYSIS (JHA) WORKSHEET

height body
hardness
7 Use tag line for 25.01-Crush - Finger injury - Keep load - Rigger - N - Medical Medic N
rigged up activity or pinch close Foreman Treatment onboard
injuries tended and
use strong
points to
secure
- Use proper
glove
8 Housekeeping 25.18-Slip, - Personal - Transfer - Rigger - N - Medical Medic N
trip and fall injury material Foreman Treatment onboard
from
obstructing
access way

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 JOB HAZARD ANALYSIS (JHA) WORKSHEET

JHA APPROVAL DURING PTW APPLICATION

REVIEWED BY APPROVED BY
NAME NAME

DESIGNATION WORK LEADER DESIGNATION PRODUCTION SUPERVISOR /MAITENANCE SUPERVISOR /BASE

SUPERVISOR/FUNCTIONAL SUPERVISOR
SIGNATURE SIGNATURE

DATE DATE

AFTER PTW HAS BEEN APPROVED

WORK TEAM (CONFIRMATION THAT JHA HAS BEEN COMMUNICATED TO WORK TEAM AS PART OF PRE_JOB/TOOLBOX MEETING _ AFTER PTW HAS BEEN APPROVED)

Name (S) Designation Signature Signature Signature Signature Signature Signature Signature Name (S) Designation Signatur Signature Signature Signatur Signature Signatur Signature
e e e

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