DOCUMENT CONTROL ID: CRITICAL TASK #:

EC.SFT. JHA-
Job Hazard Analysis (JHA) & Control JHA REVISION DATE:
n/a
REVISION #:
v.00
OWNER:
C.T. Ventures Inc. o/a Earth Communications
JOB / TASK / PROCESS
FACILITY/CLIENT LOCATION: FACILITY DEPARTMENT/CLIENT PROJECT: PROJECT DATE: DURATION OF PROJECT/TASK: JOB CODE/PERMIT #:

SCOPE OF WORK:

JHA LED BY (Print Name and Title): JHA REVIEWED BY (Print Name and Title): JHA APPROVED BY (Print Name and Title):

PERSONAL PROTECTIVE EQUIPMENT (PPE)

Hard Hat Safety Glasses Face Shield
Eyes/Face/
Head Side Impact Hard Hat Goggles - Chemical Balaclava (FR)
Other: Neck Goggles - Dust Other
Dust Mask SABA Ear Plug Other:
Respiratory Half Face Respirator SCBA Ears/Hearing Ear Muff
Full Face AP Respirator Other: Double (Ear Plugs & Muffs)
Cotton Gloves Nitrile FR Coveralls Chemical Protective Clothing Type:
Hands/Arms Leather Gloves Chemical Body High Visibility Vest
Puncture/Cut Resistant Other: FR Rain Suit Other:
Safety Boots – Leather or Rubber
All selections are potential requirements. PPE is task, weather, legislative and substance specific. Select the
Feet Traction Aids
appropriate PPE based on CSA Standards or equivalent, OHS Legislation and SDS requirements.
Other:

SEVERITY (For any incident or potential incident check all effects) PROBABILITY
POTENTIAL Chance of Occurrence
People Property Damage (loss) Environmental Impact Public Image & Reputation
CONSEQUENCES
Frequent Likely to occur repeatedly in one year
Catastrophic Lost Time Injury or Fatality More than $10,000 Reportable Occurrence Government Intervention
Permanent Impairment or Between $5,000 and Owner and Local Media Probable Likely to occur several times in one year
Critical Owner Standard Not Met
long-term injury/illness $10,000 Intervention
Serious Injury (Restricted Housekeeping Not to Community or Local Occasional Likely to occur sometimes in one year
Moderate Between $1,000 and $5,000
Work or Medical Aid) Standard Attention
Remote Not likely to occur in one year but possible
Minor First Aid or Near Miss Less than $1,000 No Impact Individual or None
Improbable Extremely unlikely to occur in one year
Marginal Unsafe Act/Condition $0 No Impact None

DECISION MAKING FLOWCHART

RISK ASSESSMENT SEVERITY
MATRIX Frequent (5) Probable (4) Occasional (3) Remote (2) Improbable (1) Where the final risk falls in one of these categories, the
appropriate authorization MUST be met prior to start of work.
Catastrophic (5) 25 20 15 10 5
15 to 26 – Risk Approved by Management
PROBABILITY

Critical (4) 20 16 12 8 4
Moderate (3) 15 12 9 6 3 5 to 14 – Risk Approved by Supervision
Minor (2) 10 8 6 4 2
Less than 5 – Managed at Field Level
Marginal (1) 5 4 3 2 1

Detailed Instruction(s)
EC.DOC.SFT.002, v.02 C.T. Ventures Inc. o/a Earth Communications Page 1 of 2
 DOCUMENT CONTROL ID: CRITICAL TASK #:
EC.SFT. JHA-
Job Hazard Analysis (JHA) & Control JHA REVISION DATE:
n/a
REVISION #:
v.00
OWNER:
C.T. Ventures Inc. o/a Earth Communications
Initial Risk Hazard Control Final Risk
Describe the precautions that will be used

Priority (H/M/L)
H –Health Risk
S – Safety Risk
Basic Steps Potential Hazards Hierarchy of Controls

Control Used
Probability

Probability
List steps required to complete task What hazards are involved in this S – Elimination or Substitution

Initial Risk

Final Risk
Severity

Severity
E – Engineering
A – Administration
P – Personal Protective Equipment (PPE)

Job Hazard Analysis Review (Work Team Reviews and Sign-Off)

Name (Print) Signature Date Name (Print) Signature Date Name (Print) Signature Date

SENIOR MANAGEMENT MANAGEMENT HSE REPRESENTATIVE

EC.DOC.SFT.002, v.02 C.T. Ventures Inc. o/a Earth Communications Page 2 of 2