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Pre Job Work Hazard Assessment Form

This pre-job work hazard assessment form requires checking off any applicable high-risk hazards that require permits or plans, such as confined space entry, excavation, fall hazards, and hot work. It also requires assessing and inventorying any hazardous materials like asbestos, lead, mercury, and PCBs. Additional hazards are listed like biological hazards, powered mobile equipment, cranes/hoists, emergency response, and more. It includes describing additional hazards and controls at the work location and ranking risks. The form must be signed by a competent worker prior to starting work and again upon job completion to ensure all permits are closed out, the area is cleaned with no hazards, and there were no accidents or injuries.

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462 views1 page

Pre Job Work Hazard Assessment Form

This pre-job work hazard assessment form requires checking off any applicable high-risk hazards that require permits or plans, such as confined space entry, excavation, fall hazards, and hot work. It also requires assessing and inventorying any hazardous materials like asbestos, lead, mercury, and PCBs. Additional hazards are listed like biological hazards, powered mobile equipment, cranes/hoists, emergency response, and more. It includes describing additional hazards and controls at the work location and ranking risks. The form must be signed by a competent worker prior to starting work and again upon job completion to ensure all permits are closed out, the area is cleaned with no hazards, and there were no accidents or injuries.

Uploaded by

just a random fnaf kid
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Pre-Job Work Hazard Assessment Form

Check off the hazards that apply. Provide details and the plans to eliminate or control the hazard(s). (Use back of page if needed).

High Risk Hazards Requiring Permits or Plans Hazardous Materials Assessment/Inventory


! Confined Space Entry…! Have Permit ! Asbestos……… ! SWP /! Abatement
! Energy/ Electrical …. ! PJHA Lock-out/Tag-out ! Lead ………… ! SWP/! Abatement
! Excavation…… ! Have Permit /Service Locate ! Mercury …….. ! SWP/! Abatement
! Fall Hazard > 3 m … ! Have Fall Protection Plan ! Mould……….. ! SWP/! Abatement
! Hot Work …. ! Have Permit ! PCBs ….. ! SWP/! Abatement
! Restricted Space… ! Have Permit ! Permit N/A ! Other Chemicals…. ! MSDS & !Label !Eyewash
Other Precautions:

“ADDITIONAL” Hazards:
! Biological (other than mould) ! General Precautions ! Powered mobile equipment
! Cranes/Hoists/Lifting Devices ! Hoisting & Rigging ! Public Safety
! Emergency response !Lifting & handling load ! Scaffolds
! Entrances/walkways/stairways/ladders ! Noise ! Tools & equipment/machinery
! Electrical (other) ! Overhead power lines ! Working Alone
! Fire/explosion ! Personal Limitations
! Fall Hazard < 3m ! Personal Protective Equipment (PPE)

DESCRIBE “ADDITIONAL” HAZARDS & CONTROLS AT THIS WORK LOCATION

Risk Matrix - Ranking:


Consequences: High (H) – Serious; Medium (M) – Moderate; Low (L) – Minor
Probability: High (H) – Often; Medium (M) – Sometimes; Low (L) – Rarely

RISK RANKING = Probability x Consequence (High, Medium, Low)

HAZARDS RISK RANKING HAZARD CONTROLS IN PLACE

PRE-JOB HAZARD ASSESSMENT JOB COMPLETION (1/2): JOB COMPLETION (2/2):


Sign below prior to starting work:
All Permits closed out?
Yes ! No!
Competent Worker’s Signature Area cleaned up / no hazards? Competent Worker’s Signature
Yes ! No!
Any accidents or injuries?
Yes ! No!
Date: Time: Date: Time:

May 2014

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