Job Hazard Analysis (JHA) – Powered Mobile Plant
نموذج تعبئة Job Hazard Analysis (JHA) - Powered Mobile Plant · FORM-31104
- JHA #
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- Date JHA completed
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- Time
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- Review Due Date
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- Business Name
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- Business Address
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- ABN
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- Business Contact
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- Position
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- Phone #
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- Person/s responsible for ensuring compliance with JHA
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Workers consulted in the development, approval and communication of this JHA
Name | Job Title | Signature | Date |
|---|---|---|---|
Primary contractor / workplace owner details
- Business Name
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- Address
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- Business Contact
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- Phone #
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Workplace details
- Name
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- Address
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- Location
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Emergency management
- Emergency Contact Numbers
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- First Aid Kit Location/s
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- Evacuation Point/Assembly Area
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- Safety Officer/s Name & Phone
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Job description
Focus on critical risks – safety essentials
Identified site hazards
Identified environmental hazards
Determine the risk score
| Consequence → | |||||
|---|---|---|---|---|---|
| Likelihood ↑ | InsignificantNo effect, or so minor that the effect is acceptable | MinorMinor first aid treatment, minimal business disruption, minimal environmental effect | ModerateSerious injuries, medium business interruption, medium environmental impact | MajorExtensive injuries or fatality, significant business interruption, environmental harm, prosecution | CatastrophicMultiple permanent disabilities or fatalities, business failure, substantial environmental harm, prosecution or imprisonment |
| Almost certainExpected in most circumstances | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute | 4 A4 Acute |
| LikelyWill probably occur in most circumstances | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute | 4 A4 Acute |
| PossibleCould possibly occur at some time | 1 L1 Low | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute |
| UnlikelyUnlikely but possible | 1 L1 Low | 1 L1 Low | 2 M2 Moderate | 3 H3 High | 4 A4 Acute |
| RareHighly unlikely to occur | 1 L1 Low | 1 L1 Low | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High |
- 1 L1 LowRecord and monitor. Proceed with work, and review the risks regularly.
- 2 M2 ModerateMaintain control measures. Be cautious when working, and monitor and review regularly.
- 3 H3 HighReview before commencing work. Introduce new controls or maintain high-level controls to lower the risk level, and monitor the controls frequently.
- 4 A4 AcuteDo not proceed until the risk level is reduced. Immediately introduce high-level controls, and re-assess before proceeding.
Score | Action |
|---|---|
Hierarchy of controls
Other hazards
Hazard | Risk Rating | SWI / EI* | Control Measures |
|---|---|---|---|
- Person Responsible
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- Person Responsible
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Worker Sign Off
I have read the above JHA, and I understand its contents. I confirm that I have the skills and training, including relevant certification, to conduct the tasks I have been allocated to complete. I agree to comply with safety requirements within this JHA, including identifying and monitoring hazards and adhering to risk control measures, relevant Risk Assessment, SWMS and permit requirements.
| Worker’s name | Licences, competencies & qualificationsType / descriptionClassNumber | Date | Signature |
|---|---|---|---|
| - | - | - | - |
| - | - | - | - |
| - | - | - | - |
Supervisor
- Name
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- Signature
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- Date
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الإرشادات والأمثلة المعبّأة فيه مقفلة
يمكنك رؤية تصميم النموذج. احصل عليه لتعبئته على أي جهاز، أو طباعته، أو تخصيصه لعملك.
نموذج تعبئة Job Hazard Analysis (JHA) - Powered Mobile Plant · FORM-31104
