Job Hazard Analysis (JHA) – Powered Mobile Plant
Job Hazard Analysis (JHA) - Powered Mobile Plant Form · FORM-31104
- JHA #
- —
- Date JHA completed
- —
- Time
- —
- Review Due Date
- —
- Business Name
- —
- Business Address
- —
- ABN
- —
- Business Contact
- —
- Position
- —
- Phone #
- —
- Person/s responsible for ensuring compliance with JHA
- —
Workers consulted in the development, approval and communication of this JHA
Name | Job Title | Signature | Date |
|---|---|---|---|
Primary contractor / workplace owner details
- Business Name
- —
- Address
- —
- Business Contact
- —
- —
- Phone #
- —
Workplace details
- Name
- —
- Address
- —
- Location
- —
Emergency management
- Emergency Contact Numbers
- —
- First Aid Kit Location/s
- —
- Evacuation Point/Assembly Area
- —
- Safety Officer/s Name & Phone
- —
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
- —
- Person Responsible
- —
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
- —
- Signature
- —
- Date
- —
Its guidance and example entries are locked
You can see how the form is laid out. Get it to fill in on any device, print it, or make it your own.
Job Hazard Analysis (JHA) - Powered Mobile Plant Form · FORM-31104
