JHA WORKSHEET

HOW TO USE THIS FORM Installation/Facility

1. Crew performing task reviews ALL generic JHA considerations. Location
2. Review previous JHA updates for useful information which will help this task. Associated Work Permit Type
3. Create new JHA update with generic form and ALL considerations for this task. Associate Work Permit Number
4. Carry out tasks as per plan. If any conditions change - STOP AND RE-ASSESS Electrical Isolation Certificate Number
5. File JHA update for future reference. Physical Isolation Certificate Number
Work Description PAINTING JHA Cross Reference Number

JOB HAZARDS ANALYSIS

Job Potential Control Recovery
Description of Job Steps Potential Hazards L S R L S R Result
Step Impact Measures Measures

 Applicant, Authorizing,
Approval Signatories
be familiar with the
 Fail to
 Incident may job.
identify all the
occur and  Competent Personal Medical treatment
1 Preparation of PTW potential hazard 1 2 2 1 1 1 Acceptable
personnel may to conduct the Constantly updating JHA
associated with
get injured operations
the activity
 Personnel applying
PTW must have PTW
training

 Correct tools and third

Tools & Equipment Preparation
2 / Mobilization
(Manually)
party certified lifting
gears to be used (e.g
 Walkway pulley, trolley)
obstructions at  Safety briefing during
 Head / body
low positions or Tool Box meeting.
injury due to slip
overhead  Placing the barricade
and fall
 Improper lifting of 3 2 6 tape. Medical treatment 1 2 2 Acceptable
 Back injury
loads  Emergency response
 Materials damage
 Slip and fall procedure in place &
 Paint spill tested.
 Falling object
 Use proper lifting
techniques.
 More than one person
to be assigned to lift
heavy loads into
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position.
 Heavy items to be
transferred to work
area by crane (not
hand carried).

 Check surrounding
work area for any
obstructions and
 Personnel may fall remove/barricade/plac
and get body e warning signs.
 Slip/Trip/Fall injured  Ensure safety harness
from height or  Man overboard is secured.
overboard may happen  Buddy system.
3 Protect Painting Area 3 3 9 Medical treatment 1 2 2 Acceptable
 Sharp object  Personnel may get  If on scaffolding,
 Congested hand / finger injury ensure that it has
work area  Incorrect body been checked and
posture can cause approved by
backache Scaffolding Inspector
 Use complete PPE
 Use correct body
movement techniques

Application of paint 3 3 9 Medical treatment 1 2 2 Acceptable

4  Supervisor to ensure
o Mixing Paint  Obstructions in  Head / body no overhead activities
o Application of Paint work path injury due to slip take place while
 Blocking escape and fall personnel on location.
route  Erect barriers where
 Slip and fall due required. Keep work
to slippery surface area clear of
 Congested area unnecessary
 Strong wind materials & assign
 Water splash at personnel to monitor
splash zone area activities.
 Bad weather  Ensure approved
procedure in place
and reviewed.
 Emergency response
procedure in place &
tested.
 Materials to be
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transferred to working
area in sealed / intact
containers.
 Use proper body
posture technique
 Use proper PPE
 Personnel need to
double check the
erected scaffolding
 Weather forecast
need to be available

 Lung damage 2 3 6  Full Chemical Medical treatment 1 2 2 Acceptable

 Excess inhalation  Internal injury Protective Equipment
of paint vapor  Eye injury Worn During Mixing &
 Ingestion of paint  Skin Irritation Dispensing.
 Splash into eyes  Finger injury  Barrier creams to be
 Splash onto skin used on all exposed
 Sharp edges skin areas.
 Respiratory Protection
Device to be used
 All Personnel to be
clear of landing area
when paint is being
applied
 MSDS or CSDS to be
available on site and
personnel briefed on
possible health risk
during Tool Box
Meeting.
 Awareness of location
of safety shower &
eye wash station from
site.
 Appropriate First Aid
Equipment to be
available on site.
 Wrap with cotton rags
for all identify sharp
edges
 Unauthorized
personnel not allowed
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to enter the working

area

 Use proper PPE with

work vest.
 Certified scaffolding
erected
 Working at  Note: Every scaffold
 Injury due to
height / splash zone 3 3 9 has to have handrails Medical treatment 1 2 2 Acceptable
fall
area (level 2) and attached
to a toe board to block
personnel or
equipment from falling
down.

 Secured every hose

connection with
whiplash (safety
 May cause
cable) and safety
the paint to
 Hose pins
splash all over 3 3 9 Medical treatment 1 2 2 Acceptable
detachment  Awareness of location
the place
of safety shower &
eye wash station from
site.

 Tie-up / secure hoses

with ropes to the
nearest still structure.
 May cause
Loose hoses  Awareness of location
injury to 2 3 6 Medical treatment 1 2 2 Acceptable
connection of safety shower &
personnel
eye wash station from
site.

 May cause injury 3 2 6 Medical treatment 1 2 2 Acceptable

Burst hose to personnel  Pre-inspection of all
hoses.
 Awareness of location
of safety shower &
eye wash station from
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site.


 Protect the area with

canvas
 Equipment  Replace new
Overspray other 2 3 6  Supervisor need to 1 2 2 Acceptable
damage equipment
components inspect of any expose
area

 Hoses crossing  Roll in the blasting

work path  Body injury due hoses away from work
 Slip and fall to slip and fall path.  Medical
5 Inspection 3 2 6 1 2 2 Acceptable
due to slippery  Skin irritation  Wash down the area treatment
surface and inflammation prior to inspection
 Wet paint  Use proper PPE

6 Housekeeping  Improper  Body injury 2 2 4  Medical 1 2 2 Acceptable

handling of  Back injury  Secure the material treatment
materials  Finger injury with rope or put inside
 Personnel box and seal it
carrying properly.
excessive load  Carry load
 Slip and fall proportionate with
 Pinch point physical ability.
 Paint spill  Observe proper
posture while carrying
heavy load.
 Carry load with one
hand free to grip
handrail.
 Clear work path from
any obstruction
 Limit the loads carried
per person
 Use proper PPE
 Secure and close
properly paint
container after used
 Label the used
chemical (e.g paint,
thinner, etc.) prior to
sent back to onshore
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L - LIKELIHOOD S - SEVERITY R - RATING RESULT

S
CATEGORY DEFINITION CATEGORY DEFINITIONS E H 3 6 9 6-9 UNACCEPTABLE
LOW 1 Remote LOW 1 No Injury No Damage No Pollution V M 2 4 6 3-4 TOLERABLE
E
MEDIUM 2 Possible MEDIUM 2 First Aid Minor Damage Minor Pollution R L 1 2 3 1-2 ACCEPTABLE
HIGH 3 Probable HIGH 3 Lost Time Injury Major Damage Major Pollution I L M H
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IS THERE A SAFER WAY TO COMPLETE THE JOB ? ARE THERE ALTERNATIVES WITH LESS RISK ? LIKELIHOOD
T

JHA Number Date This JHA Created :

TASK SAFETY MANAGEMENT OUTLINE
Date JHA Last Revised : 22nd Oct 2010
WORK ACTIVITY EQUIPMENT
Type of Equipment Manufacturer Tag No Precise Work Site

WORK ACTIVITY PARTICIPANTS THIS JHA CREATED BY

Performed Job
Name Discipline Position Name Discipline Position
Before?

WORK ACTIVITY RESPONSIBILITY JHA SUBMITTED BY JHA ACCEPTED BY JHA ENDORSED BY

WORK LEADER RECEIVING AUTHORITY APPROVING AUTHORITY AREA AUTHORITY
Name Name Name Name
Signature Signature Signature Signature
Date Date Date Date
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Time Time Time Time