Date: Page 1 of 5
Job Hazard Analysis Version No:
Job/Work Order No: Department/Company: Carlos M. Ilagan (Contractor) Inc. JHA No.:
Work Party Representative:Harlene Marie M. Ilagan No of Workers: 8
Work Location:FGCEC Administration Building Compound, Sta. Rita, Batangas City Equipment ID No (if available):
Description of Work: CLEANING OF CISTERN
List Tools and Equipment Required: Exhaust Fan (For Ventilation), Scrubbing Tools, Chlorine, Cleaning Detergent, Chemical Suit, Mask, Safety Glasses, Gloves, Boots, Ladder,
Lighting Equipment, Emergency Eye Wash, Stretcher, etc.
Job Hazard Analysis Worksheet (Attach additional pages as needed)
Safety and Health Risks Control Measures Verified By:
(Initials/Signature)
Job Steps
Elimination/ Substitution/ Personal Protective
Hazard Consequence Engineering Control
Administrative Control
Equipment
1 Delivery of Materials, Tools and Caught between pinch Slight to minor injury Position your hand away Buddy system and Wear appropriate
Equipment using transport point from pinch point and coordination. gloves
sharp edges.
Fall, Same level Slight to minor injury Use of pedestrian lane Ensure that access Wear safety
Slip/Trip/Fall and access walkways walkways are clean and free shoes/boots
from any obstruction. Place
signages and signals
Struck by moving Slight injury to Observed plant and Observe site speed limit (25 Wear seatbelt
object fatality; damage to vehicle operation KPH); Observe proper
property procedures caution during loading and
unloading on vehicle;
Observe safety traffic rules
and regulations
2 Manual Hauling and Lifting Caught in settling Slight to minor injury Provision of lifting Observe proper body Wear appropriate
materials equipment; mechanics when lifting gloves
weights (e.g. lift with knees
bent, not with back);
Seek assistance if load is too
heavy.
Job Hazard Analysis Form
PRM-02-SNH-003: Work Permit System, Rev. 02
Manual Hauling and Lifting (cont.) Fall, Same level Slight to minor injury Use of pedestrian lane Ensure that access Wear safety
Slip/Trip/Fall and access walkways walkways are clean and free shoes/boots.
from any obstruction. Place
signages and signals
Caught in pinch point Slight to minor injury Ensure Proper Posture Conduct Tool Box meeting Wear appropriate
and Positioning before (topics relevant to physical gloves
lifting hazards); Use right tools for
the job
Overexertion to lifting Discomfort to minor Use lifting aids such as Observe proper body Wear appropriate
and repetitive motion illness or injury push carts or trolleys mechanics when lifting gloves
weights (e.g. lift with knees
bent, not with back);
Seek assistance if load is too
heavy
Struck by moving Major injury to Observe proper Wear appropriate
object fatality; damage to housekeeping and stacking PPE (hard hat,
property; disruption of materials. safety shoes)
to operation
Exposure to heat Discomfort to slight Conduct Tool Box meting Wear PPE (safety
illness (topics relevant to physical shoes, proper
hazards), provide clean attire, gloves,
drinking water and shaded safety glasses).
resting area.
3 Manual removal of manhole and Caught on protruding Slight to minor injury Observe buddy system; Wear proper PPE
installation of ventilated fan with and moving parts Provide warning sign to (safety shoes,
ducting hose alert passers-by; hard hat, long
Conduct Tool Box meting sleeve, trousers)
(topics relevant to physical
hazards)
Caught between pinch Slight to minor injury Observe proper positioning Wear appropriate
point and procedure; gloves
Conduct Tool Box meting
(topics relevant to physical
hazards)
Fall, Same level Slight to minor injury Use of pedestrian lane Ensure that access Wear safety
and access walkways walkways are clean and free shoes/boots
from any obstruction. Place
signages and signals
Job Hazard Analysis Form
PRM-02-SNH-003: Work Permit System, Rev. 02
Manual removal of manhole and Contacted by Major injury to Guardings/ coverings in Assign competent electrical Wear proper
installation of ventilated fan with electricicty fatality; damage to place for live electrical personnel, Provide training PPE's (Special
ducting hose (cont.) property; disruption components. (proper handling of PPE(Faceshield,
to operation electrical equipment and Electrical gloves)
tendering)
Exposure to heat and Discomfort to slight Use exhaust fan/ Provide adequate rest/ Wear adequate
oxygen deficiency illness/injury ventilation breaks. Emergency eye respiratory
workplace wash should be readily protection
accessible/ available.
4 Cleaning of Cistern including drain, Exposure to oxygen Discomfort to fatality Conduct gas testing, Shifting (maximum of SCBA if needed
scrub and fill deficiency workplace install ventillation 45mins inside confined
space), Assign trained and
competend personnel
Caught on protruding Discomfort to slight Position your hand away Buddy system, assessment Wear proper
object injury from pinch point and and coordination PPE's (Rubber
sharp edges. boots, cotton
gloves and use
proper hand
tools)
Caught between pinch Discomfort to minor Observe proper positioning Wear appropriate
point illness or injury and procedure; PPE (gloves,
Conduct Tool Box meting coverall/jacket)
(topics relevant to physical
hazards)
Struck by falling Slight to minor injury Ensure guards are in Pre-use check of tools Wear appropriate
materials place before and during PPE
use of exhaust fans.
Exposure to heat Discomfort to slight Use exhaust fan/ Provide adequate rest/ Wear adequate
illness/injury ventilation breaks. Emergency eye respiratory
wash should be readily protection
accessible/ available (respirator), body
protection
(chemical suits)
Fall to below unstable Serious illness to Provide adequate Ladder secured. Wear slip
footing fatality lighting and adequate Maintain 3 point contact. resistant boots
ladder access (3 rungs Observe good housekeeping
extend above the man-
hole)
Trapped in confined Serious illness to The air in the area shall No worker shall enter a Wear appropriate
spaces fatality be checked for: confined space unless an PPE (hard hat,
Job Hazard Analysis Form
PRM-02-SNH-003: Work Permit System, Rev. 02
explosive gases, fumes entry watcher is available safety shoes,
and vapors, oygen who is familiar with the job safety goggles,
content and carbon and in contact with the men chemical suit) and
monoxide, if any burning at regular intervals and respiratory
or products of burning equally provided with apparatus if
have been involved. Gas breathing apparatus for necessary
testing shall be done ready use in case of
before entering; emergency;
If any of the above is No smoking or open lights,
present over normal torches, arcs or flames shall
levels, the area shall not be permitted in confined
be entered until spaces until an inspection
ventilation by blower is has been conducted to
effected; ensure that fire or explosion
Gas testing shall be done possibilities have been
continouosly during the eliminated;
course of the work No spraying or painting
inside the confined using volatile solvents of oil
space. shall be undertaken in
confined spaces unless the
necessary respiratory and
other adequate protection
are provided;
Any manhole, tank, opening
or other opening which is
left unattended should be
protected during the day by
barricades, and at night by
barricades and lanterns,
with appropriate warning
signs;
Adequate means of ingress
and egress from any
confined or enclosed space
shall be provided.
Job Hazard Analysis Form
PRM-02-SNH-003: Work Permit System, Rev. 02
Job Hazard Analysis Page 4 of 5
Guide for Identifying Primary Sources of Potential Job Hazards Categories for Control Measures
Hazard analysis consideration General Hazard category Specific hazards based on category Category Example
Can worker be struck by Struck by (SB) Moving objects Elimination or Substitution Use of lead free, non-toxic paint
anything? Flying objects Use a trolley instead of manual handling
Falling material Engineering controls Set-up ventilation
Can worker strike against Strike against (SA) Stationary or moving objects Install barricades
anything? Protruding objects Administrative controls No smoking policy
Sharp of jagged edges Rotating personnel
Can worker be caught between Caught between (CB) Moving and/or stationary objects Job frequency reduction
anything? Pinch points Safe work practice or procedure Confined Space Entry procedure
Can worker come into contact Contact with (CW) Electricity Lock Out / Tag Out procedure
with any energy source or Chemicals Gas Testing procedure
hazardous material? Hazardous plants Personal protective equipment Hard hats; safety shoes; safety glasses
Extreme Heat/Cold Respirators
Can worker by contacted by any Contacted by (CBy) Splashing chemicals Chemical protective clothing
energy source or hazardous Animals and Insects Fall protection harness
material? Arcing electricity
Can worker be caught on Caught on (CO) Moving parts JHA Development Team
anything? Sharp or jagged edges
Name Position Signature Date Time
Protruding objects
Harlene Marie Ilagan Proj Engr.
Can worker be caught in Caught in (CI) Settling material Mark Payawal Safety Officer
anything? Falling material
Moving parts
Can worker fall to same level? Fall, same level (FS) Slip/trip/fall
Poor footing
Wet surfaces
Can worker fall to level below? Fall to below (FB) Unstable footing
Unprotected platforms
Is there a possibility of Overexertion (O) Lifting
overexertion? Pulling / Pushing
Repetitive motion
Is there a possibility of exposure Exposure (E) Chemical vapors; toxic gases
to hazardous chemicals or Oxygen Deficiency
Approvals
temperatures or other Excessive noise
environmental conditions? Radiation Name Signature Date Time
Heat / Cold Permit Holder Harlene Marie Ilagan
Weather conditions Permit Issuer
Is there a potential to spill, leak, Release to (RT) Environmental issues Permit Approver
or discharge hazardous Ground / Water contamination
Responsible Party
materials? Public involvement
Job Hazard Analysis Form
PRM-02-SNH-003: Work Permit System, Rev. 02
Job Hazard Analysis Page 5 of 5
Guidance Checklist for Discussion of Emergency Precautions during Pre-Task Safety Meeting (PTSM)
Item Y N n/a Item Y N n/a Item Y N n/a
First Aiders and First Aid Kits available? Evacuation route known? Emergency Contact Numbers known?
Fire extinguishers or fire hoses provided? Evacuation Area/Muster Point identified? Rescue team available?
Oil/Chemical spill kits available? Nearest Medical Facility identified? Emergency Plans discussed w/ Work Party?
Nearest safety shower & eyewash located? Emergency Transportation available? Others (specify)
Emergency Shut Down Device located? Emergency communications ready? _______________________________
General Guidance Checklist for Pre-Task Safety Meeting Pre-Task Safety Meeting Revalidation
Item Y N n/a Item Y N n/a After revalidation of PTW or following a Stop Work action, a
PTW and Additional Work Forms completed and approved? Lessons Learned/Safety Improvement Areas reviewed? PTSM must be conducted again to review new potential hazards
and control measures identified during the risk assessment.
PTW and Additional Work Forms discussed with the Work Party? Required PPE in good condition and worn by worker?
Area Owner (or equivalent) informed of the work? Work Party trained, certified& competent? Time of PTSM PTSM Led By (Name & Signature)
Scope of work and work schedule discussed? All members of Work Party Checked In and Fit for Duty?
Health and Safety Plan (HASP) reviewed (if required)? Barricades with posted signage in place?
Job Hazard Analysis (JHA) reviewed and discussed to Work Party? Required tools/equipment available in work area?
All identified hazard control measures in place in work area? Gas testing of work area completed?
Incident/Near Miss Reporting protocols reviewed? MSDS available & discussed w/ Work Party?
Mode of communication available and tested? Other Specify:____________________________________
Work Party Statement of Acceptance
The requirements for the safe performance of this task/ job based on the Job Hazard Analysis have been explained to us. Having clearly understood the requirements we hereby give our unconditional
commitment to comply and adhere to them so we can do and complete the task/job in the safest and most efficient manner.
Name Position Company Time In Signature Time Out Signature
Note: Use a separate sheet or the back of this page for additional entries as needed
Job Hazard Analysis Form
PRM-02-SNH-003: Work Permit System, Rev. 02
