JHA WORKSHEET

HOW TO USE THIS FORM: 1) Crew performing tasks reviews ALL generic considerations. 2) Review previous JHA update(s) for useful information which will help this task. 3) Create new JHA update with generic form and ALL considerations for this task. 4) Carry out task as per plan .If any conditions change ... STOP & RE-ASSESS 5) File JHA update for future reference.

Installation/Facility Location Associated Work Permit Type Associated Work Permit Number Electrical Isolation Certificate Number Physical Isolation Certificate Number JHA Cross-Reference Number Potential Impact L S R Control Measures Recovery Measures L S R Result N/A N/A Hot Work Permit

WORK ACTIVITY Job Step

Perform Photo Taking for PASR Auditing Potential Hazards

Description of Job Step

Walking at work site.

1. Slippery Area 1. Trip/slip 2. Hot surface 2. Body injury

1. Identify any obstruction walk way. 1. Barricade the 4 2. Make sure the area. area is safe for carry out photo taking

Acceptabl e

Camera battery operated.

1. Battery might 1. Explosion near cause work area. explosion.

1. Use
rechargeable battery.

1. Make sure the battery is in good condition before use.

1 Acceptabl e

JHA WORKSHEET

Taking photography

1. Hazardous area for usage 1. Back pain and ergonomics

1. Make sure the area free from 1. Flash light off. any gases. 2. Inform site 4 2. Required gas operation test before before perform taking any the job. photos

Acceptabl e

L-LIKEHOOD CATEGORY LOW MEDIUM HIGH 1 2 3 DEFINITION Remote Possible Probable CATEGORY LOW MEDIUM HIGH 1 2 3 No injury Non LTI

S-SEVERITY DEFINITIONS No Damage Minor Damage Major Damage No Pollution Minor Pollution Major Pollution

Lost Time Injury

IS THERE A SAFER WAY TO COMPLETE THE JOB?

ARE THERE ALTERNATIVES WITH LESS RISK?

S E V E R I T Y

R-RATING H M L 3 2 1 L 6 4 2 M 9 6 3 H 6-9 3-4 1-2

RESULT UNACCEPTABLE TOLERABLE ACCEPTABLE

LIKELIHOOD

JHA WORKSHEET
JHA Number

TASK SAFETY MANAGEMENT OUTLINE

Date This JHA Created : 16/06/2011

JHA WORKSHEET
Date JHA Last Revised : 16/06/2011 WORK ACTIVITY EQUIPMENT Type of Equipment Camera Manufacturer Tag No. Precise Work Site

WORK ACTIVITY PARTICIPANTS Name Discipline Position Performed Job Before

THIS JHA CREATED BY Name Discipline Position

WORK ACTIVITY RESPONSIBILITY WORK LEADER Name : Signature : Date : Time :

JHA SUBMITTED BY RECEIVING AUTHORITY Name : Signature : Date : Time :

REVIEWED BY APPROVING AUTHORITY REPS Name : Signature : Date : Time :

JHA ACCEPTED BY APPROVING AUTHORITY Name : Signature : Date : Time :