Job Hazard Analysis and Tool Box Discussion Form

JHA No H001 – “Handling Chemicals”

Department: Hotel Department Job Description

Responsible Supervisor: Asst Housekeeper Handling of chemicals for housekeeping jobs.

Date: 7/31/2014
     

HAZARDS AND CONTROL MEASURES

No Description of Hazard. Description of measures taken to control the hazard.
1 Eye damage from chemical. Non ventilated goggles to be worn.

2 Hand injury from chemical. Rubber gloves to be worn.

3 Skin injury from chemical. Apron to be worn and all skin to be covered.

4 Throat and lung injury from chemical Respirator to be worn when applicable.

NB! CONSULT MSDS OF CHEMICAL BEFORE HANDLING !

PERSONAL PROTECTIVE EQUIPMENT REQUIRED

Personal Protective Equipment to be used:

If additional PPE is required, list below:

TOOLBOX DISCUSSION FORM Work Permit Completed if required? JHA Reviewed/Discussed?

Signs or Barriers in place and area roped off where required?

Any additional instructions required? If so, give details:

       

Are all persons involved in the task satisfied that there

are sufficient control measures in place to reduce all YES NO
risks to a tolerable level to complete the work?    

By signing below I acknowledge that I have discussed and understood the safety requirements for the above task:
       

Employee Name:   Employee Signature: 

Employee Name:   Employee Signature: 

Employee Name:   Employee Signature: 

Employee Name:   Employee Signature: 

Employee Name:   Employee Signature: 

Employee Name:   Employee Signature: 

Employee Name:   Employee Signature: 

Employee Name:   Employee Signature: 

Employee Name:   Employee Signature: 

Employee Name:   Employee Signature: 

Employee Name:   Employee Signature: 

Employee Name:   Employee Signature: 

Employee Name:   Employee Signature: 

Employee Name:   Employee Signature: 

By signing below the supervisor confirms that the job has been inspected at the work place and it is safe to continue with the work.

Supervisor Name:     Supervisors Signature: