JOB HAZARD ANALYSIS (JHA) WORKSHEET

SECTION 1

JHA NO. PTW NO WORK PERMIT TYPE

FACILITY LOCATION SPECIFIC WORKSTATION
EQUIPMENT NO. WORK DESCRIPTION
OVERALL RISK RATING Low Medium High Very High
(TICK √)
NOTES:
1. JHA Shall be applicable for all work activities which required PTW.
2. Personnel carrying out the work shall be fully familiar with the written Work/Operating Procedures develop for the job. The Work/operating procedures shall describe, in step-by-step
instructions, the correct method of executing the specified work.
3. Prior to commencement of work, the task specific JHA shall be discussed amongst all personnel involved in the execution; and requirements contained shall be fully understood
and agreed by all involved personnel.
4. Overall Risk Rating to be based on PETRONAS Risk Matrix 5x5 with applicable supporting input from other existing Risk Assessment e.g., HAZID, HER, HRA, CHRA.
5. STOP WORK AUTHORITY to be enforced for any deviation from JHA job step

MONITORING MONITORING
JOB POTENTIAL POTENTIAL ACTION RECOVERY ACTION
DESCRIPTION OF JOB STEP CONTROL BARRIERS REQUIREMENT REQUIREMENT
STEP HAZARD CONSEQUENCES PARTY (Y/N) BARRIERS PARTY (Y/N)

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 JOB HAZARD ANALYSIS (JHA) WORKSHEET

SECTION 2

JHA PRECAUTIONARY CONTROL BARRIER (JPCB) CHECK

NOTE
1. Barriers to be extracted from JHA and timing for Barrier Verification Frequency to be agreed between JHA Leader and AAR/AS
2. JPCB check to be filled for every PTW revalidation

BARRIER VERIFICATION FREQUENCY

NO. JHA BARRIERS (DATE: ) REMARKS
(TICK √ AND TIMESTAMP WHERE APPLICABLE)

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 JOB HAZARD ANALYSIS (JHA) WORKSHEET

SECTION 3

JHA APPROVAL DURING PTW APPLICATION

NOTE
Minimum Approving Authority Level:
1. Low & Medium - Supervisor or higher
2. High & Very High - Manager or higher
PREPARED BY (JHA LEADER) REVIEWED BY (SHO/SSE/SUPERVISOR/EIC) APPROVED BY (JHA APPROVING AUTHORITY)
NAME NAME NAME

DESIGNATION DESIGNATION ( DESIGNATION

SIGNATURE SIGNATURE SIGNATURE

DATE DATE DATE

SECTION 4

JHA COMMUNICATION

NOTE
1. Confirmation that JHA has been communicated to work team as part of pre-job/ toolbox meeting after PTW has been approved.

Name (S) Designation Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Name (S) Designation Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Signature Signature Signature Signature Signature Signature Signature Signature Signature Signature Signature Signature Signature Signature

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