JHA WORKSHEET

HOW TO USE THIS FORM Installation/Facility PDPP

Location KVDT
1. Crew performing task reviews ALL generic JHA considerations. Associated Work Permit Type
2. Review previous JHA updates for useful information which will help this task.
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
5. File JHA update for future reference.

Work Description Drainage Work JHA Reference Number IRV/JHA/WP

JOB HAZARDS ANALYSIS

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

1 3 3
- PPE plus face shield,
- Personal 1 1 1
- firewatcher c/w fire  Apply STOP
Use of hand and Eye injury; injury (face) 1 2 2
extinguisher. work policy
1 power tools – Lacerations and - Burn 1 1 1 ACCEPTABLE
- Wear appropriate hand  Apply first aid
General hand injuries - Finger get 2 1 2
protection measure
caught in 1 1 1
pinch area 1 2 2
- PPE plus face shield,  Apply STOP
- Electrical
- Eye injury - firewatcher c/w fire work policy
hazards 1 2 2 1 1 1
2
Power brush / extinguisher.  Apply first aid ACCEPTABLE
Grinding - Electric - Wear appropriate hand measure
- Metal in eyes & 1 2 2 1 1 1
shock protection
cuts
-deaths of
- Water fauna/ flora
-Keep equipment at safe
accumulation -widespread Apply STOP work policy
distance from trench’s edge 1 1 1
- collapse of community
1 2 2 minimum 1m away from the pit
3 Dewatering excavation impact Apply first aid measure ACCEPTABLE
1 2 2
resulting in
-Provide proper drainage of 1 1 1
illness, injury
water
or
inconvenience
- personnel
1 2 2 Apply STOP work policy 1 1 1
- Inhalation of injured - wear proper PPE
Use scrapper and
4 paint dust, ACCEPTABLE
sand paper Apply first aid measure
dust is eyes - respiration - wear mask and safety glass
1 2 2 1 1 1
problem
 JHA WORKSHEET

Working on or
near shutters, - Insect bites, - personnel 1 2 2 - wear proper PPE
5 Apply first aid measure 1 1 1 ACCEPTABLE
eaves, roof lines, animal bites injured
etc..

Working in sunny - work outside

1 2 2 - Drink plenty water, take
6 and/or hot - heat stroke in cooler part Apply first aid measure 1 1 1 ACCEPTABLE
frequent break
weather. of day

- Asphyxiation 1
1 2 2 -Regular PPE including dust 1 1
- Dust - Slip, trip and 1
1 2 2 mask 1 1
- Obstruction fall Apply STOP work policy 1
Housekeeping 1 2 2 - Buddy system 1 1
7 - Manual - Back ache 1 ACCEPTABLE
1 2 2 - Barricade work area 1 1
handling - Minor injury Apply first aid measure
- Sharp edge (hand)

L - LIKELIHOOD S - SEVERITY R - RATING RESULT

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

JHA Number Date This JHA Created :08/02/2021

TASK SAFETY MANAGEMENT OUTLINE
Date JHA Last Revised :08/03/2021

WORK ACTIVITY EQUIPMENT

Type of Equipment Manufacturer Tag No Precise Work Site

WORK ACTIVITY PARTICIPANTS THIS JHA CREATED BY

Name Discipline Position Performed Job Before? Name Discipline Position

 JHA WORKSHEET

WORK ACTIVITY RESPONSIBILITY JHA SUBMITTED BY JHA ACCEPTED BY

WORK LEADER RECEIVING AUTHORITY AUTHORISED SUPERVISOR

Name ARIEFF Name ZULFADHLI Name

Signature Signature Signature

Date Date Date

Time Time Time