Job Hazard Analysis (JHA) — Template Rev 2
1. Job information
| Customer / site | Date(s) | ||
|---|---|---|---|
| Prime contractor | Motion Industries / Direct | Avetta WR # | |
| LEO Job ID | WO-2026-____ | Shift / hours | Day / Overnight ____ to ____ |
| Equipment / area | |||
| Task description (start to finish) | |||
| Site contact | LEO lead on site | ||
2. Crew — every worker signs before work starts
| Worker name | Role | LOTO Authorized (LEO-LOTO-002) | Signature | Date |
|---|---|---|---|---|
| Lead | Yes / No | |||
| Yes / No | ||||
| Yes / No | ||||
| Yes / No |
3. Required PPE
☐ Safety glasses ☐ Face shield ☐ Hard hat ☐ Hi-vis vest ☐ Safety-toe boots ☐ Hearing protection ☐ Cut-resistant gloves ☐ Chemical/oil gloves ☐ Heat gloves ☐ Arc-rated clothing (cal/cm² ___) ☐ Respirator (type ___) ☐ Fall protection ☐ Other ________
4. Energy control — Lockout/Tagout (LEO-LOTO-002)
| # | Energy source (electrical, hydraulic, pneumatic, gravity, spring, thermal) | Isolating device & location | Stored-energy release / verification |
|---|---|---|---|
| 1 | |||
| 2 | |||
| 3 |
LOTO statement: Each worker applies their own personal lock and tag to every energy-isolating device (group lockout uses a hasp). No worker removes another worker's lock. Zero energy is verified by try-start and test instruments before work begins. The customer's site LOTO procedure is also followed; the more protective requirement applies.
5. Other hazard screens
| Confined space entry | ☐ N/A — no entry ☐ Permit required — attach |
|---|---|
| Work at height | ☐ N/A ☐ Yes — method ________ |
| Hot work (weld / cut / grind) | ☐ N/A ☐ Yes — permit # ______ |
| Energized electrical work | ☐ N/A ☐ Yes — NFPA 70E energized work permit |
| Chemicals / SDS | ☐ N/A ☐ Yes — SDS reviewed |
| Mobile equipment / forklift traffic | ☐ N/A ☐ Yes — barricade / spotter |
6. Task steps — every step assigned to a named worker
| # | Task step | Hazards | Controls | Assigned to |
|---|---|---|---|---|
| 1 | Check in; review this JHA with crew and site contact | Unknown site hazards | Review JHA; confirm work area, exits | |
| 2 | Shut down and lock out (Section 4) | Unexpected start-up, stored energy | Personal locks; release stored energy; verify zero energy | |
| 3 | ||||
| 4 | ||||
| 5 | ||||
| 6 | Remove tools, reinstall guards, clear personnel | Struck-by on start-up | Headcount; guards verified before lock removal | |
| 7 | Remove locks, restore energy, test run with site contact | Unexpected motion | Each worker removes own lock; controlled start-up |
7. Stop-work authority
Any worker may stop the job at any time for any safety concern, without penalty. Stop and call the LEO office (513-375-4814) if conditions change, a new energy source is found, or the scope changes.