Job Safety Analysis
Appendix D
Job Title:
Job Location:
Analysis by:
Date:
Task Description
Potential Hazard
Personal Protection
□ Lockout (personal or group) Specify
Machine
□ Hard Hats
□ Eye Protection ( specify safety glasses,
goggles or face shield)
□ Body Protection
□ Hearing Protection
□ Hand Protection (type of glove)
□ Foot Protection
□ Fall Protection
□ Respiratory Protection
□ Fire Protection
EHS Program:
Revision: 0
Issue Date: 01/22/14
Hazard Control
Area Hazards
□ Chemical or Process products
□ Combustion Hazards
□ Electrical Hazards
□ Slip, Trip, Fall Hazards
□ Heat Hazards
□ Access Hazards (ladder, lift, other)
□ Other Work Above, Below or Nearby
□ Barricade Needed
□ Lifting Hazards
□Confined Space Hazards
□Special Tools Required
□ Respiratory Hazards