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Construction Job Hazards Analysis: This Is A TEMPLATE

This document is a construction job hazards analysis template for work requiring fall protection. It lists tasks like working at heights over 6 feet without proper fall protection or guardrails as potential safety risks. It requires the use of a fall protection system, fall protection plan, and fall protection matrix. It outlines safety controls like using fall protection equipment, maintaining a safe distance from edges, keeping work areas clear of debris, and ensuring all workers are trained on fall protection. Employees are required to sign off to acknowledge reviewing the analysis.

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45 views

Construction Job Hazards Analysis: This Is A TEMPLATE

This document is a construction job hazards analysis template for work requiring fall protection. It lists tasks like working at heights over 6 feet without proper fall protection or guardrails as potential safety risks. It requires the use of a fall protection system, fall protection plan, and fall protection matrix. It outlines safety controls like using fall protection equipment, maintaining a safe distance from edges, keeping work areas clear of debris, and ensuring all workers are trained on fall protection. Employees are required to sign off to acknowledge reviewing the analysis.

Uploaded by

dhila
Copyright
© Attribution ShareAlike (BY-SA)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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C/M or P/M

Reviewed:
CONSTRUCTION JOB HAZARDS ANALYSIS
Using Fall Protection
Rev: 2015
Building & Room(s): Contractor/Subcontractor Name:

Project: Date:

Scope of Work: Please provide your scope of work to be performed while using fall protection & the system you have chosen here. (and remove these directions).

Tasks being Performed Potential Safety Risks/Hazards Safety Controls / Mitigations

Risks of injury from an Working from heights over 6’ without the guardrail system in place or maintaining three points of contact, fall
This is a TEMPLATE exposure to a fall resulting protection is required.
from unprotected or leading
edges, skylights and open When Fall Protection is infeasible, A Fall Protection Plan will be “REQUIRED”
Working from Heights over 6’ holes in floors & walls.
without maintaining 3 points of A Fall Protection Matrix is “REQUIRED” when using FP equipment.
contact, fall protection may be
required. Follow FP Matrix guidelines for equipment & system use.

Please describe your Fall All Non-Roofers shall remain 15’ from an unprotected edge with the use of a Warning Line System.
Protection System you have
chosen to complete your task. Roofer shall maintain 6’ from an unprotected edge with the use of a Warning Line System.
(unless using a Safety Monitor system) (Roofers “Shall” submit a Fall Protection work plan)
(Fall Protection Matrix Required)

Risks of injury from Improper use or All employees shall be trained and instructed in the safe use of Fall Protection equipment under the
set up of equipment supervision of a competent person.

Pre-shift inspections of Fall Protection equipment by the user & competent person shall occur prior to
the start of work.

Manage the Fall Protection equipment for proper use.

Risk of slip, trips & falls Area on, near or around the working surface is to be kept clear of any debris.

Be aware of your surroundings at all times.

Maintain proper footing and body positioning.

Employee Signatures: Date: Employee Signatures: Date: Employee Signatures: Date:

A signed copy of this JHA must be posted while the applicable subcontractor is working on-site and be available to any employee upon request.

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