Job Hazard Safety & Environment Analysis (JHSEA) Worksheet

Division Tools and or Equipment

Required
Office / required: JHA No: Rev. No.:
Permits:
Project:
Job
Location & Permit To Work Date Prepared:
Details:
JHA Excavation
Participants:
PPE Requirements: Approved by PM or
HV Switching
nominee:
Shoes/
Hot Work Helmet Gloves
Boots
Face
Confined Space Glasses Harness
Shield
Responsible Environmental Vest
Ear
Site Clearance Respirator Plugs Date:
Supervisor:
Others/Specify

Page 1 of 3
F-CIM-021
Rev. 3; 17 Dec 2014
 Job Hazard Safety & Environment Analysis (JHSEA) Worksheet

HAZARDS
JOB STEP IDENTIFIED CONTROLS REQUIRED (E.g. Remove overhead
(E.g. Set Up (E.g. ACTION BY/RECORD
cable or isolate /health overhead or monitor with
Cra Electrocution (E.g. Supervisor)
spotter) Training PPE Needs
ne) from 11Kv
Cables)

Page 2 of 3
F-CIM-021
Rev. 3; 17 Dec 2014
 Job Hazard Safety & Environment Analysis (JHSEA) Worksheet

HAZARDS CONTROLS REQUIRED (E.g. Remove

JOB STEP IDENTIFIED overhead cable or isolate /health overhead ACTION BY/RECORD
(E.g. Set Up Crane) (E.g. Electrocution from 11Kv or monitor with spotter) Training PPE (E.g. Supervisor)
Cables) Needs

Page 3 of 3
F-CIM-021
Rev. 3; 17 Dec 2014