Job Hazard Analysis Form

Rows	Safety Helmet	Safety Shoes	Visibility Vest	Dust Mask	Safety Gloves(Depending on task)	Ear Protection	Eye Protection	Overall
Site set out and excavation	2	3	4	5	6	7	8	9
Backfilling	10	11	12	13	14	15	16	17
Construction of plinths and perimeter wall	18	19	20	21	22	23	24	25
Cabling	26	27	28	29	30	31	32	33
Moving Equipment	34	35	36	37	38	39	40	41
Loading &Offloading material	42	43	44	45	46	47	48	49
Electrical Works	50	51	52	53	54	55	56	57
Welding/Grinding an Hot works	58	59	60	61	62	63	64	65
Use of Power tools	66	67	68	69	70	71	72	73
Site completion works	74	75	76	77	78	79	80	81
Site Clean up	82	83	84	85	86	87	88	89
Threading	90	91	92	93	94	95	96	97

Rows	Yes	No	N/A
Exact scope of work discussed associated risks and mitigation measures	98	99	100
Absolute site rules and EHS commitment	101	102	103
Equipment Inspection	104	105	106
PPE Inspection	107	108	109
Results of risk assessment and fall protection plan	110	111	112
Emergency rescue procedures, evacuation procedures and first aid briefing	113	114	115
Plant,Exacavations,Backfilling,Tower rigging and electricals works discussed	116	117	118
Safety moment Topic	119	120	121
Others	122	123	124

COMMITMENT

''We have participated in todays safety meeting and agree with the topics discussed and the way necessary safety measures have been taken into consideration in the planning of activities.''

Rows	Yes	No	N/A
Are the windows in good condition and do they open properly?	125	126	127
Do the doors open and close properly?	128	129	130
Are the windscreen and the rear window in a good condition?	131	132	133
Do the wipers front and rear operate properly and are the blades in good condition?	134	135	136
Is the rear view mirror in place and in good condition	137	138	139
Is the side mirrors in place and in good condition?	140	141	142
All the four tires in good condition including a spare tire	143	144	145
Are the airbags intact?	146	147	148
Is the air conditioning functional?	149	150	151
Vehicle fluid levels okay?(oil,brake fluid, power steering fluid coolant)	152	153	154
Are the door locks functional?	155	156	157
Do all sits have seatbelt? Are the seatbelts functioning properly?	158	159	160
Does the horn operate properly?	161	162	163
Is the battery in good condition?	164	165	166
Do the brake lights illuminate when the brake pedal is depressed?	167	168	169
Does the headlights operate properly?	170	171	172
Does the parking /hand brake work properly when engaged?	173	174	175
Do the turn signal indicators blink front and rear	176	177	178
Do the headlight operate properly?	179	180	181
Are the chevron reflectors in place and in good condition?	182	183	184
Does the vehicles have any dents or scratches?	185	186	187

Rows	Yes	No	N/A
is thers an adequate and well supplied firt aid kit?	188	189	190
Is fire extinguishers in place, properly charged and currently inspected?	191	192	193
SIs there a wheel spanner in a good condition?	194	195	196
Is there a wheel jack in a good condition?	197	198	199
Are the life savers in place and in a good condition?	200	201	202

Job Hazard Analysis Form

Emergency Evacuation Plan

Emergency Response Team

PPE Matrix

Tool Box Talk Sheet

Employees Present

Vehicle Inspection Checklist