Sample JHA Worksheet
In the JHA form below, we have added some potential hazards and possible injuries that might occur as the worker performs each step in the form below.
| JOB: Loading Products into Trailer | ||
|---|---|---|
| Basic Task Step | Hazards - Possible Injuries | Preventive Measures |
| 1. Driver/Spotter: Spot position of trailer | 1. Spotter: Caught-between injury if caught between trailer and dock 2. Vehicle: Struck-against damage if truck hits dock |
|
| 2. Driver: Exit truck | 1. Spotter: Struck-by or Caught-between injury if energized truck moves 2. Driver: Fall injury from jumping off truck |
|
| 3. Driver: Set chocks | 1. Driver: Struck-against injury if driver strikes trailer 2. Driver: Fall to same surface injury if driver trips, slips, or falls while in the dock well 3. Driver: Caught-in injury while positioning chocks |
|
| Safe Job Procedure | ||
Knowledge Check Choose the best answer for the question.
3-9. What type of hazard would be listed in column 2 of the JHA if an employee might receive a concussion if he did not wear a hard hat?
You forgot to answer the question!