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Job Details Resources Required Work Permits Required
BMHS 33KV Technicians skills Hot works Confined Space
Specific Location of task : Electricians Welder Lifting Others Specify
Duct Fabricator Plumber Electrical (LOTO)
Insulator Rigger Suspended Man basket
Pipe fitter Others Formwork (casting/striking)
Responsible In charge: Hazardous materials / chemicals : Emergency Contact Numbers:
33284344
Contact Names & Numbers: Plant / Equipment / Power tools : Male Nurse :
Mr. Shafeek / Mr. Sishoy
33277890
Permit to Work Number (PTW): Area Safety Officer:
Description of Works :
Before work starts, the following must be in place
Induction Supervision Test Certificates Communication Drinking Water Risk Assessment Permit To Work Area Lighting
SELECT SELECT CONTROLS
HAZARDS ( Tick to identify the controls in place)
Fall from Risk Access Access Edge Adequate Guards for
Secure Ladder Fall Arrestor Life Lines
height Assessment Ladder Handrail Protection Work Platform Openings
Manual Risk Check Mechanical Wrong
Access Route Training Team Lifting Right Method Others
Handling Assessment Weight Aids method
Colour code
Risk Guards in Proper Cable Dust
Power tools inspection Check Cable Proper Scaffold Ventilation
Assessment place Positioning Protection extraction
tag
Risk Permit to Check plug
Electricity Training Tag out Lock out Warning Signs Check Cable Others
Assessment work tops
Confined Risk Permit to Communicatio Rescue
Survey Gas Detection Access/egress Monitoring Air supply
Space Assessment work n System
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SELECT SELECT CONTROLS
HAZARDS ( Tick to identify the controls in place)
Use Adequate Jumping
Risk Clean Access House Check oil
Trip and fall Pedestrian Access/egress Work manholes / Others
Assessment route keeping spills
way Platform trenches
Risk Lifting points / Check Lifting Examination / Packing
SWL Tag Lines Banks man Load stability
Assessment hooks gear Inspection Pieces
Lifting Weather Ground Exclusion Communicati Loading/unloa Spreader Check Ground Check
Others
operations condition conditions zone on ding vehicles Beams conditions outriggers
Compresse Risk Cylinder Cylinder Permit to Flash Back Hose/pipe Pressure
Warning Signs No smoking
d Gas Assessment storage Trolley Work Arrestors check Gauges
Fall from Risk Don’t use in Check Ladder anti
Secure Ladder Over Reaching Others Others Others
ladder Assessment edges stability skid shoe
Adequate
Risk Check Over Edge Weather Ground
Scaffold Scaffold Tag Access Ladder Out riggers Work
Assessment head works Protection condition condition
Platform
Industrial Risk Warning Examination
SWL Load stability Route survey Speed Limits Banks man Secure Load
Vehicles Assessment devices / Inspection
Chemical
Risk Controlled Respiratory Fume
Chemical Check Label Training resistant Hand Ventilation Others
Assessment access equipment extraction
Gloves
Emergency Emergency ABC Fire CO2 Fire
Fire Response Training
Fire Blanket Fire Hose Fire Exit Assembly point
Plan Extinguisher Extinguisher
Risk Check slope / Access /
Excavation Shoring Barricade Others Others Others Others
Assessment repose angle egress
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SELECT SELECT CONTROLS
HAZARDS ( Tick to identify the controls in place)
Leather
Welding / Risk Permit to Welding Welding face Fume Barricade hot
Training Ventilation apron /
Hotworks Assessment Work screens shield extraction work zone
gloves
Adequate
Risk Permit to Warning Guard shaft Proper
Fall Arrestor Life Lines Access / egress Work
Assessment Work boards openings Scaffold
Platform
Shafts /
Overhead Opening
Floor Training Ventilation Task light Others Others Others Others
Protection guards
Openings
Waste
Biological Environment Wash rooms / Waste
Survey Pest control management Waste Skip Others Others
Hazard Assessment Toilets removal
/ Recycling
Others
Others Others Others Others Others Others Others Others Others
(Hazard)
Safety Eye Ear Safety
Hand Gloves Coveralls Face Shield Hi vest Jacket Safety Shoe
Helmet protection Protection Harness
PPE
Respiratory Breathing
Dust mask Fall Arrestor Others Others Others Others Others
Equipment Apparatus
Any Others
Observations and
actions taken:
Task Hazard Analysis
Name: Signature:
Prepared BY
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Attendee Form
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