Job Hazard Analysis (JHA) Form

1.0 General Information

• Technician Name: [Insert Name]
• Facility: [Insert Facility Name]
• Task: [e.g. Warehouse Floor Waxing]

2.0 Universal Safety Mandates

1. Peter Sentinel: Verified pre-task safety snapshot taken.
2. Guidance First: If a hazardous material is unlabeled, ASK supervisor before touching.

3.0 Hazard Control Table

4.0 PPE Verification

• [ ] Safety Glasses
• [ ] Non-slip Boots
• [ ] GHS-compliant Gloves
• [ ] High-visibility Vest (for Logistics Hubs)

5.0 Authorization

• Employee Signature: ____ Date: __
• Supervisor Approval: ____ Date: __

6.0 Revision History