Task Hazard Assessment (THA)

Job Safety Analysis with Real-Time Quality Coaching

📋 SWISS CHEESE MODEL VALIDATION

📝 New THA

📂 My Open THAs

✅ Close Out THA

📋 General Information

Date *

Company *

Location *

Work Area

Crew Lead *

Phone/Radio

Task Description *

Job Planning Notes

Procedure Exists?

Yes

N/A

Procedure Reviewed?

Yes

N/A

🚗 Driving / Backing

Driving or backing?

Yes

⚡ Energy Wheel

⚡ Energy Types Present

⬇️

Gravity

Falls, drops

🚗

Motion

Vehicles

⚙️

Mechanical

Pinch points

⚡

Electrical

Shock

💨

Pressure

Hydraulic

☠️

Chemical

Toxic

🔥

Temperature

Burns

🔋

Stored

Springs

🛡️ Control Types

🚫Elimination

🔄Substitution

🔧Engineering

🚧Guarding

🔒LOTO

⚠️Warnings

📋Procedures

🦺PPE

☑️ Pre-Task Checklists

General Items

Emergency Response PlanCommunication PlanWork Area InspectedTools InspectedWeather CheckedSIMOPS Reviewed

PPE Requirements

Hard HatSafety GlassesSteel Toe BootsGlovesFRC/NomexHearing ProtectionFall ProtectionRespiratoryFace ShieldH2S Monitor

Permits Required

Hot WorkConfined SpaceLOTOExcavationOpening/BlindingUnit WorkElectricalGeneral Work

Potential Hazards

Pinch PointsElectricalPressurized SystemsChemical ExposureH2SFall HazardsStruck ByCaught In/BetweenNoiseTemperature ExtremesLifting/ErgonomicSlips/Trips/Falls

📝 Task Steps, Hazards & Mitigations

🎯 GOAL: Paint a picture of the ACTUAL work!

#	Task Step	Hazards	Controls
1
2
3

👷 Crew Sign Off

🔒 Complete quality check to unlock

Name	Company	Comments

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