3210Appendix T2

Task Hazard Analysis (THA) Worksheet

 

 

Author:

Date:

Task #:

If applicable

Frequency of use:

Complete all information.  Use as many sheets as necessary

Task Location:

Task Title:

Division:

Department:

Lead Worker:

Mitigation already in place:

Standard Protecting Measures

Work Control Documents

 

Sequence of Task Steps

Task Steps/Potential Hazards

Consequence Level

Probability Level

Risk Code (before mitigation)

Proposed Mitigation

(Required for Risk Code >2)

Safety Procedures/ Practices/Controls/Training

Risk Code

(after mitigation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Highest Risk Code before Mitigation:

 

 

Highest Risk Code after Mitigation:

 

 

When completed, if the analysis indicates that the Risk Code before mitigation for any steps is “medium” or higher (RC≥3), then a formal Work Control Document (WCD) is developed for the task.  Attach this completed Task Hazard Analysis Worksheet.  Have the package reviewed and approved prior to beginning work.  (See ES&H Manual Chapter 3310 Operational Safety Procedure Program.)

 

 

ISSUING AUTHORITY

FORM TECHNICAL

POINT-OF-CONTACT

APPROVAL DATE

EFFECTIVE DATE

EXPIRATION DATE

REV.

 

 

 

ESH&Q Division

Harry Fanning

10/05/09

01/01/09

10/05/12

0

 

This document is controlled as an on line file.  It may be printed but the print copy is not a controlled document.  It is the user’s responsibility to ensure that the document is the same revision as the current on line file.  This copy was printed on 2/9/2011.