1
Job Hazard Analysis
Form
3552 Young Place, Lynchburg VA 24501
Phone: 434-582-3389 lusafety@liberty.edu
Task:
Name of Shop
or Dept.:
Job Title(s):
Analyzed by:
Date:
Required PPE:
Required/Recommended Trainings:
TASK
HAZARDS
CONTROLS
Other -
Hard Hat
Gloves
Safety Glasses
Hi Viz Vest
Safety Toe Boots
Respirator
Dust Mask
Fall Protection
Confined Space Eqpt.
2
TASK
HAZARDS
CONTROLS
NOTES:
3
Pictures:
4
Sign in Sheet
Project Name:
Date:
Employee Name (Print)
Employee Signature
LU ID #
Date
Department