Confined Space Entry Job Hazard Analysis (JHA)
Project / Location
Date
Supervisor
JHA Completed By
Work Description
Confined Space Details
Confined Space Location
Type of Space
Permit Required?
Hazard Assessment
Step / Task
Hazards
Controls
Responsible Person
Status/Comments
Rescue Plan
Equipment/PPE Required
Atmospheric Testing
Date/Time
Oxygen (%)
LEL (%)
H
2
S (ppm)
CO (ppm)
Tester Initials
Authorized Entry Team
Name
Role
Signature
Supervisor Signature
Date