DN Tanks

Task/Activity Hazard Analysis (THA/AHA)

Task/Activity Name: Powered Industrial Truck Task/Activity Number: 4 Dept. Construction
Revision #: 2 Revision Date: 11/4/2016
Project Name: Overall Risk Assessment Code (RAC) (Use highest code)
Project Location: Risk Assessment Code (RAC) Matrix
Project Number: Probability
Severity
Contract Number: Frequent Likely Occasional Seldom Unlikely
Catastrophic E E H H M
Date Prepared: 12/4/2015 Critical E H H M L
Prepared by: Mike Erwin/Joe Pacheco
Marginal H M M L L
Date Reviewed: 11/4/2016
Negligible M L L L L
Reviewed by: Dan Wallace
Step1: Review each "Hazard" with identified safety "Controls" and determine RAC (See above)

Project Manager: "Probability" likelihood to cause an incident, near miss, or accident and
RAC Chart
Superintendent: Identified as: Frequent, Likely, Occasional, Seldom or Unlikely.
Foreman: "Severity" is the outcome/degree if an incident, near miss, or accident did E = Extremely High Risk

occur and identified as: Catastrophic, Critical, Marginal, or Negligible H = High Risk

Using Powered Industrial Trucks on the jobsite to Step 2: Identify the RAC (Probability Severity) as E, H, M, or L for each M = Moderate Risk
Description of Work:
move equipment and materials
"Hazard" on THA/AHA. Annotate the overall highest RAC at the top of THA/AHA L = Low Risk

Competent/Qualified Person Required for Programs Below*

Personal Protective Equipment, Powered Industrial *Must attach Training Documents if Required
APSP Programs:
Truck, Hearing Protection, Fire Prevention, Task/Activity Qualified
Y ☒ N ☐ Name:
Person:
Hard hat, Steel/Safety Toe Work boots, Safety Respiratory Protection: Y ☐ N ☒ Name:
PPE Required: Glasses, High Viz. Garment, Work gloves, Fall
Protection, Hearing Protection Confined Space: Y ☐ N ☒ Name:

Diesel, Oil, Hydraulic fluid, Coolant fluid, ABC Fire Fall Protection: Y ☐ N ☒ Name:
Chemicals/SDS Used:
Extinguisher Forklift Certification: Y ☒ N ☐ Name:

First Aid/CPR Y  N ☐ Name:

Certified Employees: Y  N ☐ Name:

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 DN Tanks
Task/Activity Hazard Analysis (THA/AHA)
Task/Activity Name: Powered Industrial Truck Task/Activity Number: 4 Dept. Construction

List TASK/ACTIVITY Process in

sequence to be performed: REGULATION
HAZARD HAZARD CONTROL RAC
*This list is separate from the hazard list and NUMBER
the orders do not correlate
1. Inspect offloading area,  Only inspect the forklift when it is off and the keys have been removed to
determine if traffic control prevent any starting during inspection
program is needed, and if G.C. is  Use only approved storage areas in the cab to store materials to avoid
responsible material from obstructing safe operations
2. Unload the forklift (only truck  Never operate the forklift while outside the cab and not seated in designated
driver that is delivering can Crushing seat M
offload forklift)  Proper size of dunnage must be used under each load; at least 3” tall and
3. Inspect Work area long enough to support the total material size to avoid tip over
4. Inspect Forklift  Never stand a board on end as dunnage, it must be laid flat
5. Discuss operation with other  Keep all body parts in the cab during all operation
workers  Only authorized mechanics are allowed to perform repairs
6. Use lift to safely move needed Chemical  While inspecting the forklift, be sure to wear appropriate gloves to protect
material M
Contact against chemical exposure
7. Properly park and stow lift  Always operate equipment at a safe working speed.
 Maintain machine level while lifting, traveling, and parking
 Chock wheels when parked on a slope
 Know the weight of the load; consult operating load charts before lifting
Roll/  Always wear a seatbelt when using the forklift.
L
Tip over  Never drive with a load in a raised position, always keep the forks as low to
the ground as possible
 Always level machine before raising a load
 If outrigger equipped then use outriggers for increased stability or if required
per the load chart
 Do not operate equipment near overhead hazards
Overhead
 Maintain at least 20 feet (6.1m) from power line at all times
Electrical L
 Never drive over electrical cords, hoses, or concrete lines
Hazards
 Never store material or equipment under overhead electrical lines
Slips, Trips,  Use foot-step & grab bars when entering/exiting cab. L
& Falls  Always park forklift in safe location, not in mud or other slippery area
 Always place forks on the ground flat when the lift is not is use
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 DN Tanks
Task/Activity Hazard Analysis (THA/AHA)
 Maintain 3 points of contact when climbing into and out of the cab
 Do not jump down when exiting forklift
 No passengers allowed. One seat and seat belt for each employee required
Site/  Never operate a forklift in an electrical storm
Weather  Always adjust your driving methods depending on weather conditions L
Conditions  Care must be taken when rain, ice, snow, high winds or fog is present
 When operating, be aware of blind spots
Limited
 When handling materials/ equipment that can't be seen around, qualified L
View
signal person must be used or driving in reverse is acceptable
 Proper maintenance of equipment is essential to avoid any spills
 Do not use a piece of equipment that has a leak
 Always have a plan on how to contain and clean any leak or spill that may
Spills occur L
 Have a spill kit available
 Have a spill response person pre-designated and trained at the start of each
job
Elevated  Never allow anyone to get underneath an elevated load
L
Loads  Never put body part between load and fixed object at any time
Eye Hazard  Wear approved safety glasses 100% of the time. L
 All workers must wear hearing protection when exposed to noises over 85
Noise L
decibels
 All forklifts are required to have at minimum, a 2.5 lb (1.13kg)ABC fire
extinguisher mounted on them
Fire  Fire extinguishers must be inspected monthly, and the inspection tag L
completed
 No open flames or sparks allowed during refueling
 Be aware of many pinch points of material when moving around with forks
 Never allow a person to get in one of these pinch points, this is the operators
Pinch
responsibility L
Points
 Fork-cage shall be positioned properly when forks are being moved to a new
position.
Pressurized  Inspect the equipment when it arrives and every day prior to use L
Lines  Never try to do repairs unless you are qualified
 Stay clear of hydraulic fluids. If injected, seek medical attention immediately.
Take the SDS for Hydraulic fluid with you when seeking medical attention

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 DN Tanks
Task/Activity Hazard Analysis (THA/AHA)
 Use only designated lifting baskets for workers
 Operator must stay at the controls while workers in are in the basket
Heights  Personnel must be out of basket while forklift is travelling L
 Workers must be tied off to approved anchor point while working in the
basket

Training Requirements/Competent
Tools Required: Equipment to be Used: Inspection Requirements:
or Qualified Personnel name(s):
 Grease gun  Forklift
 Forklift: Documented  Forklift: Documented
 Hand tools  Forklift attachment

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 DN Tanks
Task/Activity Hazard Analysis (THA/AHA)

Task/Activity Name: Powered Industrial Truck Task/Activity Number: 4 Dept. Construction

By signing below, each employee acknowledges that they have reviewed this complete Task Hazard Analysis.
Employee Name (Please print) Employee Signature Date Reviewed

Supervisor that provided this THA/AHA Training to the above Employee(s):

Supervisor Name Supervisor Signature Date Reviewed

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