JHA FORM EHS-PR-12.

F01

Activity/Task Sitting-up of Air Condition System (Copper Piping And Drain Piping), Start-up / Commissioning
Date July 11, 2022 Company MDC Project UNIQLO Location Sta Rosa, Laguna
Complete the JHA Questionnaire
If a hazardous substances / chemicalis to be used, do you have the MSDS available? NO YES
Equipment & Tools to be used:

Does the task require a permit or other document approval? NO YES Indicate which

Excavation Permit Confined Space Permit Isolation Permit Lifting Permit

Working Near Overhead Power LinePermit Working at Height Permit Hot Work Permit Demolition
Works Permit Formwork Inspection &Concrete Pouring Permit Gondola Operations
Scaffold Inspection and tag

Logical Steps in Task Hazard / Unwanted Event What controls are required to manage the hazard?
(What could go wrong,) (Consider Hierarchy of Controls)

Deployment of manpower at work site •Biological hazard (highly contagious COVID-19 disease) • Accomplishing of Health and Travel Declaration Form (HTDF) daily;
• Checking of workers origin (HTDF) against the list of identified COVID-
19 High-Risk areas;
• Ensure that each worker is provided with face mask, vaccination card
shall always with them ready for inspection to health authorities;
• During the trip, only point to point is allowed, no stopping at any point to
prevent from exposure from anybody;
Transporting of contractors personnel using its authorized vehicle to • Biological hazard (highly contagious COVID-19 disease) • Service vehicle should be in good running condition with necessary
the project site and Materials delivery (Contractor Supplied • Transportation accident while traveling to the workplace. common trouble shooting tool kits;
Materials & Local Supplier) •Only authorized driver/personnel shall operate / drive the service vehicle,
with appropriate driver's license;
•Authorized driver is free from any alcohol or prohibited drug intake and
in good mental, health and physical condition;
Document Number – Title Owner Date Approved Revision Status Next Review Date
EHS-PR-12.F01 JHA Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy

Only Authorized Printed Version Is Deemed To Be ControlledPage1 of 4

 • No other passenger will be allowed to ride in the service vehicle, it is for
the contractors personnel use only;
Site survey and walkthrough prior to project activities • Trip hazard due to ongoing construction; • Ensure mental alertness and assumed any component has energized
• Exposure to extreme weather • Buddy-buddy system practice
• Wear PPE ( Hard Hat, Safety Glass, Safety Shoes, Cotton Gloves /
Leather Glove, Ear Plug, Dust Mask; Safety Belts) as appropriate while in
the construction site;
Chipping or tearing part of wall, floor, slab with the used of power • Strike against sharp or jagged edges (cuts, laceration); • Wear PPE’s ( Hard Hat, Safety Glass, Safety Shoes, Cotton Gloves /
tools. • Overexertion, repetitive motion, fragile positions while using Leather Glove, Ear Plug, Dust Mask, Safety Belts) as appropriate while in
a. Use of ladders and or scaffolds in height related work in ladders and (Fracture); the construction site ;
preparation for the nesting line of the insulated copper pipes and • Vibratory fatigue (nerve damage); • Observe vigilance and check surrounding hazards by looking above,
condensate drains. • Exposure to Excessive noise (Hearing Problem) behind, below, & inside and clear the area and remove object with sharp
b. Removal, cleaning and hauling of debris to the designated disposal • Getting hit by flying debris especially in overhead and or side or jagged edges;
areas at the workplace. wall work (Eye Injury, cuts, laceration); • Conduct housekeeping every after the end of the day’s work;.
• Fall hazard (Fractures, death , damage of power tools); • Identifying and tagging of holes or putting-up barriers (ex. Plywood);
• Inhalation of accumulated dust during concrete chipping or • Avoid overreaching and ensure appropriate position of ladders,
grinding & waste disposing (chronic bronchitis and heart and observance of proper or appropriate anchorage of ladder and or scaffolds;
lung disorders) • SOP’s in using ladder and or scaffolds:
• Visual inspection should be carried out before use ladder and or
scaffolds;
• Proper or appropriate anchorage of ladder and or scaffolds;
• Observance of 3 point contact SOP;
• Setting up of 4:1 ratio for vertical and horizontal slope;
• Avoidance of erecting ladders / scaffolds in slippery/uneven surfaces;
• No stacking of materials on scaffolds;
• Take regular brake, ask for help, and observe buddy-buddy system;
• Provide portable safe lighting equipment.
Insulation Works (Copper Tubing, Condensate Drain Pipe) • Use of power / hand cutting tools (Cuts, Abrasions); • Personnel with Mandatory 8 hrs Safety Training Course are strongly
• Use of adhesive solvents (Inhalation Exposure). directed to be assigned in this specific work;
• Authorized personnel are only allowed to undertake the job;
• Wear appropriate PPE’s

Document Number – Title Owner Date Approved Revision Status Next Review Date
EHS-PR-12.F01 JHA Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy

Only Authorized Printed Version Is Deemed To Be ControlledPage2 of 4

 Hot works - Fabrication of cable trays, bracket, hanger, • Hot falling embers (Fire, burns, damage of property); • Wear appropriate PPE’s;
• Electric Shock (burns, death, damage of property) • Portable fire suppression equipment (Fire extinguisher) is always
available at hot work area.
Install (overhead/above ceiling, side walls) and or mounting of • Fall hazard while using ladder and or scaffolds; • Visual inspection should be carried out before use of ladder and or
insulated materials (Copper Tubing / Pipes, Condensate Drain Pipe • Overexertion Lifting or passing. scaffolds ;
Line) • Observance of SOP’s in using ladder and or scaffolds.

Brazing (overhead/above ceiling, side walls) of each copper tubing’s • Falling embers or melted copper parts (Fire, burns, damage of • Wear appropriate PPE’s
up to the required length ready for tapping to outdoor and indoor air- property); • Portable fire suppression equipment (Fire extinguisher) is always
con units; • Electric Shock (burns, death, damage of property); available at hot work area;
• Leak test and flushing of connected copper pipe lines (using • Fall hazard while using ladder and or scaffolds; • Observance of SOP’s in using ladder and or scaffolds:
Nitrogen Gas)
Tapping of Condensate Drain, and Gravity Testing for longer run • Exposure or accidental contact with energized conductors • Awareness of energized conductors, de-energized all possible electrical
(Electrocutions, damage of power tools); system or device/s that will be affected or may affect in the course of
• Fall hazard while using ladder and or scaffolds. operation;
• Observance of SOP’s in the use of ladder and scaffolds.
- Before Commencing task; and
Orientation and sign off by all persons involved in work under this JHA is Mandatory
- If additional hazards and controls have been identified
Name: Signature: Date: Name: Signature: Date:

Responsible Process John Miko Vallejo

Signature: Date:
Owner Name:
A. Lucena/
EHS Approver Name: Signature: Date:
E.K.Pabalan

Document Number – Title Owner Date Approved Revision Status Next Review Date
EHS-PR-12.F01 JHA Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy

Only Authorized Printed Version Is Deemed To Be ControlledPage3 of 4

Document Number – Title Owner Date Approved Revision Status Next Review Date
EHS-PR-12.F01 JHA Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy

Only Authorized Printed Version Is Deemed To Be ControlledPage4 of 4