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  • Doe A-6004-784 2013

Get Doe A-6004-784 2013-2026

: Contractor Safety: Work Supervisor: Radio/Phone No.: Specific Work Location(s): Pre-job Walkthrough Conducted: Yes No KNOWN OR POTENTIAL HAZARDS Yes No Reference 1. Radiation Area Work RWP / CHPRC-00073 2. Hazardous Waste Operations 29 CFR 1910.120 29 CFR 1926.65 3. Confined Space 4. Hot Work 5. Roof Work 6. Fall Hazards ( 6 ft) DOE-0360 Yes No Reference 17. Respiratory Hazards DOE-0352 18. Noise Exposure PRC-PRO-.

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How to fill out the DOE A-6004-784 online

This guide provides clear and instructive steps to assist you in completing the DOE A-6004-784 form online. By following the outlined process, you will ensure that all required sections are filled out accurately and thoroughly.

Follow the steps to complete the form successfully.

  1. Press the ‘Get Form’ button to acquire the form and open it in your editor.
  2. In the first section, enter the project number and task order/contract number. This information is essential for identifying the specific project associated with the job hazard analysis.
  3. Complete the 'Prepared By' field by entering your name and the company name involved in the project. This identifies the responsible person for the analysis.
  4. Fill out the 'Building' and 'Area' fields to specify the location related to the job hazard analysis.
  5. Describe the work scope in the 'Work Scope/Description' section, detailing the specific tasks to be performed.
  6. Indicate the primary contractor safety personnel and the work supervisor along with their radio/phone number for communication purposes.
  7. Mark whether a pre-job walkthrough was conducted by selecting 'Yes' or 'No'. This is crucial for identifying site hazards before work begins.
  8. Review the list of known or potential hazards and mark 'Yes' or 'No' as appropriate. Refer to the specific guidelines for each hazard listed.
  9. For the identified hazards marked as 'Yes', provide a detailed hazard analysis in the 'Specific Hazard Analysis and Safe Work Requirements' section, including any necessary safety measures and personal protective equipment (PPE).
  10. Complete the minimum dress/PPE requirements section, listing the necessary attire and any exceptions.
  11. Finally, ensure that all required signatures are collected in the designated areas and write the corresponding dates.
  12. Save your changes, and then download, print, or share the completed form as necessary.

Take the next step and complete your document online today!

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