First, describe the work and worksite
A small crew will mix and place nonshrink cementitious grout beneath an installed steel baseplate on a ground-level foundation. The supported member remains stabilized under the erection plan. This fictional learning example records planned controls; it supplies no actual inspections or work authorization.
- The connection design and product specification provide the grout, preparation and load-release requirements.
- Forms, clearances and access can be prepared without disturbing the member’s temporary support.
- This excludes epoxy grout, pumped masonry grout, pressure injection and release of structural bracing.
Questions before work
- What keeps the member stable while the grout is placed and cures?
- Which preparation and mix instructions apply to this product?
- Who can release loading or remove temporary support after cure?
Build the analysis one step at a time
What will the worker do? How could someone be harmed? What prevents or reduces that exposure? Who checks the control, and when?
1. Confirm support and the grout release
Hazard: Disturbing support or changing a connection can cause movement of the supported member.
Control: Foreperson confirms the erection support remains effective and identifies the grouting limits. No bolts, shims or bracing are altered without the required design release.
Verification: Compare the actual support and baseplate condition with the current erection and grouting instructions.
Why this belongs in the analysis: Grout placement does not authorize changing structural support.
2. Prepare the base and containment
Hazard: Loose debris, sharp edges and dusty preparation can injure the crew or obstruct the pour.
Control: Use the specified preparation method with assessed dust controls. Install forms and route access so workers can place grout without reaching into a pinch zone.
Verification: Lead checks the prepared surface and form stability before materials are mixed.
Why this belongs in the analysis: Preparation must preserve the supported member’s stability.
3. Inspect the mixer and stage bags
Hazard: Moving mixer parts, heavy bags and cement dust can cause injury.
Control: Use guarded equipment in suitable condition, handle bags with assistance or equipment and stage them near the feed point without blocking access. Follow the applicable silica-control assessment and product handling instructions.
Verification: Operator checks guards and controls; lead checks the feed route and dust-control arrangements.
Why this belongs in the analysis: Bag handling and dry charging differ from wet placement.
4. Mix the specified batch
Hazard: Cement splash can burn skin and eyes; reaching into moving equipment can cause entanglement.
Control: Charge and mix in the product sequence with selected cement protection. Keep hands and tools outside moving parts and stop and secure energy before clearing the mixer.
Verification: Operator confirms water and batch settings against instructions and checks splash containment.
Why this belongs in the analysis: The product controls the mix; the JHA does not invent a ratio.
5. Place grout without disturbing support
Hazard: Wet grout can contact skin; rushed placement can force workers into awkward or trapped positions.
Control: Place from the planned access using suitable containers and tools. Maintain support and containment, prevent contact and hold the work if form leakage or member movement appears.
Verification: Lead monitors forms and member condition while the crew places grout.
Why this belongs in the analysis: A clear access method reduces both cement contact and structural interference.
6. Clean and maintain the cure restriction
Hazard: Wet residues can cause slips and burns; early loading can compromise the planned support.
Control: Clean by the specified wet method, collect residues and mark the cure restriction. Keep load and support decisions with the designated authority and communicate them at handover.
Verification: Foreperson checks cleanup and records the required loading release and responsible authority.
Why this belongs in the analysis: A filled baseplate is not evidence that strength criteria have been met.
What does a useful control look like?
| Needs improvement | More useful for this scenario |
|---|---|
| Be careful around the equipment. | Use guarded equipment in suitable condition, handle bags with assistance or equipment and stage them near the feed point without blocking access. Follow the applicable silica-control assessment and product handling instructions. |
| Check the area before starting. | Foreperson confirms the erection support remains effective and identifies the grouting limits. No bolts, shims or bracing are altered without the required design release. |
Decisions that change the analysis
May the crew remove bracing when the grout appears hard?
No. Appearance alone is not the specified strength or connection release. Use the project’s documented cure, testing and support-release criteria with the designated authority.
What must be recorded before this example is used on a job?
Replace the scenario with the actual work, identify additional hazards with the crew, and record the applicable instructions, responsible people, inspection findings, unresolved actions and required authorization. A planned verification is not an inspection result.
Agree when the crew will pause
- Support moves or anyone proposes adjusting bolts, shims or braces.
- Product, preparation or mix method changes.
- Leakage, dust-control failure or an unclear loading release occurs.
After a pause, correct the condition, reassess the work, and obtain required authorization before restarting. Keep unresolved actions visible.
Download the worked example and free template
No account or paid membership required. The worked example contains planned controls. The blank template is for your own work; neither includes fabricated inspection results, signatures or approval.
Your editable working copy
Build and download your draft
Start blank or load the learning example. Replace its assumptions with your actual conditions and involve the people doing the work. Your entries stay in this browser tab; download a copy before leaving or refreshing.
1. Describe your work and site
2. Work through each task
Describe an observable step, how someone could be harmed, and the control that acts on that hazard. Identify who checks it and what evidence is needed.
3. Record changes, checks, and open actions
Walk the work area, review with the crew, and resolve missing controls. Follow the required approval process. This tool does not judge completeness, verify signatures or authorize work.
Open the downloaded file in a browser, then use Print → Save as PDF for a printable copy.
Training needs to confirm
- Mixer guarding and shutdown, cement protection and applicable silica instruction.
- Recognizing the support and load-release boundary.
Confirm applicable qualifications, task instruction and actual training evidence for the people assigned. Related toolbox talks support crew discussion; they do not establish competence.
Common questions
Can this be used as a JSA?
Use the Task | Hazard | Control structure if it meets the employer’s format. Adapt the boundaries, controls, verification and records to the actual job.
Does this provide a completed USACE AHA?
No. Use the project’s required AHA process, risk method, supporting fields and acceptance requirements. The existing formwork AHA explains the additional structure.
Are these resources part of a paid course?
This walkthrough, browser draft builder and downloads are free public resources, separate from Academy course enrollment.
References and source note
- OSHA 1926.702 Concrete equipment and tools
- OSHA 1926.701 General concrete construction requirements
- OSHA 1926.1153 Respirable crystalline silica
- OSHA 1926.21 Safety training and education
Original worked example developed for the stated scenario. Primary references support the planning framework; the actual equipment manual, product instructions and project design must supply applicable operating and acceptance criteria. Use actual equipment instructions and site requirements alongside these references. Reference review: October 9, 2026.