B&G - JSA

• Project #

• Client / Site

• Audit Title

• Conducted on

  Date

• Prepared by

• Signature

  Sign

Crew / Personnel

• Team Members

Team Member

• Signature

  Sign

Steps of Task

• Steps of Task

Task

• Task

• Hazard

• Safe Plan

• Additional PPE, Training, Tools, etc. Needed

Other Informatiom

• Anyone new to crew today? If yes, provide and describe additional instruction:

  Yes

  No

  N/A

• Is everyone in the crew physically and mentally fit for today's task?

  Yes

  No

  N/A

Check List