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WME Job Safety Analysis

JSA Details
Individuals involved with the development of the JSA

Click "Add Personnel" to enlist names & roles

• Full Name & Role

Work Permits / Authorizations Required
Select the applicable work permit(s) / authorization(s) required

Enter other work permit

Safety Equipment Required

MC_PPE.jpg
Select the applicable safety equipment(s) required for the job
Competencies & Trainings

List down applicable competencies & training to carry out individual tasks (Enumerate)

Equipment Check & Special Considerations

List down checked equipments & any special considerations (Enumerate)

Job Safety Analysis & Risk Assessment
Job Step / Tasks and Risk Analysis

Click "Add Job Step / Task" to enlist the job steps / tasks, hazards, controls & risk ratings

• Step in Process / Task

• Hazards

People
Work Environment
Environmental
Equipment / Plant / Machinery

• Existing Controls

• Initial Risk Analysis

Consequence
Likelihood
Risk Rating

VLOW.jpg

LOW.jpg

MEDIUM.jpg

HIGH.jpg

Additional Controls

• Residual / Revised Risk Analysis

VLOW.jpg

LOW.jpg

MEDIUM.jpg

HIGH.jpg

VHIGH.jpg

VHIGH.jpg

Additional Controls

• Residual / Revised Risk Analysis

VLOW.jpg

LOW.jpg

MEDIUM.jpg

HIGH.jpg

VHIGH.jpg
JSA Acknowledgement & Completion

Status of the JSA

JSA conducted by (Name and Signature)

NOTE: If there are changes or if the JSA is incomplete, REVIEW the whole JSA and initiate the Task Review below.

Task Review

Were any additional hazards identified while doing the task?

Were hazards and controls have been added to the JSA form?

• Has a copy been filed in the central filing system?

• Is a Permit to Work required?

• Does a procedure need amending as a result of this JSA?

• Does the JSA trigger a training need?

Reviewed by Area / Manager (Name and Signature)
Supervisor Authorization (Name and Signature)
Personnel Details

Click "Add Personnel" to enlist names & signatures of those who were involved with the JSA
Name and Signature

Comprehensive Job Hazard Analysis Form Checklist

Created by: SafetyCulture Staff | Industry: General | Downloads: 150

Use this template to conduct more detailed hazard analysis in your workplace. Explore the features of iAuditor and modify the checklist based on your workplace needs. Start by listing the names of the people who develops JSA procedures, and select the work permits, authorizations and PPE required for the activity. Next enumerate applicable trainings to carry out individual tasks. Also, take note of the equipment checks conducted. Proceed with the job safety analysis and risk assessment by adding steps, selecting hazards and identifying controls. Conduct an initial risk assessment, add controls (if needed), then rate the residual/revised risk analysis. Confirm whether the process is completed or not. If not, conduct a task review to serve as a basis for the continuity of the process. Finally, acknowledge by getting all people involved to sign off.

Signup for a free iAuditor account to download and edit this checklist. It will be added to your free account and you will be able to conduct inspections from your mobile device.

Download and edit this free checklist

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WME Job Safety Analysis

JSA Details
Individuals involved with the development of the JSA

Click "Add Personnel" to enlist names & roles

• Full Name & Role

Work Permits / Authorizations Required
Select the applicable work permit(s) / authorization(s) required

Enter other work permit

Safety Equipment Required

MC_PPE.jpg
Select the applicable safety equipment(s) required for the job
Competencies & Trainings

List down applicable competencies & training to carry out individual tasks (Enumerate)

Equipment Check & Special Considerations

List down checked equipments & any special considerations (Enumerate)

Job Safety Analysis & Risk Assessment
Job Step / Tasks and Risk Analysis

Click "Add Job Step / Task" to enlist the job steps / tasks, hazards, controls & risk ratings

• Step in Process / Task

• Hazards

People
Work Environment
Environmental
Equipment / Plant / Machinery

• Existing Controls

• Initial Risk Analysis

Consequence
Likelihood
Risk Rating

VLOW.jpg

LOW.jpg

MEDIUM.jpg

HIGH.jpg

Additional Controls

• Residual / Revised Risk Analysis

VLOW.jpg

LOW.jpg

MEDIUM.jpg

HIGH.jpg

VHIGH.jpg

VHIGH.jpg

Additional Controls

• Residual / Revised Risk Analysis

VLOW.jpg

LOW.jpg

MEDIUM.jpg

HIGH.jpg

VHIGH.jpg
JSA Acknowledgement & Completion

Status of the JSA

JSA conducted by (Name and Signature)

NOTE: If there are changes or if the JSA is incomplete, REVIEW the whole JSA and initiate the Task Review below.

Task Review

Were any additional hazards identified while doing the task?

Were hazards and controls have been added to the JSA form?

• Has a copy been filed in the central filing system?

• Is a Permit to Work required?

• Does a procedure need amending as a result of this JSA?

• Does the JSA trigger a training need?

Reviewed by Area / Manager (Name and Signature)
Supervisor Authorization (Name and Signature)
Personnel Details

Click "Add Personnel" to enlist names & signatures of those who were involved with the JSA
Name and Signature