Detailed Job Hazard Analysis Form

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.

Title Page

Site conducted
Role being evaluated
Date

InterDesign Job Safety Analysis

JSA Details

• Full Name & Role

Safety Equipment Required

Select the applicable safety equipment(s) required for the job
- Hi Viz / Safety Boots
- Hard Hat
- Eye Protection
- Hand Protection
- Ear Protection
- Face Protection
- Protective Clothing
- Dusk Mask / Respirator
- Gas Detector
- Life Jacket
- Tripod (Confined Spaces)
- Fall Protection

Competencies & Trainings

List down applicable competencies & training to carry out individual tasks (Enumerate)
- Hazard Communication
- Material Handling
- Powered Industrial Trucks
- Accident/Near Miss
- Fall Protection
- First Aid CPR
- Spill Prevention
- Hearing Conservation
- Lock Out/Tag Out
- Confined Space
- Fire Extinguisher
- Respiratory Protection
- Ergonomics (Proper Lifting)

Equipment Check & Special Considerations

List down checked equipments & any special considerations (Enumerate)
- Powered Industrial Truck
- Hand Pallet Jack
- Box Cutter
- Tape Gun
- Shrink wrap Machine

Job Safety Analysis & Risk Assessment

• Step in Process / Task
• Hazards
People
- Communication
- Fatigue
- Human Error
- Not Authorized
- Not Competent
- Poor Decision
- Distractions
- Hazard Awareness
- Medication
- Manual Handling
- Pedestrians
- Stress
Work Environment
- Access / Interactions
- Confined Area
- Foreign Objects
- Lighting / Visibility
- Poor Ergonomics
- Sun Exposure
- Air Movement
- Energy Release
- Gravity
- Lightning
- Pressure (fluid / air)
- Vibration
- Body Positioning
- Fumes / Vapours
- Ground Stability
- Noise
- Sharp Objects
- Weather Conditions
- Chemicals
- Falling Objects
- Housekeeping
- Oils / Greases
- Slip / Trip / Falls
- Work Surface
Environmental
- Spills / Chemical
- Waste Disposal
- Dust
- Noise
Equipment / Plant / Machinery
- Caught Between
- Moving Parts
- Pressure (fluid / air)
- Object Weight
- Stored Energy
- Electricity
- Maintenance
- Poor Controls
- Guarding
- Modifications
- Traffic Interactions
• Existing Controls
• Initial Risk Analysis
Likelihood
Consequence
What is the physical demand?
- Lift over 30 pounds
- Lift over 50 pounds
- Stand 8-10 hours
- Sit most of the day
- Bend, stretch, work overhead
- Sort, stack, count or verify
- Look at computer
- Possess manual dexterity
- Repetitive lifting or motions
- Regularly push or pull
Risk Rating
Additional Controls
• Residual / Revised Risk Analysis
Additional Controls
• Residual / Revised Risk Analysis

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?
• Does a procedure need amending as a result of this JSA?
• Does the JSA trigger a training need?
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
Were any additional hazards identified while doing the task?
What additional hazards?
Does a procedure need amending as a result of this JSA?
What procedure needs added?