Information
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Employee JSA reviewed with
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Does the JSA have the required general information?
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Did the Safety Lead involve the entire crew when filling out the JSA?
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Did the crew acknowledge that they understand the JSA job steps, hazards, and mitigation steps prior to signing onto the JSA?
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Does the JSA identify all the required PPE to preform the job?
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Does the JSA identify all the jobs steps?
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Does then JSA identify all the hazards associated with the job steps?
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Does the JSA identify all actions to mitigate each hazard listed?
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Is the JSA filled out neatly?
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Is the JSA specific to the job being performed?
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Are all personnel signed on the JSA that are in the safe work permit?
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Copy of JSA
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Signature of Auditor
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Signature of Auditee
