Job Safety Analysis (JSA)

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Worksite Set-up

• Pedestrian management assessed

  Yes

  No

  N/A

• Traffic Management assessed

  Yes

  No

  N/A

• Appropriate signage and guarding

  Yes

  No

  N/A

Assess/review the job and its surroundings

• Presence of snakes, spiders and sharps assessed

  Yes

  No

  N/A

• Sufficient traffic and pedestrian access

  Yes

  No

  N/A

• All appropriate PPE on site

  Yes

  No

  N/A

• Weather conditions suitable

  Yes

  No

  N/A

• Light sufficient for all tasks

  Yes

  No

  N/A

Accessing Customer Premises

• Ground surfaces assessed for trips and slips

  Yes

  No

  N/A

• Noise, electrical and chemical hazards assessed

  Yes

  No

  N/A

• Presence of dogs, wasps and gases assessed

  Yes

  No

  N/A

• Exposed asbestos assessed

  Yes

  No

  N/A

• Breathing protection used in concealed/confined spaces

  Yes

  No

  N/A

• Isolation of electrical hazards assessed

  Yes

  No

  N/A

• 3rd party present for concealed/confined space access

  Yes

  No

  N/A

• Working at heights assessed

  Yes

  No

  N/A

Additional site hazards

• Are there any additional site hazards?

  Yes

  No

  N/A

• If Yes, please complete Hazards and Control

  Yes

  No

  N/A

Hazards and Control

• Additional Site Hazards

• Additional Site Controls

Final

• Signed

  Sign

• Date and Time

  Date

• Photos Attatched

  Media