Job Safety Analysis Worksheet 2022 R1

• Audit Title

• Client / Site/ Project

• Conducted on

  Date

• Prepared by

• Location
  Address

• Document No.

Information

• Task or equipment I.D.

• Equipment or Task Photo

  Media

• Location

• Date and Time JHA Started

  Date

• General Description of Task/s

Sequence of steps

• Step 1

• Photo of task

  Media

• Description of task

• Step Catagory

  Select Engineering controls Administrative controls PPE Required Job rotation Machine guarding Stretching - Pre shift Shielding Workspace re-design Adjust work surface to worker Develop Safe work procedure Training Use lifting aids Team lift Use pullbacks Ergonomic Mats Lockout tagout Use adjustable work station Use work lift tabel Substitution Limit exposure Increase lighting Use sound absorbing barriers Use chip guards Install protective barriers Paint safe work zones Chain off area Post warning signage Apply warning or danger stickers Install ventilation Restrict access to area Stage work properly

  • Engineering controls
  • Administrative controls
  • PPE Required
  • Job rotation
  • Machine guarding
  • Stretching - Pre shift
  • Shielding
  • Workspace re-design
  • Adjust work surface to worker
  • Develop Safe work procedure
  • Training
  • Use lifting aids
  • Team lift
  • Use pullbacks
  • Ergonomic Mats
  • Lockout tagout
  • Use adjustable work station
  • Use work lift tabel
  • Substitution
  • Limit exposure
  • Increase lighting
  • Use sound absorbing barriers
  • Use chip guards
  • Install protective barriers
  • Paint safe work zones
  • Chain off area
  • Post warning signage
  • Apply warning or danger stickers
  • Install ventilation
  • Restrict access to area
  • Stage work properly

• Hazards associated with task

  Select Struck by an object Caught between Pinch or crush hazard Awkward position Repetitive motion Hot surface Slip or Fall Tripping hazard Respiratory hazard - Dust Respiratory hazard - Fumes Electrical shock hazard Poor workspace design Vibration Excessive noise levels Back strain Flying chips or particles Extended periods of standing or sitting High traffic area - forklifts Confined space hazard Hot surface Lighting - poor visibility Danger of falling objects Fire or explosion hazard Environment - Heat illness Rotating parts Exposed cutting blades Slippery surface High pressure Laceration Excessive vibration Low clearance Chemical hazard Poor workspace design Moving parts Belt or Gear exposure

  • Struck by an object
  • Caught between
  • Pinch or crush hazard
  • Awkward position
  • Repetitive motion
  • Hot surface
  • Slip or Fall
  • Tripping hazard
  • Respiratory hazard - Dust
  • Respiratory hazard - Fumes
  • Electrical shock hazard
  • Poor workspace design
  • Vibration
  • Excessive noise levels
  • Back strain
  • Flying chips or particles
  • Extended periods of standing or sitting
  • High traffic area - forklifts
  • Confined space hazard
  • Hot surface
  • Lighting - poor visibility
  • Danger of falling objects
  • Fire or explosion hazard
  • Environment - Heat illness
  • Rotating parts
  • Exposed cutting blades
  • Slippery surface
  • High pressure
  • Laceration
  • Excessive vibration
  • Low clearance
  • Chemical hazard
  • Poor workspace design
  • Moving parts
  • Belt or Gear exposure

• PPE Required

  Select Safety Glasses Goggles Face Shield Gloves - Chemical Resistant Gloves - Flame resistant Cut Resistant Gloves Ear Protection Foot Protection Head protection Back belts Wrist brace - down movement restrictive Wrist brace - up movement restrictive Dust mask Respirators Fall protection Non slip shoes Knee pads Aprons Flame retardant overalls Arc rated gloves Arc rated tools

  • Safety Glasses
  • Goggles
  • Face Shield
  • Gloves - Chemical Resistant
  • Gloves - Flame resistant
  • Cut Resistant Gloves
  • Ear Protection
  • Foot Protection
  • Head protection
  • Back belts
  • Wrist brace - down movement restrictive
  • Wrist brace - up movement restrictive
  • Dust mask
  • Respirators
  • Fall protection
  • Non slip shoes
  • Knee pads
  • Aprons
  • Flame retardant overalls
  • Arc rated gloves
  • Arc rated tools

• Summary of controls to reduce or eliminate hazards

Jobsite and Task Summary of Analysis

• Additional Recommendations

Signatures

• Supervisor

  Sign

• Date approved

  Date

• Reviewed

• EHS Manager

  Sign

• Date approved

  Date

• Reviewed

• Worker

  Sign

• Worker

  Sign

• Worker

  Sign

• Worker

  Sign

Comments/Discussion

• General Comments/Discussion

• Add media

  Media