• Task Analysis Form

  • Document No.

  • Company Name

  • Site Address

  • Location
  • Job Description

  • Conducted on

  • Prepared by

  • Contact Telephone Number

Job Safety Analysis Steps

  • Tasks Analysis Steps

  • Step
  • Step Description


  • Hazards

  • List other hazards here

Details of possible harm

  • Harm

  • List other harmful outcomes here

Initial Risk Rating

  • Turn on guidance

  • Risk Matrix

  • Select Initial Risk Rating

Control Measures

  • Turn on guidance

  • Hierarchy_of_Controls.png
  • Elimination Measures

  • Minimisation Measures

Plant & Equipment

  • Plant and Equipment

  • List any other plant and equipment here

Residual Risk Rating

  • Turn on guidance

  • Risk_Matrix.png
  • Select Residual Risk Level

Personal Protective Equipment

  • Select appropriate PPE to be worn?


Worker Signatures

    Worker Signatures
  • I hereby acknowledge that I have read (or been given instruction on) the above JSA and will abide by the conditions at all times

  • Worker Signature

  • Date

Manager/Supervisor Signature

  • Manager/Supervisor Signature

  • Date

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.