Job Safety Analysis

• Task Analysis Form

• Document No.

• Company Name

• Site Address

• Location
  Address

• Job Description

• Conducted on

  Date

• Prepared by

• Contact Telephone Number

Job Safety Analysis Steps

• Tasks Analysis Steps

Step

• Step Description

Hazards

• Hazards

  Select Falls or falling objects from height Slips, trips and falls Trapping Entanglement Protruding objects Cuts or abrasions Chemicals Moving parts Moving vehicles Hot or cold surfaces Manual handling Collapse Overturning Electricity Environmental contamination Fumes or dusts Flying particles Fire / flammable atmospheres Bursting / explosion / over pressure Vibration Noise Exposure to radiation Oxygen enrichment Asphyxiation Engulfment Drowning Adverse weather Poor Lighting Bacteria or Virus Pedestrians

  • Falls or falling objects from height
  • Slips, trips and falls
  • Trapping
  • Entanglement
  • Protruding objects
  • Cuts or abrasions
  • Chemicals
  • Moving parts
  • Moving vehicles
  • Hot or cold surfaces
  • Manual handling
  • Collapse
  • Overturning
  • Electricity
  • Environmental contamination
  • Fumes or dusts
  • Flying particles
  • Fire / flammable atmospheres
  • Bursting / explosion / over pressure
  • Vibration
  • Noise
  • Exposure to radiation
  • Oxygen enrichment
  • Asphyxiation
  • Engulfment
  • Drowning
  • Adverse weather
  • Poor Lighting
  • Bacteria or Virus
  • Pedestrians

• List other hazards here

Details of possible harm

• Harm

  Select Death Head Injury Headache Broken Bones Burn/Scald Spinal Injury Laceration Amputation Eye Injury Eye Strain Infection Bruising Crushing Puncture Wound Industrial Disease Sprain / Strain Hearing Loss Dislocation Foreign Body Internal Injury Respiratory Condition Mental Stress Electrocution Electric Shock Soft Tissue Injury Poisoning Hyperthermia Skin Cancer Heat Stroke Heat Exhaustion Bites

  • Death
  • Head Injury
  • Headache
  • Broken Bones
  • Burn/Scald
  • Spinal Injury
  • Laceration
  • Amputation
  • Eye Injury
  • Eye Strain
  • Infection
  • Bruising
  • Crushing
  • Puncture Wound
  • Industrial Disease
  • Sprain / Strain
  • Hearing Loss
  • Dislocation
  • Foreign Body
  • Internal Injury
  • Respiratory Condition
  • Mental Stress
  • Electrocution
  • Electric Shock
  • Soft Tissue Injury
  • Poisoning
  • Hyperthermia
  • Skin Cancer
  • Heat Stroke
  • Heat Exhaustion
  • Bites

• List other harmful outcomes here

Initial Risk Rating

• Turn on guidance

  Off

  On

• Risk Matrix

  

• Select Initial Risk Rating

  Select Very Low Low Moderate High Very High Critical

  • Very Low
  • Low
  • Moderate
  • High
  • Very High
  • Critical

Control Measures

• Turn on guidance

  Off

  On

• 

• Elimination Measures

• Minimisation Measures

Plant & Equipment

• Plant and Equipment

  Select Air Compressor Angle Grinder Barriers Battery Drill Biscuit Jointer Blower/Vac Bobcat Chainsaw Compound Mitre Saw Cones & Tape Crane Digger Direction Drill Drone Edge Protection Electric Drill Electric Jigsaw Electric Planer Elevated Work Platform Fencing Forklift Grader Hand Tools Jackhammer Ladder Man Cage Mobile Scaffold Tower Morticer Nail Gun Oxyacetylene Torch Panel Saw Piling Rig Post Hole Digger Push Mower Radial Arm Saw Ride on Mower Rope/Slings Router Safety Nets Safety Signage Sander Scissor Lift Scaffolding Skill Saw Soldering Iron Sprayer Stepladder Strops Table Saw Telehandler Telescopic Mop Tie Down Straps Weedeater Welder Waterblaster

  • Air Compressor
  • Angle Grinder
  • Barriers
  • Battery Drill
  • Biscuit Jointer
  • Blower/Vac
  • Bobcat
  • Chainsaw
  • Compound Mitre Saw
  • Cones & Tape
  • Crane
  • Digger
  • Direction Drill
  • Drone
  • Edge Protection
  • Electric Drill
  • Electric Jigsaw
  • Electric Planer
  • Elevated Work Platform
  • Fencing
  • Forklift
  • Grader
  • Hand Tools
  • Jackhammer
  • Ladder
  • Man Cage
  • Mobile Scaffold Tower
  • Morticer
  • Nail Gun
  • Oxyacetylene Torch
  • Panel Saw
  • Piling Rig
  • Post Hole Digger
  • Push Mower
  • Radial Arm Saw
  • Ride on Mower
  • Rope/Slings
  • Router
  • Safety Nets
  • Safety Signage
  • Sander
  • Scissor Lift
  • Scaffolding
  • Skill Saw
  • Soldering Iron
  • Sprayer
  • Stepladder
  • Strops
  • Table Saw
  • Telehandler
  • Telescopic Mop
  • Tie Down Straps
  • Weedeater
  • Welder
  • Waterblaster

• List any other plant and equipment here

Residual Risk Rating

• Turn on guidance

  Off

  On

• 

• Select Residual Risk Level

  Select Very Low Low Moderate High Very High Critical

  • Very Low
  • Low
  • Moderate
  • High
  • Very High
  • Critical

Personal Protective Equipment

• Select appropriate PPE to be worn?

  Select Hard Hat Hearing Protection Gloves Visor Respirator Safety Footwear Hi Viz Vest Safety Glasses Safety Googles Chaps Dust Mask Respirator BA Set Overalls Sunscreen Harness Knee Pads Arm Guard Waterproof Clothing Gum Boots Fireproof Clothing

  • Hard Hat
  • Hearing Protection
  • Gloves
  • Visor
  • Respirator
  • Safety Footwear
  • Hi Viz Vest
  • Safety Glasses
  • Safety Googles
  • Chaps
  • Dust Mask
  • Respirator
  • BA Set
  • Overalls
  • Sunscreen
  • Harness
  • Knee Pads
  • Arm Guard
  • Waterproof Clothing
  • Gum Boots
  • Fireproof Clothing

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

  Sign

• Date

  Date

Manager/Supervisor Signature

• Manager/Supervisor Signature

  Sign

• Date

  Date