Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • JSA number

  • JSA Review is to be carried out by asking the following questions (answer yes or no if the JSA meets required standards) Add any further action required

JSA Review

  • Is the JSA located on the job and its location known?

  • Is the JSA signed by the employee/s before the task is started?<br>

  • Was the employee/s involved in the development of the JSA?

  • Has the JSA been reviewed (today) by the employee/s doing the task? If "NO" see points 15-16.

  • Are the JSA steps consistent with the activity being carried out? (ask person to explain the task)

  • Are the hazards identified in the JSA consistent with the task area?

  • Have hazard controls been identified and implemented?

  • Are hazard controls adequate for the task?

  • Are individuals responsibilities clearly defined?

  • Have persons received adequate JSA training? If yes, describe what/when

  • Does the JSA identify task specific requirements including: Personnel, Equipment/Tools, Process Controls, Permits, etc?

  • Has a specific means of communication been identified?

  • Are emergency procedures clearly defined for the task?

  • Is 'Safe Talk' Practise in the team and what was the feedback received, by whom?

Action

  • General Comments

  • Further action required

  • By Whom?

  • By When?

  • Add signature

  • Add signature

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.