JSA (Job Safety Analysis)

• Conducted on

  Date
• Location
  Address

• Prepared by

Job Task Being Assessed

• Job description

• Select job type

  Select Has exposure to hazardous and harmful products Has high accident frequency New established job Modified job due to procedure changes Infrequently performed jobs Other

  • Has exposure to hazardous and harmful products
  • Has high accident frequency
  • New established job
  • Modified job due to procedure changes
  • Infrequently performed jobs
  • Other

• Enter job type

• List employees undertaking works under JSA

Tasks, Hazards and Preventive Measures

• 1) Break a job down into smaller tasks
  2) Click + to add a "Job Step" and fill in the relevant information
  3) Identify the potential hazards for each task
  4) Determine preventive measures and controls to overcome these hazards

Job Step

• Enter job step description

• Potential risk or hazard identified while task is being performed (select all that apply)

  Select Chemical (Toxic, Flammable, Corrosive) Explosion (Chemical Reaction, Over Pressurization) Electrical (Shock, Short Circuit, Fire, Static, Loss of Power) Ergonomics (Strain, Sprains, Human Error) Excavation (Collapse) Fall (Slip, Trip) Fire Mechanical (Mechanical Failure, Stuck between objects) Noise Radiation (Alpha, Beta, Gamma, X-rays) Struck by Objects Extreme Temperature Visibility (lack of lighting, Obstructed vision) Weather Other

  • Chemical (Toxic, Flammable, Corrosive)
  • Explosion (Chemical Reaction, Over Pressurization)
  • Electrical (Shock, Short Circuit, Fire, Static, Loss of Power)
  • Ergonomics (Strain, Sprains, Human Error)
  • Excavation (Collapse)
  • Fall (Slip, Trip)
  • Fire
  • Mechanical (Mechanical Failure, Stuck between objects)
  • Noise
  • Radiation (Alpha, Beta, Gamma, X-rays)
  • Struck by Objects
  • Extreme Temperature
  • Visibility (lack of lighting, Obstructed vision)
  • Weather
  • Other

• Enter other potential risk/s identified

• Rate risk/ hazard before control measures

  Extremely High Risk

  High Risk

  Moderate Risk

  Low Risk

• Take a photo of step/ activity (Optional)

  Media

• Hazard Control Measures

  Select Engineering Controls Administrative Controls Personal Protective Equipment Isolation Other

  • Engineering Controls
  • Administrative Controls
  • Personal Protective Equipment
  • Isolation
  • Other

• Engineering Controls

• Administrative Controls

• Personal Protective Equipment used for task

• Other preventive measures

• What was Isolated?

  Yes

  No

  N/A

• Explanation of control measures

Recommendation to Workplace Health & Safety

• Recommendations

Staff Names signing off JSA

• Full Name and Signature of Staff Member

  Sign