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Job Safety Analysis (JSA)

Job Task Being Assessed

Job description

Select job type

Enter job type

List employees being observed during JSA

Tasks, Hazards and Preventive Measures

1) Break a job down into smaller tasks and observe a worker performing it
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)

Enter other potential risk/s identified

Rate risk/ hazard before control measures

Take a photo of step/ activity (Optional)
Hazard Control Measures

Engineering Controls

Administrative Controls

Personal Protective Equipment

Other preventive measures

Explanation of control measures

Recommendation from Health and Safety Committee

Recommendations

Completion
Full Name and Signature of Inspector
Full Name and Signature of Health and Safety Committee Member

JSA Template Checklist

Created by: SafetyCulture Staff | Industry: General | Downloads: 1,365

JSA template used to document: 1) observations of workers performing individual tasks; 2) identified hazards; and 3) preventive measures and controls

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Job Safety Analysis (JSA)

Job Task Being Assessed

Job description

Select job type

Enter job type

List employees being observed during JSA

Tasks, Hazards and Preventive Measures

1) Break a job down into smaller tasks and observe a worker performing it
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)

Enter other potential risk/s identified

Rate risk/ hazard before control measures

Take a photo of step/ activity (Optional)
Hazard Control Measures

Engineering Controls

Administrative Controls

Personal Protective Equipment

Other preventive measures

Explanation of control measures

Recommendation from Health and Safety Committee

Recommendations

Completion
Full Name and Signature of Inspector
Full Name and Signature of Health and Safety Committee Member