Title Page

  • Conducted on

  • Location
  • Prepared by

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


  • Full Name and Signature of Inspector

  • Full Name and Signature of Health and Safety Committee Member

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.