• Location:

  • Customer:

  • Division:

  • Task Leader:

  • Task Leader Job Title:

  • Supervisor:

  • Audit Date:

  • Task:

  • Project/Account Manager:

  • JSEA Date:

  • 1. Is the JSEA written for the task being performed?

  • 2. Is the latest version of the JSEA being used?

  • 3. Are all sections of the review form filled out completely?

  • 4. Have all relevant signatures been captured?

  • 5. Have SSEs been identified with a mentor?

  • 6. If there are required references identified (e.g procedures, permits, etc.) are these documents attached to the JSEA?

  • 7. Is the pre-job hazard assessment form used to identify applicable hazards?

  • 8. Are hazards identified on the pre-job hazard assessment mitigated in the JSEA?

  • 9. Is the "sharp" process being utilized in the JSEA?

  • 10. Does the JSEA have a sufficient number of steps to cover the basic job task?

  • 11. Are hazards controls relevant to the potential hazards identified?

  • 12. Does the JSEA cover "site-specific" hazards as well as "task-based"?

  • 13. If required, did team make changes to an existing work procedure or practice?

  • 14. Have assigned person(s) been identified on each task step?

  • 15. Does the JSEA address the hazards of the tools and equipment being used?

  • 16. Does the JSEA address the specific PPE required for the hazards listed?

  • 17. Does the JSEA address appropriate body position and "line of fire" issues?

  • 18. Does the JSEA address weather and other environmental concerns?

  • 19. Has the after action review form been filled out?

  • 20. Has the JSEA been reviewed by the supervisor and reviewed by entire work crew? (On site assessments)

  • 21. Is the crew following the steps on the JSEA? (On site assessment)

  • 22. Have the recommended mitigation actions and/or procedures been put to place? (On site assessment)

  • 23. Is the JSEA available at the job site for reference and review as job conditions change? (On site assessment)

  • Are you (auditor) satisfied with the overall quality of this JSEA?

  • Audit Summary:

  • Job Title:

  • 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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.