Title Page

  • Client / Site

  • Job Number

  • JSA Number

  • Date

  • Location

KRM Job Safety Analysis

JSA Details

  • Individuals involved with the development of the JSA

    Click "Add Personnel" to enlist names & roles

  • Personnel
  • • Full Name & Role

Work Permits / Authorizations Required

  • Select the applicable work permit(s) / authorization(s) required

  • Enter other work permit

Safety Equipment Required

  • MC_PPE.jpg
  • Select the applicable safety equipment(s) required for the job

Competencies & Trainings

  • List down applicable competencies & training to carry out individual tasks (Enumerate)

Equipment Check & Special Considerations

  • List down checked equipments & any special considerations (Enumerate)

Job Safety Analysis & Risk Assessment

  • Job Step / Tasks and Risk Analysis

    Click "Add Job Step / Task" to enlist the job steps / tasks, hazards, controls & risk ratings

  • Job Step / Task
  • • Step in Process / Task

  • • Hazards

  • People

  • Work Environment

  • Environmental

  • Equipment / Plant / Machinery

  • • Existing Controls

  • • Initial Risk Analysis

  • Consequence

  • Likelihood

  • Risk Rating

  • VLOW.jpg
  • LOW.jpg
  • MEDIUM.jpg
  • HIGH.jpg
  • Additional Controls

  • • Residual / Revised Risk Analysis

  • VLOW.jpg
  • LOW.jpg
  • MEDIUM.jpg
  • HIGH.jpg
  • VHIGH.jpg
  • VHIGH.jpg
  • Additional Controls

  • • Residual / Revised Risk Analysis

  • VLOW.jpg
  • LOW.jpg
  • MEDIUM.jpg
  • HIGH.jpg
  • VHIGH.jpg

JSA Acknowledgement & Completion

  • Status of the JSA

  • JSA conducted by (Name and Signature)

  • NOTE: If there are changes or if the JSA is incomplete, REVIEW the whole JSA and initiate the Task Review below.

Task Review

  • Were any additional hazards identified while doing the task?

  • Were hazards and controls have been added to the JSA form?

  • • Has a copy been filed in the central filing system?

  • • Is a Permit to Work required?

  • • Does a procedure need amending as a result of this JSA?

  • • Does the JSA trigger a training need?

  • Reviewed by Area / Manager (Name and Signature)

  • Supervisor Authorization (Name and Signature)

  • Personnel Details

    Click "Add Personnel" to enlist names & signatures of those who were involved with the JSA

  • Personnel
  • Name and 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.