Knife River Job Safety Analysis

Use this template to conduct more detailed hazard analysis in your workplace. Explore the features of SafetyCulture and modify the checklist based on your workplace needs. Start by listing the names of the people who develops JSA procedures, and select the work permits, authorizations and PPE required for the activity. Next enumerate applicable trainings to carry out individual tasks. Also, take note of the equipment checks conducted. Proceed with the job safety analysis and risk assessment by adding steps, selecting hazards and identifying controls. Conduct an initial risk assessment, add controls (if needed), then rate the residual/revised risk analysis. Confirm whether the process is completed or not. If not, conduct a task review to serve as a basis for the continuity of the process. Finally, acknowledge by getting all people involved to sign off.

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
• Full Name & Role

Work Permits / Authorizations Required

Select the applicable work permit(s) / authorization(s) required
- Working at Heights
- High Voltage
- Confined Space
- Notifiable Work
- Crane Work
- Hot Work
- Isolation (Lock out)
- Hazardous Work
- Excavation & Trenching
- Traffic Management Plan
- Other
Enter other work permit

Safety Equipment Required

Select the applicable safety equipment(s) required for the job
- Hi Viz / Safety Boots
- Hard Hat
- Eye Protection
- Hand Protection
- Ear Protection
- Face Protection
- Protective Clothing
- Dusk Mask / Respirator
- Gas Detector
- Life Jacket
- Tripod (Confined Spaces)

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
• Step in Process / Task
• Hazards
People
- Communication
- Fatigue
- Human Error
- Not Authorized
- Not Competent
- Poor Decision
- Distractions
- Hazard Awareness
- Medication
- Manual Handling
- Pedestrians
- Stress
Work Environment
- Access / Interactions
- Confined Area
- Foreign Objects
- Lighting / Visibility
- Poor Ergonomics
- Sun Exposure
- Air Movement
- Energy Release
- Gravity
- Lightning
- Pressure (fluid / air)
- Vibration
- Body Positioning
- Fumes / Vapours
- Ground Stability
- Noise
- Sharp Objects
- Weather Conditions
- Chemicals
- Falling Objects
- Housekeeping
- Oils / Greases
- Slip / Trip / Falls
- Work Surface
Environmental
- Air Emissions
- Land Disturbance
- Spills / Chemical
- Waste Disposal
- Dust
- Noise
- Water Control / Runoff
- Wildlife
Equipment / Plant / Machinery
- Caught Between
- Hydraulic Injection
- Moving Parts
- Pressure (fluid / air)
- Construction
- Isolation
- Object Weight
- Stored Energy
- Electricity
- Maintenance
- Poor Controls
- Tooling
- Guarding
- Modifications
- Poor Signage
- Traffic Interactions
• Existing Controls
• Initial Risk Analysis
Consequence
Likelihood
Risk Rating
Additional Controls
• Residual / Revised Risk Analysis
Additional Controls
• Residual / Revised Risk Analysis

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
Name and Signature