Job Safety Analysis (JSA)

:Picture of JSA
Conttractor(s)
JSA AUDIT

JSA available and posted at the site location? In plain view or easy to locate?

Responsible Contractor

Has the Specific Job Location / Job Description been completed and accurate?

Responsible Contractor?

Does the JSA identify the specific equipment to be worked on ?

Responsible Contractor

Contract Company name and Supervisor filled out and is accurate?

Responsible Contractor?

PFI Production Manager and PFI Project Manger filled out and accurate?

Responsible Contractor

Has the "Filled Out By" and "Today's Date" filled out and accurate?

Responsible Contractor

Has the "Project End Date" and "Form Expiration Date" filled out, accurate and is within the 30 day allotment period?

Responsible Contractor

Notes:

LOCATION OF:

Does the JSA identify a Medical Treatment Facility?

Responsible Contractor

Does the JSA list directions to the Medical Treatment Facility?

What evacuation location is listed on the JSA?

Does the JSA identify an Evacuation Route and Location?

What location is listed and is the location appropriate to the location of the construction activities

Responsible Contractor

Does the JSA list the location of the SDS (MSDS)?

Responsible Contractor

Does the JSA identify an Eye Wash Station and is the location accurate?

Responsible Contractor

Does the JSA list the locations and type of fire extinguishers?

Responsible Contractor?

Does the JSA list the location of the contractors First Aid kit?

Responsible Contractor?

Notes:

Personal Protective Equipment

Does the JSA identify proper PPE requirements for the task being performed? (Hardhat, Safety Glasses, Gloves, Foot Protection, Face Shield, Hearing Protection, etc)

Responsible Contractor

Notes:

JSA ASSESSMENT

Is the work being performed in a Production Area?

Is the work being performed in close proximity to the production?

Does the JSA outline the precautions being taken to assure no product contamination?

Responsible Contractor

Project Manager Notified?

Corrective Action Issued?

Will any used equipment be introduced into the Production Area?

Does the JSA explain how the equipment is prepared not to cross contaminate?

Responsible Contractor

Project Manager notified?

Correction Action issued?

Will the contractor be introducing any chemicals and / or paint into the production area?

List chemical(s), listed on the JSA

Has the SDS (MSDS) been submitted tot he project manager?

Responsible Contractor

Project Manager aware?

Notes

PERMITS

Is there any location the contractor will be performing work that is classified as a confined space?

Has the location been air sampled to verify that it is not Permit Required Confined Space?

What is the last air sample reading?

Responsible Contractor

Project Manager notified

Corrective Action issued?

Is the contractor conducting hot work? (Producing any sparks or flames)

Does the JSA identify a hot work permit?

Responsible Contractor?

Does the JSA address fire suppression methods?

Responsible Contractor

Does the JSA cover all points of Permits?

Responsible Contractor

Notes:

JOB STEPS

Does the JSA outline Preparation Sequence Steps? Is the Steps accurate?

Responsible Contractor?

Does the JSA properly identify Preparation Food and Human Safety Hazards?

Responsible Contractor?

Does the JSA list the Steps to Preparation - Eliminate and / or Reduce Food and Human Safety Hazards?

Responsible Contractor?

Does the JSA identify Traffic Flow Sequence Steps?

Responsible Contractor

Does the JSA identify Traffic Flow Food and Human Safety Hazards?

Responsible Contractor

Does the JSA identify Steps to Traffic Flow Eliminate / Reduce Food and Human Safety Hazards?

Responsibile Contractor?

Does the JSA properly identify the Job Steps - Sequence of Steps?

Responsible Contractor

Does the JSA properly identify Job Steps - Food and Human Safety Hazards?

Responsible Contractor

Does the JSA properly identify Job Steps - Steps to Eliminate or Reduce Food and Human Safety Hazards?

Responsible Contractor?

Does the JSA cover all points of the Job Steps?

Responsible Contractor

Notes:

COMPLETION (CLEAN UP, REMOVAL of TRASH, CURTAIN REMOVAL and PROJECT RELEASE)

Has the JSA, Completion - Sequence of Steps been properly filled out and is complete?

Responsible Contractor

Has the JSA, Completion - Food and Human Safety Hazards been properly filled out and complete? Is the information accurate?

Responsible Contractor

Has the JSA, Completion - Steps to Eliminate or Reduce Food and Human Safety Hazards been filled out and complete? Is the information accurate?

Responsible Contractor

Does the JSA cover all points of Completion?

Responsible Contractor

Notes:

OTHER

Does the JSA identify break location(s)

Responsible Contractor

Has the JSA been signed by all workers working at the location?

Responsible Contractor

Does the JSA identify Heat Illness and Injury Prevention methods / distribution of water?

Responsible Contractor

Does the JSA identify Smoking locations?

Responsible Contractor
CORRECTIVE ACTIONS

Is the JSA accurate? No corrective actions required?

List the corrective actions needed.

Project Manager has been notified of the corrective actions needed?

Is the contractor(s) aware of any corrective actions that need to be completed?

What companies were notified of JSA deficiencies
How was the contractor(s) notified?
Date and time the contractor was informed of the corrective action

Site Audit

AERIAL and SCISSOR LIFTS

Workers have been trained in the use of equipment?

Exposing Contractor

Lift occupants wearing harness correctly? Employees been trained in fall protection?

Exposing Contractor

Workers tied off to boom or basket? (Not required in scissor lifts unless the lift moves when lift is up)

Exposing Contractor

Lift controls clearly marked and readable?

Exposing Contractor

Workers not tied off to adjacent structures?

Exposing Contractor

Both feet remain on the floor of the basket?

Exposing Contractor

Operators not exceeding the load limits of the basket / lift?

Exposing Contractor

Lift is stationary when boom is elevated?

Exposing Contractor

Employees are not transferring at height while in a scissor lift?

Exposing Contractor

Mid-rail chain / gate used when in operation?

Exposing Contractor

Operators maintaining safety compliance while operating lift?

Exposing Contractor

Notes:

CONCRETE / MASONRY

Rebar / flat stakes guarded (covered) to eliminate impalement hazard?

Exposing Contractor

Employees working in concrete wearing proper hand and foot protection?

Exposing Contractor

Connectors, ties or whips used to secure pressurized air hoses?

Exposing Contractor

Guard down on pump (on pump truck)?

Exposing Contractor

Masonry saw blades guarded?

Exposing Contractor

Fugitive dust controlled while cutting block or conducting finish work?

Exposing Contractor

Masons wearing face shields AND safety glasses while cutting block?

Exposing Contractor

Formwork capable of supporting vertical / lateral loads?

Exposing Contractor

Shoring equipment inspected?

Exposing Contractor

Base plates secured to foundation / mud sill / formwork?

Exposing Contractor

Jacks / supports do not exceed the rated capacity?

Exposing Contractor

Limited access zone equal to the wall height plus 4 feet?

Exposing Contractor

Limited access zone strictly enforced?

Exposing Contractor

Walls over 8 feet braced to prevent collapse?

Exposing Contractor

Masons maintaining safety compliance?

Exposing Contractor

Notes:

CONFINED SPACE

JSA and rescue plan on-site and available? Employees been trained on the plan?

Exposing Contractor

Entry permit completed and signed?

Exposing Contractor

Air sampling completed and documented prior to entry?

Exposing Contractor

Proper warning signage posted at entry to the permit space?

Exposing Contractor

Forced air ventilation used for the duration of entry?

Exposing Contractor

Proper lighting provided?

Exposing Contractor

Rescue team trained and readily available?

Exposing Contractor

Retrieval system (Tripod) available and utilized?

Exposing Contractor

Entrants attached to the retrieval line?

Exposing Contractor

Attendant on duty outside the permit space?

Exposing Contractor

Attendant only performs monitoring duties?

Exposing Contractor

Confined space team is maintaining safety compliance?

Exposing Contractor

Notes:

CRANES / RIGGING

Crane(s) inspected and properly maintained?

Exposing Contractor

Crane operator, rigger and signal person certified?

Exposing Contractor

Crane load charts visible to the operator?

Exposing Contractor

Hand signal charts posted or available?

Exposing Contractor

Fire extinguisher located within the cab?

Exposing Contractor

Pick (Lift) plan on-site, reviewed and the load is within load capacity?

Exposing Contractor

Crane outriggers fully extended and on cribbing properly?

Exposing Contractor

Swing radius identified and barricaded?

Exposing Contractor

Workers remained clear of the in the swing radius and under suspended loads?

Exposing Contractor

All power lines are a minimum 15 feet away from all lifting and boom swing radius?

Exposing Contractor

Rigging equipment inspected and in good condition?

Exposing Contractor

Rigging equipment maintain lift capacity markings?

Exposing Contractor

Crane operations maintaining safety compliance?

Exposing Contractor

Notes:

ELECTRICAL

Electrical cords maintain ground posts?

Exposing Contractor

Electrical cords are free from damage / repair / alterations?

Exposing Contractor

Electrical cords protected from damage and roll over?

Exposing Contractor

Electrical cords are not ran through door ways or windows?

Exposing Contractor

Electrical cords kept clear of work areas and walk ways?

Exposing Contractor

Electrical cords are rated for construction? Flat cords removed from site?

Exposing Contractor

Spider box being inspected quarterly?

Exposing Contractor

Power strips and 3 way splitters construction rated?

Exposing Contractor

Electrical equipment being used per the manufacturers specifications?

Exposing Contractor

GFCI being used on 120V single-phase, 15/20 amp outlets?

Exposing Contractor

All outlets have cover plates when outlets are energized?

Exposing Contractor

Temp light cords are hung with non-metallic fastener, off the ground and does not cause a hazard?

Exposing Contractor

Temp light bulbs maintain cages and all bulbs?

Exposing Contractor

Electrical rooms maintain proper warnings and labels per NFPA 70e?

Exposing Contractor

Access to electrical room(s) restricted per NFPA 70e?

Exposing Contractor

Electrical panels are covered, labeled and all breaker slots are covered?

Exposing Contractor

3 foot clearance around all electrical panels being maintained?

Exposing Contractor

Employees are not allowed to work near unprotected circuits / panels?

Exposing Contractor

Employees are locking and tagging out equipment and panels and NOT working on hot equipment?

Exposing Contractor

Employees working with energy maintaining safety compliance?

Exposing Contractor

Notes:

FALL PROTECTION

JSA and fall protection rescue plan has been established and all effected employees have been trained?

Exposing Contractor

All employees have been trained in fall protection?

Exposing Contractor

A fall protection system is provided for all employees working above 7 1/2 feet? (6 feet for rod busters)

Exposing Contractor

PFA rigged to prevent contact with any surface? (Max fall distance allowed is 6 feet)

Exposing Contractor

Harnesses have been inspected prior to use?

Exposing Contractor

Employee wearing harness correctly, wearing the appropriate lifeline (lanyard) and attached to an anchor?

Exposing Contractor

Fall protection anchors are set up per specifications and all elements are rated to 5000 lbs?

Exposing Contractor

Guardrails are able to with stand 200 lbs outward and down force?

Exposing Contractor

Guardrails do not exceed 2 inch deflection in any direction?

Exposing Contractor

Guardrails and mid-rails are at the proper height?

Exposing Contractor

Guardrail posts are not more than 8 foot OC?

Exposing Contractor

Guardrails / mid-rails are constructed to be on the inside on the guardrail posts?

Exposing Contractor

Guardrails and mid-rails have been placed around floor / roof openings?

Exposing Contractor

Floor holes greater than 2 inches have been covered, properly labeled and secured from movement?

Exposing Contractor

The fall protection selected is appropriate for the fall exposure?

Exposing Contractor

Floor hole covers are capable of handling 2 times the intended load?

Exposing Contractor

Safety monitor performs only monitoring duties?

Exposing Contractor

Safety monitor is at the same surface as the work with visual and verbal contact?

Exposing Contractor

Warning line 6 feet back for roofing activities?

Exposing Contractor

Warning line 15 feet for non-roofing activities?

Exposing Contractor

Warning line erected on all open sides?

Exposing Contractor

Warning line flagged and suspended at proper height?

Exposing Contractor

Access and hoisting areas guarded?

Exposing Contractor

All materials stored more than 6 feet back from roof or deck edge?

Exposing Contractor

Safety compliance being maintained?

Exposing Contractor

Notes:

FIRE SAFETY

Employees trained in the use of fire extinguishers?

Exposing Contractor

Fire extinguishers in good condition, fully charged and recently inspected?

Exposing Contractor

Fire extinguishers replaced annually?

Exposing Contractor

Fire extinguishers are within 75 feet of workers?

Exposing Contractor

Fire extinguishers within 15 feet of hot work?

Exposing Contractor

Minimum of 1 fire extinguisher per floor / level?

Exposing Contractor

Fire extinguishers within 50 feet of flammable materials?

Exposing Contractor

Flammables stored in an approved and closed containers?

Exposing Contractor

No smoking signs posted near flammables?

Exposing Contractor

Flammable liquids protected from ignition sources?

Exposing Contractor

Flammables not stored near access and egress locations?

Exposing Contractor

Scrap piles, debris and trash stored more than 10 feet from building or structure?

Exposing Contractor

Maintaining fire safety compliance?

Exposing Contractor

Notes:

FORKLIFTS

Forklift operators been trained for the specific forklift they are operating?

Exposing Contractor

Forklift inspected prior to use?

Exposing Contractor

Forklifts have not been modified or altered?

Exposing Contractor

Outriggers being used on extended reach fork lift?

Exposing Contractor

Forklift is operating within lift capacities?

Exposing Contractor

Forklift slings have been inspected and maintain lift capacity tags?

Exposing Contractor

Forklifts have lift, load and angle charts?

Exposing Contractor

Forklift has fire extinguisher in the cab?

Exposing Contractor

Forklift forks are down when not in operation?

Exposing Contractor

Forklift operator wearing seat belt when in operation?

Exposing Contractor

Forklift has an audible back up alarm that can be heard up to 200 feet away?

Exposing Contractor

Spotters are used when forklift has to travel through barrier curtains or blind accesses?

Exposing Contractor

Operator is traveling less than 10 MPH, stopping at all intersections and stop signs?

Exposing Contractor

Workers under lifted / suspended loads?

Exposing Contractor

Lift basket secured to forklift?

Exposing Contractor

Forklift maintains an operator when the lift basket has employees in it?

Exposing Contractor

Forklift operators maintaining safety compliance?

Exposing Contractor

Notes:

HOUSEKEEPING

Work site / location reasonably organized - Good housekeeping?

Exposing Contractor

Lunch trash picked up and removed from site?

Exposing Contractor

Trash removed at regular intervals?

Exposing Contractor

Scrap, pipe cut offs, pipe and other slip / trip hazards removed?

Exposing Contractor

Staging / lay down area in good condition / good housekeeping?

Exposing Contractor

Gang boxes free from combustible / flammable materials?

Exposing Contractor

All scrap lumbar / planks has nails removed or bent over?

Exposing Contractor

Housekeeping is being maintained?

Exposing Contractor

Notes:

LADDERS and STAIRS

Ladders inspected / no visible defects?

Exposing Contractor

Ladders rated for construction (1 AA ladder) ?

Exposing Contractor

Spreaders fully extended and locked into position on A frame ladders?

Exposing Contractor

Top two steps of a step ladder not being used?

Exposing Contractor

Ladders set up on firm stable base?

Exposing Contractor

Ladders being used for the intended purpose?

Exposing Contractor

Proper ladder selected for task?

Exposing Contractor

Extension ladder extends 3 feet above landing surface?

Exposing Contractor

Extension ladder set up at 4:1 angle?

Exposing Contractor

Extension ladders tied off at the top and secured at the bottom to prevent slip?

Exposing Contractor

Stair/ladder/ramp used at elevation break of 18 inches or more?

Exposing Contractor

Handrails on stairs with 4 or more risers?

Exposing Contractor

3 feet around the ladder at the top and bottom remain clear of all materials and debris?

Exposing Contractor

Employee is maintaining 3 points of contact while climbing ladders?

Exposing Contractor

Treads / landings on pan stairways filled?

Exposing Contractor

Ladder / steps used when access a flat bed trailer?

Exposing Contractor

Ladder users maintaining safety compliance?

Exposing Contractor

Notes:

MEDICAL / FIRST AID

Emergency numbers posted on site, visible to all employees?

Exposing Contractor

Location of nearest medical facilities posted, visible to all employees?

Exposing Contractor

Eye wash / body wash stations set up when required?

Exposing Contractor

A minimum of 1 CPR / FA / AED certified employee per crew?

Exposing Contractor

Every trade maintains their own first aid kit / supplies? First aid kit fully stocked?

Exposing Contractor

Maintaining safety compliance with medical / first aid?

Notes:

PERSONAL PROTECTIVE EQUIPMENT

Maintaining safety compliance with personal protection equipment ?

Exposing Contractor

PPE provided to the employee / available as required?

Exposing Contractor

PPE being maintained in good condition?

Exposing Contractor

Replacement PPE readily available?

Exposing Contractor

Hard hats being worn, properly and without alterations?

Exposing Contractor

Eye protection used as required? Glasses rated as eye protection?

Exposing Contractor

Hand protection used when required? (Digging, handling tag lines etc)

Exposing Contractor

Safety boots (Steal toe) footwear worn when required (Compacting soil, jack hammering etc)?

Exposing Contractor

Respirators provided / used as required?

Has the employee been trained in respiratory protection?

Does employer maintain a current written respirator program?

Has the employee been seen by a physician and been fit tested?

Employee using the proper filter for respirator?

Respirator being stored correctly?

Exposing Contractor

Hearing protection used as required?

Exposing Contractor

High visibility clothing worn as required?

Exposing Contractor

Face protection used as required?

Exposing Contractor

Notes:

POSTINGS / SAFETY SIGNS

OSHA Workplace Poster displayed at all locations?

Exposing Contractor

Emergency numbers / contacts posted?

Exposing Contractor

OSHA 300 log posted Feb. 1st through April 30th?

Exposing Contractor

Danger / warning signs posted? Each site maintains proper signage?

Exposing Contractor

Danger - Keep out signs posted on security fencing?

Exposing Contractor

All posting meet safety compliance?

Notes:

SAFETY TRAINING

Toolbox / tailgate meetings completed daily? Documented?

Exposing Contractor

Toolbox / tailgate meetings completed weekly? Documented?

Exposing Contractor

Equipment (Machine) operator training conducted and documented?

Exposing Contractor

Job-specific safety training provided / documented?

Exposing Contractor

Safety orientation training provided and verified?

Exposing Contractor

All employees have been trained in Heat Illness and Injury Prevention? (8CCR3395)

Exposing Contractor

Employer is maintaining good safety training and maintaining compliance?

Notes:

SANITATION

Adequate supply of potable water provided at no cost to the employee ( Minimum of 1 quart of water per hour per employee)?

Exposing Contractor

Single use, disposable drinking cups provided? (Common cup and drinking directly from the container is prohibited)

Exposing Contractor

Trash cans provided at all drinking locations?

Exposing Contractor

NON-POTABLE water is clearly marked and identified?

Exposing Contractor

1 toilet per 20 workers at the job site? Females have a separate facilities?

Exposing Contractor

Hand washing stations provided? 1 hand washing outlet per 20 workers?

Exposing Contractor

Facilities (toilets and hand washing facilities) are being maintained in sanitary conditions?

Exposing Contractor

Sanitation locations are being maintained in good conditions and maintaining safety compliance?

Notes:

SCAFFOLDS

Guard rails are installed between 42 - 48 inches off of platform?

Exposing Contractor

Mid-rails are installed between 21 - 24 inches off of platform?

Exposing Contractor

Perry Scaffolds has guard rails and mid rails when platform is at 7 1/2 feet?

Exposing Contractor

Perry Scaffolds have outriggers when scaffold is 3 times the base?

Exposing Contractor

Perry Scaffold is built per manufacturers specifications?

Exposing Contractor

Employees are not "surfing" or scooting on Perry Scaffolds?

Exposing Contractor

Employees have both feet on the platform at all times?

Exposing Contractor

Trades maintaining good compliance with Scaffolds?

Exposing Contractor

Scaffold(s) are free of materials for the employees to gain additional height?

Exposing Contractor

All employees have been trained in Scaffold Awareness to work off of scaffolds?

Exposing Contractor

Competent person inspecting scaffold before daily occupancy? From all trades working off of scaffolds?

Exposing Contractor

Scaffold was erected under the supervision of a Competent Person?

Exposing Contractor

Scaffold inspection tags are located at each scaffold ladder? Inspection tags filled out and maintains current inspections?

Exposing Contractor

Working platforms fully planked?

Exposing Contractor

Fall protection provided at 7 1/2 feet and above?

Exposing Contractor

Legs / frames bear on base plates / mud sills?

Exposing Contractor

Base plates / mud sills clear from dirt, debris and obstructions? Able to inspect? Base plate secured to mud sill?

Exposing Contractor

Mud sills free from undermining?

Exposing Contractor

Planks in good condition? Scaffold grade planks? Free from splits, cuts and damage?

Exposing Contractor

Planks / Working platform clean, free from excessive debris, trash and materials?

Exposing Contractor

Ladder provided and used to access all scaffold platforms?

Exposing Contractor

Scaffold plank overlap a minimum of 6 inches max. 18 inches, and overlap is over a frame?

Exposing Contractor

Scaffold is tied into structure at 12, 26 and 30 feet (or top of structure)?

Exposing Contractor

Toe-boards provided above all access / egress points and anywhere employees are working below?

All types of scaffold(s) maintaining safety compliance?

Notes:

STEEL ERECTION

Site erection plan available for review?

Exposing Contractor

Lay down area graded, drained and adequate?

Exposing Contractor

Decking secured upon placement?

Exposing Contractor

Guardrails around stair / elevator / perimeters openings?

Exposing Contractor

Floor opening covers properly marked and secured?

Exposing Contractor

Structure members secured with two bolts per connection?

Exposing Contractor

Diagonal bracing secured with one bolt per connection?

Exposing Contractor

Tools secured against accidental displacement?

Exposing Contractor

Perimeter cables installed when decking is completed?

Exposing Contractor

Perimeter cables flagged at 6 foot intervals?

Exposing Contractor

Perimeter cables maintain less than 2 inch deflection?

Exposing Contractor

Ramps and runways properly guarded?

Exposing Contractor

Iron workers / steel erection maintaining safety compliance?

Notes:

TOOLS (HAND and POWER)

Hand and power tools in safe operating condition?

Exposing Contractor

Tool guards in place and functional on all power tools?

Exposing Contractor

All tools stopped and turned off during refueling and maintenance?

Exposing Contractor

Power tools maintain a ground post or be double or triple insulated?

Exposing Contractor

Tools are in like new condition with no alterations, repairs or damage?

Exposing Contractor

Handles on tools free from splinters and cracks?

Exposing Contractor

Safety spring(s) being maintained in all nail guns?

Exposing Contractor

Grinders and cutting wheels maintain fully functioning guards?

Exposing Contractor

All air delivery equipment maintain air pressure gauges and hose connection safety's (ties/whips/connection pins)?

Exposing Contractor

Tools are properly hoisted / lowered?

Exposing Contractor

All tools being maintained within safety compliance?

Notes:

TRAFFIC CONTROL

Personal trained in work zones traffic safety techniques?

Exposing Contractor