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Job Hazard Analysis Template

Use this template to conduct more detailed hazard analysis in your workplace. Explore the features of Lumiform 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.

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Job Hazard Analysis Template

WME Job Safety Analysis

JSA Details

Click "Add Personnel" to enlist names & positions

• Full Name & Role

Work Permits / Authorizations Required

Select applicable work permit or authorization required

Enter other necessary work permit

Safety Equipment Required

(check name not set)

Select applicable safety equipment required for the job

Competencies & Trainings

List any applicable competencies & training to carry out specific tasks.

Equipment Check & Special Considerations

List down checked equipment & special considerations

Job Safety Analysis & Risk Assessment

Job Step / Tasks and Risk Analysis Click "Add Job Step / Task" to enlist the job step tasks, hazards or controls etc.

• Step in Process / Task

• Hazards

People

Work Environment

Environmental

Equipment / Machinery

Consequence

Likelihood

Risk Rating

• Existing Controls

• Initial Risk Analysis

(check name not set)

Additional Controls

• Revised Risk Analysis

(check name not set)

Additional Control Measures

• Revised Risk Analysis

(check name not set)

JSA Acknowledgement & Completion

Status of the JSA

Name and Signature of Conductor

If there are changes or if the JSA is incomplete, REVIEW the JSA and initiate the Review below.

Task Review

Were additional hazards identified when doing the task?

Were hazards and controls added to the JSA form?

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

• Is a Work Permit required?

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

• Is there a training need because of the JSA?

Name and Signature of Reviewer

Name and Signature of Supervisor as Authorization

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

Name and Signature

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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.