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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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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
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
Additional Controls
• Revised Risk Analysis
Additional Control Measures
• Revised Risk Analysis
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.
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