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Job Safety Analysis Template

A job safety analysis template is a useful tool for monitoring high-risk tasks. It can be broken down into individual steps to better recommend corrective actions by first noting information about the workplace and the employee involved in the inspection. Ensure job site safety with this risk assessment form. It prompts the inspector to add steps, identify and record hazards, evaluate the analyzed risk, and recommend preventive measures.
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Audit
Information regarding site
number of work order
task activity
date
Site number or name
name of contractor or subcontractor
Check applicable, anticipated or potential hazards
Underground tank removal/Disposable/High vapors
Demolition
Activities in/ near traffic areas
Concrete cutting/ coring
Mobile heavy equipment activities (excavators, dump trucks, vacuum and hydrovac trucks)
Pile driving or shoring
Work which affects integrity of critical controls
Welding, cutting or grinding
Hydroblasting or sand blasting
Radiography or X-Ray testing
pressure testing
Other (please specify) :
critical procedures: when work involves any of these hazards it must be incorporated into JSA
Work at heights above 1,5m
Confined space entry (also during tank cleaning)
Electrical/Mechanical lockouts (live, lock out / tag out, isolation,)
Heavy equiptment lifting (cranes, excavators, boom trucks)
Drilling borehole or excavations (locates, sub-surface clearance)
Entry into excavations/Trenches: 1,2m deep
Hot work (in possibly explosive atmospheres)
Make sure that all hazards identified are addressed in JSA below
(A) sequence of basic job steps in order
(A) potential hazards (e.g. hazard zone, underground services etc.)
(A) safety control to reduce or eliminate hazards
(B) sequence of basic job steps in order
(B) potential hazards. (e.g. hazard zone, underground services etc.)
(B) safety controls to reduce or eliminate hazard
(C) sequence of basic job steps in order
(C) potential hazards (e.g. underground services, hazard zone etc.)
(C) safety controls to reduce or eliminate a hazard
(D) sequence of basic job steps in order
(D) potential hazards (e.g. underground services, hazard zone etc.)
(D) safety controls to reduce or eliminate hazard
(E) sequence of basic job steps in order
(E) potential hazards (e.g. underground services, hazard zone etc.)
(E) safety controls to reduce or eliminate a hazard
Equipment ( list of equipment and its storage on site, only if relevant to safety)
List
additional PPE ( minimum requirement: gloves, glasses, hard hat, safety boots, visi-vest)
Hearing protection
Fall protection
Eye protection
Portable gas monitor
Rubber footwear and gloves if in a damp area
Other (fire retardant coveralls, breathing apparatus, etc) specify :
relevant outside authorities:
outside authorities (signature)
disposal of designated substances, surplus, or impacted materials (including details)
signature
retailer or sales associate
prepared by (please sign)
date
person carrying out the work (please sign)
date
person carrying out work (please sign)
date
person carrying out work (please sign)
date
site supervisor
JSA approved retailer or sales associate (please sign)
date
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Enhancing Workplace Safety with a Job Safety Analysis Template


A Job Safety Analysis (JSA) is a systematic process that assesses potential workplace hazards and identifies appropriate preventive measures. A JSA template provides a structured framework for conducting these analyses, enabling organizations to prioritize safety, mitigate risks, and promote a secure working environment.


A Job Safety Analysis template holds significant importance for workplace safety. Firstly, it helps identify and analyze job tasks, potential hazards, and associated risks. By breaking down each task step-by-step, the template assists in recognizing potential dangers and implementing effective control measures to mitigate them. Moreover, the template promotes communication and collaboration among employees, supervisors, and safety professionals, ensuring a comprehensive understanding of safety requirements and protocols. Additionally, a standardized JSA template facilitates consistency and efficiency in conducting safety analyses across different job roles and work environments.


Using a Job Safety Analysis template is crucial for organizations committed to maintaining a safe and secure work environment.


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.

Other Templates: