Job Safety Analysis (JSA)
General information
Job Number
Date
Location of Work
Job task description
Prepared by
Signature
JSA team members
Name
Site Induction Completed?
Signature
Hazard analysis for each step and risk management plan
Steps of work
Identified risks of
Hazard
Eliminate/Isolate/Minimise Risks/Hazards Level
(Critical/High/Moderate/Low)
1
2
3
4
5
Documentation license, qualifications and permits required
Does work include:
Hot Work
Confined space work
Working from height
Specify others
( √/X) Requirements
hot work permits to JSA needed?
Confined space permits to JSA needed?
Guidance and training completed?
( √/X)
PPE & other equipment required
☐ Safety harness/lanyard
☐ Safety Observer
☐ Lighting
☐ Cones
☐ Barriers
☐ Signage
☐ Safety Footwear
Specify others
☐ Eye protection
☐ Hearing protection
☐ Weather protection
☐ Face protection
☐ Hand protection
☐ Dust mask
☐ Respirator
☐ Hard hat
☐ Fall protection
☐ Gas detector