Job Safety Analysis (JSA) Worksheet
| Job / task | Date | ||
|---|---|---|---|
| Department / area | Analyzed by | ||
| Reviewed by | New / revised | ||
| Required PPE | |||
| Required tools / equipment | |||
| # | Job step | Potential hazards | Controls |
|---|---|---|---|
| 1 | |||
| 2 | |||
| 3 | |||
| 4 | |||
| 5 | |||
| 6 | |||
| 7 | |||
| 8 |
How to use this worksheet. Watch the job performed by the person who normally does it, and list the steps in order (aim for 6 to 10). For each step, write the specific hazard: what could hurt someone, and how. Then assign the highest feasible control for each hazard, working down the hierarchy: eliminate the hazard, substitute something safer, engineer it out, control it administratively, and use PPE only as the last layer. Every hazard gets a control. Review this worksheet with the crew before work begins, and revise it after any incident, near miss, or change to the job, equipment, or materials.
Analyzed by (signature): ________________________________ Date: ______________
Reviewed / approved by (signature): ________________________________ Date: ______________