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Job Safety Analysis Template

This document provides a template for a Job Safety Analysis Worksheet. The worksheet is used to identify tasks, hazards, and risk control measures for specific activities. It requires listing the tasks in sequence, identifying hazards for each task, listing control measures to minimize risks, and assigning a responsible person to implement the controls. The goal is to develop a site-specific safety analysis including all workers to identify and mitigate risks for planned activities.

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Bambang Sumantri
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© Attribution Non-Commercial (BY-NC)
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Download as PDF, TXT or read online on Scribd
2K views1 page

Job Safety Analysis Template

This document provides a template for a Job Safety Analysis Worksheet. The worksheet is used to identify tasks, hazards, and risk control measures for specific activities. It requires listing the tasks in sequence, identifying hazards for each task, listing control measures to minimize risks, and assigning a responsible person to implement the controls. The goal is to develop a site-specific safety analysis including all workers to identify and mitigate risks for planned activities.

Uploaded by

Bambang Sumantri
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Job Safety Analysis Worksheet

Company name: Site name: Contractor: Activity: Date: Permit to work requirement: Approved by: JSA No. Yes No

Activity
List the tasks required to perform the activity in the sequence they are carried out.

Hazards
Against each task list the hazards that could cause injury when the task is performed.

Risk control measures


List the control measures required to eliminate or minimise the risk of injury arising from the identified hazard.

Who is responsible?
Write the name of the person responsible (supervisor or above) to implement the control measure identified.

Remember: Each JSA must be site specific. Include all workers in the development of this JSA.

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