Samples Job Safety Analysis Page 18
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27JOB SAFETY ANALYSIS TRAINING GUIDE
Job Title:
Page:
of
JSA No.
Date:
New
Revised
Equipment:
Supervisor:
Analysis by:
Department:
Approved by:
Required Personal Protective Equipment (PPE):
JOB STEPS
POTENTIAL HAZARDS
RECOMMENDED
SAFE JOB PROCEDURES
Break down the job into its basic steps, e.g., what
For each step, ask yourself what
For each potential accident or hazard, ask yourself what
is done first, what is done next, and so on. You can
accidents could happen to the employee
safeguards should be provided for the employee and how
do this by:
doing the job. You can get the answers
should the employee do the job step to avoid the potential
by:
accident, or what should they do or not do to avoid the
1. Observing the job
accident. You can get your answers by:
2. Discussing it with the operator
1. observing the job.
3. Drawing on your knowledge of job
2. discussing it with the operator
1. observing the job for leads
4. A combination of the three
3. recalling past accidents
2. discussing precautions with experienced job
4. a combination of the three
operators
Record the steps in their normal order of
3. drawing on your experience
occurrence. Describe what is done, not the details
Ask yourself; can he/she be struck by or
4. a combination of the three
of how it is done. Usually three or four words are
contacted by anything; could they strike
sufficient to describe each basic job step.
against or come in contact with anything;
Be sure to describe specifically the provided safeguards
could the employee be caught in, on, or
and precautions an employee must use. Don=t leave out
For example, the first basic job step in using a
between anything; can they fall; be over
important details. Number each separate recommended
pressurized water fire extinguisher would be:
exerted; or be exposed to anything
precaution with the same number you gave the potential
1. Remove the extinguisher from the wall bracket.
injurious such as gas, radiation, welding
accident (see center column) that the precaution seeks to
rays, etc.?
avoid. Use simple do or don=t statements to explain
For example, acid burns, fumes.
recommended precautions as if you were talking to the
employee.
For example: ALift with your legs, not your back.@
Avoid generalities such as, ABe careful,@ ABe alert,@
ATake caution,@ etc.
Trainee=s Name:
Training Date:
Trainer=s Name:
Trainer=s Signature:
Four-Step Instruction Completed?
Prepare the Worker . . . . . . . . . . . . Trainer=s Initials
Present the Operation . . . . . . . . . . Trainer=s Initials
Try Out Performance . . . . . . . . . . .Trainer=s Initials
Follow Up . . . . . . . . . . . . . . . . . . . .Trainer=s Initials
Page 14
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