Job Hazard Analysis Form - Lsci, Lancaster Safety Consulting, Inc.
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1Lancaster Safety Consulting, Inc.
Job Hazard Analysis Form
Project #:
Client Name:
Project Location:
Date of JSA:
Contractor:
Sub-Contractor:
Date of Work:
Project JSA Name:
H
R
R
AZARD
ISK
ATING
1. Take Step 1 rating and select the correct column.
What are the consequences of this
What is the likelihood (below) of the
2. Take Step 2 rating and select the correct line.
hazard occurring? Consider what the
hazard consequence in Step 1 occurring.
3. Use the risk score where the two ratings cross on the
most probable consequence is
matrix below.
(below) with respect to this work
H = High, S = Serious, M = Medium, L = Low
hazard.
Extreme
Multiple fatalities or
Almost
Is expected to occur in
permanent injuries
Certain
most circumstances
Critical
Single fatality or
Likely
Will probably occur at least
permanent injury
once
Major
Medical treatment or
Possible
Event might occur at some
lost time injury
time
Minor
First aid treatment
Almost Certain
M
S
H
H
H
Unlikely/Rare Event not expected to
Insignificant
Incident or near miss –
occur or only in exceptional
no treatment
Likely
M
M
S
H
H
circumstances
Possible
L
M
M
S
S
Unlikely/ Rare
L
L
M
M
S
Process/Activity
Job/Task Hazard
Hazardous Element
Hazard
Controls
Hazard
Comments and/or
(List the hazards relating to
(List the controls to manage each
Sub Category
Risk Rating
Risk Rating
Assigned to
the work)
of the hazards)
(prior to
(After Controls)
control)
Phone: (888) 403-6026 Fax: (724) 776-1007
Page 1 of 1
100 Bradford Road, Suite 100
Wexford, PA 15090
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