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JOB SAFETY ANALYSIS Date:

WORK ACTIVITY (JOB)

WORK TEAM JSA PREPARED BY(JSA):

SUPERVISOR APPROVAL

CRITICAL QUESTIONS: Everyone Ready/Capable To Work? X Potential Spill/Gas Release Addressed? Worst Case Discussed? BASIC JOB STEPS POTENTIAL ACCIDENTS OR HAZARDS WAYS TO ELIMINATE OR CONTROL HAZARDS

SAFETY EQUIPMENT REQUIRED TO DO THIS JOB

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Hard Hats?

Safety Shoes

Safety Goggles(

Face Shield?

Leather Gloves?

________

________

________

________

________

Hearing Protection?

Work Vests?

Safety Harness?

Cotton Gloves

________

________

________

________

________

Barricades

Fire Extinguisher

Lock-Out Tag Out

Hot Work Permit?

Entry Permit?

________

________

________

________

________

Other (List):

_____________________________

_____________________________

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Page:

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INSTRUCTIONS FOR COMPLETING JOB SAFETY ANALYSIS (JSA) FORMS____________________________________________________________________________________________________________________________________________________________________________________

Job Safety Analysis (JSA) is an important incident prevention tool that works by finding hazards and removing or minimizing them before the job is performed and before the

hazard becomes an incident. Use the JSA for job clarification and hazard awareness, as a guide in new employee training, for training of senior employees, as a refresher forinfrequent activities, as an incident investigation tool and for specific job hazards and protective measures.

Prioritize JSAs according to: 1) jobs that have a history of many incidents, 2) jobs that have produced disabling injuries, 3) jobs with a high potential for disabling injury or death

and 4) new jobs with no incident history. Below are instructions when filling out the three primary sections of a JSA:

1.0.0.0.1.1.1.1 Sequence of Basic Job Steps 1.0.0.0.1.1.1.2 Potential Hazards 1.0.0.0.1.1.1.3 Recommended Controls and/or Procedures

Break the job down into steps. Each step should

accomplish a major task. The task will consist of a set of

movements. Look at the first set of movements used toperform a task and then determine the next logical set of

movements. For example, the job might be to move a

box from a conveyor in the receiving area to a shelf in the

storage area. How does that break down into job steps?

Picking up the box from the conveyor and putting it on a

hand truck is one set of logical movements, so this would

be job step #1. Everything related to the one logical set

of movements is part of that job step.

The next logical set of movements might be to push the

loaded hand truck to the storeroom. Removing the boxes

from the hand truck and placing them on the shelf is

another logical set of movements. Finally, returning the

hand truck to the receiving area might be the third and

final step in this type of job.

Be sure to list ALL of the steps in a job in order. Some

steps may not be performed each time the job is

performed checking the casters on a hand truck, for

example. However, that task is part of the job as a whole

and should be listed for analysis.

Identify the hazards associated with each step. Examine

each step carefully to find and identify hazards (actions,

conditions or possibilities that could lead to an incident).

It is not enough to look only at the obvious hazards. It is

also important to look at the entire environment and

discover every possible hazard that may exist.

Be sure to list health hazards, even though harmful

symptoms or effects may not be immediate. A good

example is the harmful effect of inhaling chemical vapor

or particulate over a long period of time.

It is important to list ALL hazards. Hazards contribute to

incidents, injuries and occupational illnesses.

In order to complete part three of the JSA, potential and

existing hazards must be identified. That is why it is

important to distinguish between a hazard, an incident

and an injury. Each term has a specific meaning:

Hazard A potential danger (i.e. oil on floor)

Incident An unintended event that may result in an

injury, loss or damage (i.e. slipping on the oily floor).

Injury The result of an incident (i.e. a twisted ankle or

sprained wrist from the fall).

Some people find it easier to identify possible injuries

and illnesses and then work back to the hazards. If the

JSA is performed in this fashion, list the injury/illness

types in parentheses following the hazard that will cause

Using the first two columns as a guide, decide what

controls are necessary to an incident, injury or

occupational illness.

Among the controls that can be used are: 1) Engineering

Controls engineering the problem so that it is no longer

a hazard (i.e. crane or conveyor), 2) Administrative

Controls job rotation & work/rest regimens, 3) PPE or

Personal Protective Equipment respirators, safety

glasses, welding helmets or earplugs, 4) Job/Safety

Training training related to certain job functions and/or

safety issues, 5) Housekeeping sweeping/vacuuming

floors, removing oil/paint from equipment and/or

garments and 6) Ergonomics positioning the person in

relation to the machine or work environment so that

stresses or strains are eliminated or reduced.

List recommended safe operating procedures on the form

and also list required or recommended personal protective

equipment for each step of the job.

Be specific. Say exactly what needs to be done to correct

the hazard, such as lift the load using the leg muscles

and keep back straight, work station needs a 3-ton

crane for lifting/moving mast channels from conveyor to

the machine or recommend earplug use. Always

avoid general statements like Be careful or Pay

attention.

Recommended a control/procedure forevery hazard.

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it. However, be sure to focus on the hazard when

developing recommended controls and/or safe work

procedures.

Serious or life-threatening hazards should be corrected

immediately. Contact Site Safety for assistance.