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Complete before commencing task: identify hazards and document controls for each step
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Task Steps, Hazards & Controls
List each step of the task in sequence. Identify hazards for each step, rate the risk (H = High, M = Medium, L = Low) and document the controls in place.
| Step | Task Step Description | Hazards Identified | Risk | Controls in Place |
|---|---|---|---|---|
| 1 | ||||
| 2 | ||||
| 3 | ||||
| 4 | ||||
| 5 | ||||
| 6 | ||||
| 7 | ||||
| 8 |
Additional Controls / PPE Required
Emergency Procedures
Emergency contact: ________________ Muster point: ________________ First aider: ________________
Nearest hospital: ________________
Worker Sign-on All workers must read and understand this JSA before commencing work
| # | Name (print) | Company | Signature |
|---|---|---|---|
| 1 | |||
| 2 | |||
| 3 | |||
| 4 | |||
| 5 | |||
| 6 | |||
| 7 | |||
| 8 | |||
| 9 | |||
| 10 |
Declaration
I declare that this Job Safety Analysis has been completed for the task described above. All identified hazards have been assessed and controls documented. All workers listed have been briefed on the hazards, controls and emergency procedures before commencing work. Any changes to the task, conditions or personnel will require this JSA to be reviewed and updated.