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Job Safety Analysis Form Template

Streamline Your Safety Procedures with Our JSA Template

Incomplete safety assessments can lead to preventable accidents and costly disruptions. This Job Safety Analysis Form Template helps you identify hazards and implement effective safety measures for your team. With it, you can create detailed safety protocols, ensure compliance with regulations, and enhance communication about job risks, all while saving time with our easy-to-use format. This WCAG-aligned template invites you to tailor it to meet your specific needs-explore the live template for instant access.

Use this Template (FREE) Live Preview
Project or site name
Job or task title
Work location (address or area)
Date of analysis
Company or contractor
Supervisor or person in charge
Contact phone
Contact email
Names of participating workers (list all)
Pre-task briefing/toolbox talk completed
Yes
No
Languages used for the briefing
Stop work authority reviewed with the crew
Yes
No
Permits required for this job
Please Specify:
If Other, specify permit(s)
Required permits have been obtained and are valid
Yes
No
Step 1 - description of the task step
Step 1 - hazards present
Please Specify:
Step 1 - controls/mitigations to use
Please Specify:
Step 1 - PPE required
Please Specify:
Step 2 - description of the task step
Step 2 - hazards present
Please Specify:
Step 2 - controls/mitigations to use
Please Specify:
Step 2 - PPE required
Please Specify:
Step 3 - description of the task step
Step 3 - hazards present
Please Specify:
Step 3 - controls/mitigations to use
Please Specify:
Step 3 - PPE required
Please Specify:
Tools and equipment to be used
Please Specify:
Pre-use inspections completed for tools and equipment
Yes
No
Materials or chemicals to be used
Please Specify:
Safety Data Sheets (SDS) available for applicable chemicals
Yes
No
Lifting or rigging required
Yes
No
If lifting/rigging is required, is a lifting plan in place
Yes
No
Current weather
Clear
Cloudy
Rain
Snow/Ice
High wind
Heat
Cold
Other
Please Specify:
Surface conditions
Dry
Wet
Icy
Uneven
Obstructed
Other
Please Specify:
Lighting adequate for the task
Yes
No
Access and egress are clear
Yes
No
Underground/overhead utilities located and marked
Yes
No
Not applicable
Public or traffic exposure level
None
Low
Moderate
High
Controls in place for traffic/public
Barriers
Cones/Tape
Signs
Flagger
Spotter
Detour
Not applicable
Other
Please Specify:
Will energy isolation/LOTO be performed
Yes
No
Authorized person for LOTO (name)
All isolation points identified and verified
Yes
No
Nearest hospital or clinic
On-site emergency contact number
Assembly/muster point location
First aid kit available on site
Yes
No
Fire extinguisher accessible
Yes
No
Primary communication method during work
Two-way radio
Mobile phone
Hand signals
Public address system
Other
Please Specify:
Overall residual risk after controls
Very low
Low
Moderate
High
Very high
Additional notes or comments
Work authorized to proceed
Yes
No
Person completing JSA - full name
Role or title
Signature (type your name)
Date signed
Supervisor/competent person - full name
Supervisor signature (type your name)
Supervisor approval date
Crew acknowledgment names (list names of workers who reviewed this JSA)
Supervisor approval
Yes
No
{"name":"Project or site name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Project or site name, Job or task title, Work location (address or area)","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Colorful paper art illustration depicting a Job Safety Analysis form and related safety elements for FormCreatorAI article

When to use this form

Use this template before any non-routine or high-risk job: confined space cleaning, roof repairs, line breaks, equipment changeouts, or contractor work. Supervisors, crew leads, and safety managers benefit by mapping job steps, spotting hazards, and assigning controls and PPE. It is also useful for daily toolbox talks to brief the team and document who is fit and trained. Pair it with a Risk assessment form for site-level hazards, and attach a Hot work permit form for welding or cutting. If fire hazards are present, reference a Fire risk assessment form to confirm ignition sources and controls. The result: fewer surprises, clear responsibilities, and a written record you can share and revisit.

Must Ask Job Safety Analysis Questions

  1. What task is being done, where, and when?

    Framing the work scope, location, and timing prevents confusion and unsafe overlaps with other crews. It sets the context for permits, isolation needs, and who must be present.

  2. What are the step-by-step actions to complete the job?

    Breaking the job into steps makes it easier to spot hazards at each point. It also reveals hand-offs where controls or communication can fail.

  3. What hazards could hurt people, damage assets, or affect the environment?

    Listing physical, electrical, chemical, ergonomic, and weather risks leads to targeted controls. You also capture site-specific risks already flagged in your risk assessment.

  4. What controls, PPE, tools, and permits will you use for each step?

    Documenting guards, lockout, ventilation, and PPE ties a control to each hazard so nothing is missed. It also clarifies permit needs and readiness without delaying the job.

  5. How will you brief the team and respond to emergencies?

    A quick pre-job brief ensures everyone understands roles, alarms, and muster points; you can practice using the Fire drill checklist form. Planning communications and contacts speeds response if conditions change.

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