Job Safety Analysis: Sequence of Basic Hazards and Effects Identified Job Steps Risk (R)

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JOB SAFETY ANALYSIS

DATE: JSA #
LOCATION
DESCRIPTION

SEQUENCE OF BASIC Risk


HAZARDS AND EFFECTS IDENTIFIED
[R]
JOB STEPS

Emergency Evacuation/ Response: ALL WORKERS ARE AWARE OF MUSTER AREA AND RESPONSE TO AIR HORN FOR APPROXIMATELY 3 MINU
SAFETY EQUIPMENT REQUIRED Safety Hard Hat ( ) Gloves
General Work Permit ( ) Safety Boots ( ) Safety Harness ( )
Excavation Permit ( ) Safety Glasses ( ) Fire Extinguishers ( )
Hot Work Permit: ( ) Lifting Proctection ( ) Lock Out/Tag Out ( )
CANDIDATE NAME
SIGNATURE
ANALYSIS
SITE VISITED

Risk
CORRECTIVE MEASURES/RECOMMENDATIONS
[*R]

HORN FOR APPROXIMATELY 3 MINUTES


Goggles ( ) Hearing Protection ( )
Face Shield ( ) Scaffolding ( )
Barricades ( ) Dust Chemical Respirator ( )
Face Shield ( ) Spill Bin ( )
Risk = Likelihood x Severity
[R] = Risk BEFORE mitigation/control
[*R] = Residual Risk AFTER mitigation control

SEVERITY
LIKELIHOOD
Slight [1] Serious [2] Major [3]
Low [1] Low [1] Low [2] Medium [3]
Medium [2] Low [2] Medium [4] High [6]
High [3] Medium [3] High [6] High [9]

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