12/06/23, 13:45 JSA Template - SafetyCulture

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Folha de rosto

Conduzido em 

Localização 

Preparado pela

Análise de Segurança do Trabalho (JSA)

Tarefa de trabalho sendo avaliada

Descrição do trabalho

Selecione o tipo de trabalho

Has exposure Has New Modified

to hazardous high established job due to Infrequently Other
and harmful accident job procedure performed
products frequency changes jobs

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Enter job type

List employees being observed during JSA

Tasks, Hazards and Preventive Measures

1) Break a job down into smaller tasks and observe a worker performing it
2) Click + to add a "Job Step" and fill in the relevant information
3) Identify the potential hazards for each task
4) Determine preventive measures and controls to overcome these hazards

Job Step

Enter job step description

Potential risk or hazard identified while task is being performed (select all that apply)

Explosion
Chemical (Chemical Electrical Ergonomics Excavation Fall Fire Mechan
(Toxic, Reaction, Over (Shock, (Strain, (Collapse) (Slip, (Mecha
Flammable, Pressurization) Short Sprains, Trip) Failure,
Corrosive) Circuit, Human Stuck
Fire, Error) betwee
Static, objects)
Loss of
Power)

Enter other potential risk/s identified

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Rate risk/ hazard before control measures

Extremely High Risk High Risk Moderate Risk Low Risk

Take a photo of step/ activity (Optional) 

Hazard Control Measures

Engineering Administrative Personal Protective

Controls Controls Equipment Other

Engineering Controls

Administrative Controls

Personal Protective Equipment

Other preventive measures

Explanation of control measures

Recommendation from Health and Safety Committee

Recommendations

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Completion

Full Name and Signature of Inspector 

Full Name and Signature of Health and Safety


Committee Member

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's
solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should
independently determine whether the template is suitable for your circumstances.

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