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    This document is a job safety analysis worksheet that outlines potential hazards and required personal protective equipment (PPE) for a specific job. It lists 18 potential hazard types including mechanical/vibration, electrical, ergonomic, fall, excavation, fire and others. For each step of the job, it identifies the potential hazard, hazard type, and safe work procedures or protections. The example given is blowing off cutting fluid and metal shards from a lathe mounting plate, with potential hazards of flying debris impacting eyes, face or skin. The worksheet must be prepared, reviewed by safety personnel, and approved.

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    This document is a job safety analysis worksheet that outlines potential hazards and required personal protective equipment (PPE) for a specific job. It lists 18 potential hazard types including mechanical/vibration, electrical, ergonomic, fall, excavation, fire and others. For each step of the job, it identifies the potential hazard, hazard type, and safe work procedures or protections. The example given is blowing off cutting fluid and metal shards from a lathe mounting plate, with potential hazards of flying debris impacting eyes, face or skin. The worksheet must be prepared, reviewed by safety personnel, and approved.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    5 views2 pages

    JSA Format

    Uploaded by

    deepakkumaryadav841441
    This document is a job safety analysis worksheet that outlines potential hazards and required personal protective equipment (PPE) for a specific job. It lists 18 potential hazard types including mechanical/vibration, electrical, ergonomic, fall, excavation, fire and others. For each step of the job, it identifies the potential hazard, hazard type, and safe work procedures or protections. The example given is blowing off cutting fluid and metal shards from a lathe mounting plate, with potential hazards of flying debris impacting eyes, face or skin. The worksheet must be prepared, reviewed by safety personnel, and approved.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 2

    Job Safety Analysis Worksheet

    Job Description:

    Required PPE:

    Gloves: Face Shield: Respirator: Hard Hat: Body Harness: Weld Helmet:

    Potential PPE: Check

    All That Applies

    Potential Hazard Type (HT)


    1. Toxic chemicals 7. Mechanical / Vibration 13. Ergonomic (human error)
    2. Flammable Chemicals 8. Electrical (Shock, short circuit) 14. Vibration
    3. Corrosive Chemicals 9. Electrical fire 15. Fall (Slips/trips)

    4. Environmental 10. Electrical (Static, ESD) 16. Fall (to a different level)

    5. Explosion (Chemical reaction) 11. Electrical (loss of power) 17. Excavation (collapse)
    6. Explosion (over Pressure) 12. Ergonomic (Overexertion) 18. Fire, Heat, Thermal, Cold

    Work Elements Potential Hazard


    Step #

    Notes: Use Action words: Position, Lift, Carry, Place, Reach, Grab, etc. Look at: Tools, Equipment, Work Station, Environment, Surrounding Activities

    Example Blow off cutting fluid and metal shards from lathe mounting plate with compressed air Flying metal shards or cutting oil impacting on eyes, face or skin

    Prepared by :

    Reviewed by Safety :
    JSA Number: Original Date Issued: Revision Number: Revision Date:
    sheet
    -

    List the SPECIFIC PPE Required for Job:

    Supervisor:

    Employee:

    Employee:

    List Tools Used:


    19. Noise
    20. Radiation
    21. Visibility

    22. Weather List Chemicals Used:

    23. Caught (In, Between)


    24. Struck (By, Against)

    tential Hazard HT Safe Work Procedure or Protection

    nvironment, Surrounding Activities See Above The following and similar statements are not acceptable: Stay Alert and Pay Attention. Be specific with action words:
    wear PPE (what Type), not only what to do, but how to do it.

    Lower compressed air pressure; Use pressure relief valve; Use vacuum, brush and/or cloth to remove
    eyes, face or skin 1, 2, 3, 24 debris; In addition to safety glasses wear a face shield; Replace the use of air with coolant flush system

    Reviewed by Functional Manager :

    Approved by :

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