Project Management Group - OHS Management Team

JOB HAZARD ANALYSIS (SAMPLE TEMPLATE)

JSA No.: JSA Title Date:
Company: Prepared By: Reviewd By: Approved By:

Scope (Discription of Work):

Control Measures
Basic Job Tasks/Steps
Administrative Controls Engineering Controls PPE
Potential Hazards Potential Injury
1. JOB SITE PREPARATIONS 1.1 Tripping 1.1.1 Fall on the same 1.1.1.1-2 Housekeeping - 1.1.1.1 Barricade and Safety Helmet
Hazards level ensure that the area is clear secure work and are Safety Glass
1.1.2 Personnel Injury of unnecessary materials to prevent other Safety Shoes
(chips of metals, trash and people from entering Gloves
debris) site

1.2 Slippery 1.1.1 Fall on the same 1.2.1.1-2 Housekeeping - 1.2.1.1 Barricade and
Surface/Slipping level ensure that the area is free secure work and are
Hazards 1.1.2 Personnel Injury from spills (Oil, Water and to prevent other
Chemicals) people from entering
site