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Job Safety Analysis Worksheet Date of Analysis Company Name Job Title Analysis Done By Step 1 Sequence of Basic Job Steps Break the job into a sequence of steps. Each of the steps should accompany some major task. That task will consist of a series of movements. Look at each series of movements within that basic task. Reviewed By New Job Safety Analysis Revised Job Safety Analysis Department Step 2 Potential Hazards To complete a JSA effectively you must identify the hazards or potential hazards associated with each step* Every possible source of energy must be identified* It is very important to look at the entire environment to determine every conceivable hazard that might exist. Hazards contribute to accidents and injuries. Step 3 Recommended Procedures Using the Sequence of Basic Job Steps and Potential Hazards decide what actions are necessary to eliminate control or minimize hazards that could lead to accidents injuries damage to the environment or possible occupational illness. Each safe job procedure or action must correspond to the job steps and identified hazards. CONTINUED. Each of the steps should accompany some major task. That task will consist of a series of movements. Look at each series of movements within that basic task. Reviewed By New Job Safety Analysis Revised Job Safety Analysis Department Step 2 Potential Hazards To complete a JSA effectively you must identify the hazards or potential hazards associated with each step* Every possible source of energy must be identified* It is very important to look at the entire environment to determine every conceivable hazard that might exist. Look at each series of movements within that basic task. Reviewed By New Job Safety Analysis Revised Job Safety Analysis Department Step 2 Potential Hazards To complete a JSA effectively you must identify the hazards or potential hazards associated with each step* Every possible source of energy must be identified* It is very important to look at the entire environment to determine every conceivable hazard that might exist. Hazards contribute to accidents and injuries. Step 3 Recommended Procedures Using the Sequence of Basic Job Steps and Potential Hazards decide what actions are necessary to eliminate control or minimize hazards that could lead to accidents injuries damage to the environment or possible occupational illness. Hazards contribute to accidents and injuries. Step 3 Recommended Procedures Using the Sequence of Basic Job Steps and Potential Hazards decide what actions are necessary to eliminate control or minimize hazards that could lead to accidents injuries damage to the environment or possible occupational illness. Each safe job procedure or action must correspond to the job steps and identified hazards. CONTINUED. Each of the steps should accompany some major task. That task will consist of a series of movements. Look at each series of movements within that basic task. Reviewed By New Job Safety Analysis Revised Job Safety Analysis Department Step 2 Potential Hazards To complete a JSA effectively you must identify the hazards or potential hazards associated with each step* Every possible source of energy must be identified* It is very important to look at the entire environment to determine every conceivable hazard that might exist. Hazards contribute to accidents and injuries. Step 3 Recommended Procedures Using the Sequence of Basic Job Steps and Potential Hazards decide what actions are necessary to eliminate control or minimize hazards that could lead to accidents injuries damage to the environment or possible occupational illness. .

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