Job Safety Analysis
Site: Work Area: Date: Time
Task being Analysed: Registered JSA No.:
Accountable Person (for the task): Signature:
Supervisor (Is the reviewer): Signature:
Expiry Date (Valid for 7 days): Emergency Contact
Completed By (team): Signature: No’s
Completed By (team): Signature:
Critical Control Verification: Is a fatality risk involved in this task?
☐ Yes (If yes, tick the Fatality Risk involved and a Critical Control Verification Form needs to be
☐ No
completed by the supervisor.)
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Confined Involving Release of Vehicle Impact Vehicle Vehicle
Height Work Falling Objects Tyre Handling Vehicle Offsite
Spaces Electricity Energy on Person Collision Rollover
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Fire & Rail Impact on Exposure to Mooring
Lifting Work Rotating Parts Rail Collision Slope Failure Drowning
Explostion Person Hazardous substance Operation
Permits Required: (Permit No: _________________ ) : (Permit No: _________________ ) : (Permit No: _________________ )
☐ Working at Heights (WH) ☐ Confined Space (CS) ☐ Hot Work (HW) ☐ Hazardous Substance (HS) ☐ Structural/Grating Removal (SR)
☐ Energy Isolation (EI) ☐ Excavation (E) ☐ Other
Personal Protective Equipment (PPE) & Other Equipment Required: (in addition to minimum site requirements)
☐ Full Face Shield ☐ Gloves (suited to task) ☐ Static Lines ☐ Inertia Reels
☐ Dust Mask ☐ Welders Apron, Sleeves & Leg Guard ☐ Barricading or Witches Hats ☐ Danger / Caution Tape
☐ Respiratory Masks ☐ Hearing Protection ☐ Fire Extinguisher (suited to task) ☐ Fire Blanket
☐ Welding Shields (welders) ☐ Safety Harnesses ☐ Radios ☐ Safety Signs
JSA Reviewed by AML / DRA Officials - Name & Signature:
1. 3. 5.
2. 4. 6.
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Job Safety Analysis
List of Checklists Followed for The Job:
Sr. No. Checklist details Sr. No. Checklist details
Daily Review for Management of Change: (Mark your review response in YES/NO)
Date: Date: Date: Date: Date: Date: Date:
Sr. No Check Point
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
1. Has any changes occurred since the start of the activity?
Is there change in the supervision (Supervisor) of the
2.
job?
Have any additional hazards been identified? (Via
3.
Lesson Learnt/Why Analysis/Root cause analysis, etc.)
4. Is there change in the location of the job?
Is there any new activity in your area which might have
5.
potential impact on your task?
6. Is there any change in the job steps?
7. Is there any change in the equipment’s/tools?
8. Is there any change in job crew (workers)?
Is there change in weather conditions?
9.
(Sunny, Rainy, Windy, Lighting, etc.)
(SPECIAL NOTE: If any one of above check point response comes out to be “Yes”. Supervisor must “Proceed for Management of Change”. Management of Change must be
recorded on page no 11 & 12 of this JSA)
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Job Safety Analysis
Job Steps: Related Hazards: Hazard Control:
Step Break into logical steps necessary to
Those hazards associated with each step What has been put in place to reduce or eliminate the hazards
No. complete a job
Cube making Concrete handling Wear the mandatory ppe’s.
Skin problem due to concrete handling Wear pvc gloves and full sleeves dress.
without ppe. Keep ready eye wash station near by and wear the eye
Concrete splashes in eyes protection.
Cube testing Improper handling of cube Wear the mandatory ppe.
Not wearing mandatory ppe’s Handle the cube with proper grip.
Flying particle Wear eye protection.
Pinch point Keep away from fingers from pinch point.
Fall of cube
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Job Safety Analysis
Job Steps: Related Hazards: Hazard Control:
Step Break into logical steps necessary to
Those hazards associated with each step What has been put in place to reduce or eliminate the hazards
No. complete a job
Batching plant operation Electrocution Entry to be prohibited and restricted inside the batching plant
Moving Parts/Trip Hazard operator room other than the operator and the electrician
Fire Hazard Only authorised operator to be operated the same.
Appropriate earthing to be given and all the connections are to
be provided through Earth-leakage circuit breaker (ELCB) only.
An electrician has to use rubber hand gloves (Tested and
Trademark) while doing local test and all.
Identification boards to be displayed.
All the types of machinery to be checked and certified
by putting a green sticker
All the moving parts of the machinery/equipment to be guarded
and no loose clothing permitted near the machinery/conveyors.
Unauthorized entry to be restricted.CO2 fire extinguisher to be
provided.
Cement Loading
Dust Hazard Nose mask to be provided to those who are engaged in cement
Eye Hazard loading work.
Safety goggles to be provided other than PPE’S for all those
who are engaged in the work.
Shifting of material using Loader
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Job Safety Analysis
Job Steps: Related Hazards: Hazard Control:
Step Break into logical steps necessary to
Those hazards associated with each step What has been put in place to reduce or eliminate the hazards
No. complete a job
Proper documents of the mobile plants/ machinery or
equipment /vehicle to be examined and cleared ‘OK’ before
entering the site.
A competent operator.
Proper access to be provided by clearing all unwanted materials
or traffic to enter the workplace.
Movement area of the machine to be isolated.
Daily inspection and observation for the equipment and the
checklist to be fulfilled daily.
Continuous supervision to be provided while Placing of transit
mixer
Mobile plant/Hit Hazard Vehicle to be checked & observed and valid document to be
verified.
A valid licence for the vehicle driver.
Daily inspection for the vehicle and checklist to be
accomplished.
Access to be cleared from all waste and un-necessary materials
and traffic for vehicle movement.
Work at height. Untrained personnel Person shall be trained in work at height.
Damaged safety harness Safety shall be inspected before use.
Unavailability of anchor point
Unstable working platform Height work permit shall be taken from concerned personnel.
Improper access JSA shall be briefed to him.
Not wearing required ppe Anchor point shall be there to hook the safety harness.
Wear the mandatory ppe.
Provide good access.
Working platform shall be stable.
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Job Safety Analysis
Job Steps: Related Hazards: Hazard Control:
Step Break into logical steps necessary to
Those hazards associated with each step What has been put in place to reduce or eliminate the hazards
No. complete a job
Avoid lone working culture at site. Proper communication
facilities should be maintained. Supervision should be ensured
always.
Wear clear goggles instead of white one.
Refreshments to be provided at regular intervals. Training has
to be done to all night shift workers.
Vigilance on the workers’ health has to be ensured.
Avoid working in poor light areas
Fatigue
Ensure job rotation
Inadequate illumination
Provide adequate illumination.
Lone working conditions
Signal man must wear High visibility jacket, must have baton
Sleep deprivation
light.
Early morning drowsiness
Night shift work Check the weather report every day.
Rough weather
Avoid working in rough weather.
High wind speed
Check the ground condition for stability in case of heavy rain.
Slippery surface
Stop the crane operation in case of wind speed exceeds 32
Rain KM/Hr or rough sea weather.
Cold Climate Lower the load & boom.
Seek medical aid in case of fever.
All vehicle to follow the speed limit.
In case of slippery surface, employees should watch their step
at site, removal of stagnant water from workplace.
Work shall be stopped in case of rain or provide raincoats to
workers in case of any work was needed to do.
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Job Safety Analysis
Job Steps: Related Hazards: Hazard Control:
Step Break into logical steps necessary to
Those hazards associated with each step What has been put in place to reduce or eliminate the hazards
No. complete a job
machinery/TM’s operators are responsible for their
machinery/TM’ss, the load, and all personnel working around
them. Operators should warn pedestrians of their presence by
using the horn (if equipped). Operators should never operator
machinery/TM’s in areas where pedestrians can be caught
between fixed objects and their vehicle. machinery/TM’s are
equipped with safety equipment (e.g., backup alarms,
flashing/warning lights) to warn personnel working/walking in
the area. Operators are responsible for ensuring all loads are
appropriately stacked, balanced, and do not exceed the
capacity of the vehicle.
Whole Body vibration can be reduced in machinery/TM’sby
ensuring the seat and vehicle frames are designed to reduce
the transfer of vibrations from the equipment to the operator.
Vibrations can also be reduced/minimized by regular
Hit by machinery/TM’s preventive maintenance of the equipment (keeps equipment
Operation of Crush running smoothly). Grounds and work surfaces are
machinery/transit Inadequate body postures maintained to reduce wear, ruts, and other damage which
mixtures/vehicles Others factors like environment,etc reduces the number of impacts to machinery/TM’sand the
Incompetent operator operator's body. machinery/TM’s seats, etc... should be
adjusted to ensure a comfortable ergonomic setup for
operator.
Personnel should be trained in the basic understanding of heat
stress and recognizing warning signs. Personnel should take more
frequent short breaks on hot days in shaded or air-conditioned
areas. Personnel should drink plenty of cool beverages (water), and
avoid drinks with caffeine (coffee, tea, or pop).
Any tools, equipment, or machinery found damaged, defective, or
otherwise unsafe should immediately be removed from service and
not used until repaired or replaced. Personnel should always
consult their Supervisors on the selection and use of PPE for the
tasks being performed.
Operator shall competent and HMV licensed.
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Job Safety Analysis
Job Steps: Related Hazards: Hazard Control:
Step Break into logical steps necessary to
Those hazards associated with each step What has been put in place to reduce or eliminate the hazards
No. complete a job
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Job Safety Analysis
Signature
No Name
Date: Date: Date: Date: Date: Date: Date:
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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Signature
No Name
Date: Date: Date: Date: Date: Date: Date:
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Management of Change
Review with
Step New/ Changed Job Steps: Related Hazards: Hazard Control: work crew:
New/ Changed steps necessary to (Supervisor Name &
No: complete a job
Those hazards associated with each step What has been put in place to reduce or eliminate the hazards
signature and date)
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Job Safety Analysis
NOTE: Team members must sign onto the JSA again, if a change occurred during the job task, and any additional hazards were identified, and controls implemented.
Hazards
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Biological & Environmental Electrical Chemical Products Gravity/Height Mechanical & Motion
Altitude ☐ Arc Flash ☐ Carcinogenic ☐ Equipment Tipping/Collapsing ☐ Being Thrown Off/Under
Animal Bite/Sting ☐ Buried Utilities ☐ Combustible/Flammable ☐ Excavation/Trench ☐ Equipment ☐
Blood-Borne Pathogens ☐ Damage to Leads/Cables ☐ Explosive ☐ Falling Objects ☐ Disintegration of Moving
Contaminated Damage to Switches ☐ Toxic ☐ Floor Openings/Edges ☐ Components ☐
Food/Water ☐ Energized Corrosive ☐ Grating Removed ☐ Driving/Vehicle Traffic ☐
Insect-Borne Disease ☐ Circuits/Conductors ☐ Reactive ☐ Inadequate Support ☐ Ejection of
Pests ☐ Inadvertent Energization ☐ Client/Process Chemicals Lack of Access to Workpiece/Debris ☐
Poisonous Plants ☐ Lack of Isolation/Grounding ☐ Lack of Containment ☐ Ladders/Stairs ☐ Entanglement ☐
Precipitation ☐ Missing/Damaged Leakage/Spills ☐ Suspended Load ☐ Friction ☐
Temperature/Humidity ☐ Insulation ☐ Material Incompatibility ☐ Unstable/Insecure Materials ☐ Movement/Shifting ☐
Unsanitary Conditions ☐ Overhead Lines ☐ Produced/Disturbed by Work Above/Below Others ☐ Moving Parts ☐
Weather ☐ Overload of Circuits ☐ Work ☐ Work at Height/Fall Hazard ☐ Pinch/Crush Points ☐
Wind/Turbulence ☐ Stored Energy Asbestos ☐ Walking/Working Surface Projectiles ☐
Pressure (Batteries/Capacitors) ☐ Lead ☐ Slippery ☐ Rotating Equipment ☐
Abrasive Blasting ☐ Water Near Electrical Silica ☐ Uneven ☐ Sharp Edges, Corners, or
Compressed Gases ☐ Conductors ☐ Welding Fumes ☐ Obstructed ☐ Points ☐
High-Pressure Fluid ☐ Work Environment Dust ☐ Steep ☐ Shearing ☐
Pressure Testing ☐ Cluttered ☐ Water Discharges ☐ Moving/Swaying/Pitching ☐ Stored Energy
Pressure Confined Space ☐ Wastes Generated Insufficient/Unstable ☐ (Springs/Accumulators) ☐
Washing/Blasting ☐ Damaged Tools/Equipment ☐ Hazardous ☐ Ergonomic Striking ☐
Radiation Entrapment ☐ Non-Hazardous ☐ Awkward Trapped Between
Intense Light ☐ Erosion ☐ Sound Postures/Movement ☐ Equipment and Fixed
Lasers ☐ Hazardous Atmosphere Continuous Noise ☐ Excessive Force/ Exertion ☐ Structures ☐
Microwaves ☐ Oxygen Rich/Deficient ☐ Intermittent Noise ☐ Heavy/Awkward Load ☐ Unexpected/Uncontrolled
Naturally Occurring ☐ Contaminants ☐ Extreme Noise ☐ Repetitive Motion ☐ Movement ☐
Radioactivity ☐ Ignition Sources ☐ Impact Noise ☐ Same Position ☐
Radioactive Material ☐ Inadequate Ventilation ☐ Vibration ☐
X-Rays ☐ Poor Lighting/Glare ☐
Restricted Access/Egress ☐
Run-off ☐
Air Emissions ☐
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