Template Information
Post training jsa form
Category: general
Template Questions
- work order number
- task activity
- date Date
- Site number/Name
- name of contractor/Subcontractor
- check applicable anticipated or potential hazards
- critical procedures: where work involves any of the following hazards must be incorporated into JSA
- 1. sequence of basic job Step in order
- 1.potential hazards. (Ex. underground services, hazard zone etc.)
- 1.safety controls to reduce or eliminate hazard
- 2. sequence of basic job Step in order
- 2. potential hazards. (Ex. underground services, hazard zone etc.)
- 2. safety controls to reduce or eliminate hazard
- 3. sequence of basic job Step in order
- 3. potential hazards. (Ex. underground services, hazard zone etc.)
- 3.safety controls to reduce or eliminate hazard
- 4. sequence of basic job Step in order
- 4. potential hazards. (Ex. underground services, hazard zone etc.)
- 4.safety controls to reduce or eliminate hazard
- 5. sequence of basic job Step in order
- 5. potential hazards. (Ex. underground services, hazard zone etc.)
- 5.safety controls to reduce or eliminate hazard
- tools / Equipment ( list of tools and equipment and their storage on site, if relevant to safety
- additional PPE ( minimum requirement: safety boots, hard hat, visi-vest, glasses, gloves)
- Other (fire retardant coveralls, breathing apparatus, etc) specify :
- outside authorities
- Add signature
- prepared by
- person carrying out work
- JSA approved retailer/Sales associate signature