Jsa checklist

Template Information

Job safety analysis

Category: mining

Template Questions

  • Work \ Job \ Task Specific Location:
  • Prepared By:
  • Approved by:
  • JSA REQUIREMENTS 1 The JSA must be reviewed/revised daily, after a stoppage in work, or if work condi
  • Permit(s) Required
  • List permit required
  • HAVE YOU?
  • JOB DESCRIPTION (general)
  • Personal Protective Equipment (check all that is appropriate)
  • Type of gloves
  • List other:
  • Special Equipment and/or Other Safety Precautions (Check all that apply)
  • For each identified hazard, you should always attempt to address/control using the below methods in t
  • Job Sequence - Task Breakdown (be specific & detailed)
  • Identified Hazard(s)/Risks
  • Hazard/Accident Controls
  • Responsible Person(s) (be specific)
  • Technician Name: