JOB SAFETY ANALYSIS (JSA)

JOB SAFETY ANALYSIS
Supervisor/Foreman: ________________________________ Job No.:
Date: _____________ Time: __________ Company: _____________________________
Unit/Area: ___________________________ Permit Number:__________________________
*Consider the following, check the items applying to the job and review with the work crew.*
Permits**	Welding	Potential Risks
Cold Work	Welding Leads in Good Condition	Injection (puncture)
Hot Work	Combustibles	Flammable/Combustible
Entry	Spark Containment	Ingestion (swallowing)
Is this a Lock Out / Tag Out Job	Welding Screens (Personnel Protection)	Inhalation (breathing)
Other ___________________	Grounding	Absorption (through the skin)
Personal Protective Equipment	Water Hose	Falls
Normal PPE	Fire Blanket	Pinch Points
Hard Hat	Fire Watch	Slip-Trip Potential
Safety Glasses w/ side shields	Sewer Covers	Heat Stress
Monogoggles w/ retainer	Other _____________________	Hot, Cold Surfaces or Materials
Safety Toed Boots / Shoes		Inadequate Lighting
Work Gloves	Electrical	First Opening of Equipment
Gloves – Type:__________________	Locked & Tagged	Mech. Isolation Devices
Add'l Foot Prot.:_________________	Try Start/Stop Switch	Process Isolation Devices
Protective Clothing:______________	GFCI Test	Line or Equipment Cleared
Face Shield	Assured Grounding/Chassis Ground	Noise
Respirator: Type________________	Other ____________________________	Poor Access/Egress
Hearing Protection (Ear Plugs)		Poor Housekeeping
Fall Protection	Lifting	Sharp Objects
Seat Belts	Motorized Equip.:____________________	Other _________________________
Burning Goggles	Properly Inspected
Welding Shield	Manual Lifting Equip.:_________________	Other/Miscellaneous
Other _______________________	Properly Inspected	Barricades
Tools	Proper Rigging Practices	Signs

Welding

Potential Risks

Personal Protective Equipment

Electrical

Lifting

Other/Miscellaneous

Tools