JOB SAFETY ANALYSIS (JSA) Company name: Date: JSA No.: Site Name: Permit to work requirement: YES NO Contractor: Approved by: Activity: Hazards Risk Control Measures Who is responsible? Activity List the tasks required to perform the activity in the Against each task list the hazards that could cause List the control measures required to eliminate or Write the name of the person responsible (supervisor sequence they are carried out. injury when the task is performed. minimise the risk of injury arising from the identified or above) to implement the control measure hazard. identified.
JOB SAFETY ANALYSIS (JSA) Company name: Date: JSA No.: Site Name: Permit to work requirement: YES NO Contractor: Approved by: Activity: Activity List the tasks required to perform the activity in the sequence they are carried out. Hazards Against each task list the hazards that could cause injury when the task is performed. Risk Control Measures List the control measures required to eliminate or minimise the risk of injury arising from the identified hazard. Who is responsible? Write the name of the person responsible (supervisor or above) to implement the control measure identified.
Contractor-Selection-Induction-and-Monitoring-Form-XXX2.docx