JOB SAFETY ANALYSIS

WORK ACTIVITY (JOB) WORK TEAM SUPERVISOR APPROVAL CRITICAL QUESTIONS: Everyone Ready/Capable To Work? X Potential Spill/Gas Release Addressed?

Date:

JSA PREPARED BY(JSA):

Worst Case Discussed?

BASIC JOB STEPS

POTENTIAL ACCIDENTS OR HAZARDS

WAYS TO ELIMINATE OR CONTROL HAZARDS

SAFETY EQUIPMENT REQUIRED TO DO THIS JOB

Hard Hats? Safety Shoes Safety Goggles( Face Shield? Leather Gloves?

________ ________ ________ ________ ________

Hearing Protection? Work Vests? Safety Harness? Cotton Gloves

________ ________ ________ ________ ________

Barricades Fire Extinguisher Lock-Out Tag Out Hot Work Permit? Entry Permit?

________ ________ ________ ________ ________

Other (List): _____________________________ _____________________________ ______________________

Page: _____ of _____

INSTRUCTIONS FOR COMPLETING JOB SAFETY ANALYSIS (JSA) FORMS

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Job Safety Analysis (JSA) is an important incident prevention tool that works by finding hazards and removing or minimizing them before the job is performed and before the hazard becomes an incident. Use the JSA for job clarification and hazard awareness, as a guide in new employee training, for training of senior employees, as a refresher for infrequent activities, as an incident investigation tool and for specific job hazards and protective measures. Prioritize JSAs according to: 1) jobs that have a history of many incidents, 2) jobs that have produced disabling injuries, 3) jobs with a high potential for disabling injury or death and 4) new jobs with no incident history. Below are instructions when filling out the three primary sections of a JSA: 1.0.0.0.1.1.1.1 Sequence of Basic Job Steps 1.0.0.0.1.1.1.2 Potential Hazards 1.0.0.0.1.1.1.3 Recommended Controls and/or Procedures Using the first two columns as a guide, decide what controls are necessary to an incident, injury or occupational illness. Among the controls that can be used are: 1) Engineering Controls engineering the problem so that it is no longer a hazard (i.e. crane or conveyor), 2) Administrative Controls job rotation & work/rest regimens, 3 ) PPE or Personal Protective Equipment respirators, safety glasses, welding helmets or earplugs, 4) Job/Safety Training training related to certain job functions and/or safety issues, 5) Housekeeping sweeping/vacuuming floors, removing oil/paint from equipment and/or garments and 6) Ergonomics positioning the person in relation to the machine or work environment so that stresses or strains are eliminated or reduced. List recommended safe operating procedures on the form and also list required or recommended personal protective equipment for each step of the job. Be specific. Say exactly what needs to be done to correct the hazard, such as lift the load using the leg muscles and keep back straight, work station needs a 3-ton crane for lifting/moving mast channels from conveyor to the machine or recommend earplug use. Always avoid general statements like Be careful or Pay attention. Recommended a control/procedure for every hazard.

Break the job down into steps. Each step should accomplish a major task. The task will consist of a set of movements. Look at the first set of movements used to perform a task and then determine the next logical set of movements. For example, the job might be to move a box from a conveyor in the receiving area to a shelf in the storage area. How does that break down into job steps? Picking up the box from the conveyor and putting it on a hand truck is one set of logical movements, so this would be job step #1. Everything related to the one logical set of movements is part of that job step. The next logical set of movements might be to push the loaded hand truck to the storeroom. Removing the boxes from the hand truck and placing them on the shelf is another logical set of movements. Finally, returning the hand truck to the receiving area might be the third and final step in this type of job. Be sure to list ALL of the steps in a job in order. Some steps may not be performed each time the job is performed checking the casters on a hand truck, for example. However, that task is part of the job as a whole and should be listed for analysis.

Identify the hazards associated with each step. Examine each step carefully to find and identify hazards (actions, conditions or possibilities that could lead to an incident). It is not enough to look only at the obvious hazards. It is also important to look at the entire environment and discover every possible hazard that may exist. Be sure to list health hazards, even though harmful symptoms or effects may not be immediate. A good example is the harmful effect of inhaling chemical vapor or particulate over a long period of time. It is important to list ALL hazards. Hazards contribute to incidents, injuries and occupational illnesses. In order to complete part three of the JSA, potential and existing hazards must be identified. That is why it is important to distinguish between a hazard, an incident and an injury. Each term has a specific meaning: Hazard A potential danger (i.e. oil on floor) Incident An unintended event that may result in an injury, loss or damage (i.e. slipping on the oily floor). Injury The result of an incident (i.e. a twisted ankle or sprained wrist from the fall). Some people find it easier to identify possible injuries and illnesses and then work back to the hazards. If the JSA is performed in this fashion, list the injury/illness types in parentheses following the hazard that will cause

it. However, be sure to focus on the hazard when developing recommended controls and/or safe work procedures.

Serious or life-threatening hazards should be corrected immediately. Contact Site Safety for assistance.