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Watson Residential Tauranga
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Job Safety Analysis
Company
Date
MM slash DD slash YYYY
JSA Number
File
Drop files here or
Select files
Max. file size: 32 MB, Max. files: 10.
Site Address
Task
Names of personnel involved in development of JSA
Name
Role
Name
Role
Add
Remove
Work Permits / Authorisations Required
Working at Heights
High voltage
Confined Space
Notifiable Work
Crane Work
Hot Work
Isolation (Lock out)
Hazardous Work
Excavation and Trenching
Traffic Management Plan
Tick which safety equipment is required for the job
Hi Viz/ Safety boots
Hard hat
Eye protection
Hand Protection
Ear Protection
Face Protection
Protective Clothing
Dusk Mask / Respirator
Gas Detector
Life Jacket
Tripod (Confined Spaces)
Other
Select All
What other safety equipment is needed? List it here
Competencies and training required to carry out individual tasks
Equipment checked and/or special considerations
Job Analysis
Please list all the steps in the job, list any existing hazards, what are the causes, what controls are in place, rate the risk presented by the hazard, what have you done to make the job as safe as possible? If there is a high risk present please get a managers 'sign off' before starting the job.
Job Steps
Identify Hazards
Exisiting Controls
Risk Rating
New Controls
Add
Remove
Personnel involved with the development of the JSA and the job/task it describes must sign below to verify there understanding of the JSA
Name
Date
Name
Date
Add
Remove
If the task is incomplete (time delays between shifts) or changes occur whilst the task is being undertaken, the JSA must reviewed and signed off again. Please save the job below if this the case.
Personnel Signatures
Supervisor Authorisation
Date
MM slash DD slash YYYY
Signature
Task Review: Were any additional hazards identified while doing the task?
Yes
No
Hazard and controls been added to the JSA?
Yes
No
Please make a note of the additional hazards
Is permit work required?
Yes
No
Does a procedure need amending as a result of this JSA?
Yes
No
What permits are required?
What procedure needs amending as a result of this JSA?
Reviewed by area Manager/Supervisor
Date
MM slash DD slash YYYY
Signature
