JSA Template: Job Safety Analysis
A Job Safety Analysis (JSA) breaks a job into steps, identifies hazards in each step, and specifies controls. This template guides you through creating a JSA for any maintenance task.
What is a JSA?
A Job Safety Analysis (JSA), also called a Job Hazard Analysis (JHA) or Safe Work Method Statement (SWMS), is a process of breaking a job into individual steps, identifying the hazards associated with each step, and determining the controls needed to make each step safe. The JSA is completed before the work begins and is reviewed by all workers involved.
JSA Template
Job Information
Job title: ____________________________________________________
Location: ____________________________________________________
Date: __________________ Time: __________________
Supervisor: _________________________________________________
Workers involved: ___________________________________________
Permits required (circle): Hot Work / Confined Space / Electrical / Excavation / Height
Step-by-Step Hazard Analysis
Step 1: _________________________________________________
Hazard: ____________________________________________________
Risk (before controls): ____________________________________
Controls: __________________________________________________
Risk (after controls): _____________________________________
Step 2: _________________________________________________
Hazard: ____________________________________________________
Risk (before controls): ____________________________________
Controls: __________________________________________________
Risk (after controls): _____________________________________
Step 3: _________________________________________________
Hazard: ____________________________________________________
Risk (before controls): ____________________________________
Controls: __________________________________________________
Risk (after controls): _____________________________________
Step 4: _________________________________________________
Hazard: ____________________________________________________
Risk (before controls): ____________________________________
Controls: __________________________________________________
Risk (after controls): _____________________________________
Required PPE
☐ Safety glasses ☐ Hard hat ☐ Safety boots ☐ Hi-vis
☐ Gloves (type: ______) ☐ Face shield ☐ Hearing protection
☐ Respirator (type: ______) ☐ Fall harness ☐ SCBA
☐ Other: _______________________________________________
Emergency Procedures
Nearest first aid kit: _______________________________________
Nearest fire extinguisher: ___________________________________
Emergency assembly point: ___________________________________
Emergency contacts: _________________________________________
Sign-off
I have read and understood this JSA and will follow the controls specified:
Worker 1: ______________________ Signature: ___________________
Worker 2: ______________________ Signature: ___________________
Worker 3: ______________________ Signature: ___________________
Supervisor: ____________________ Signature: ___________________
When to Use a JSA
- Non-routine maintenance tasks — tasks that are performed infrequently
- Tasks that involve multiple hazards (electrical, hot work, confined space, working at height)
- Tasks that require a permit to work
- New tasks — tasks that haven't been performed before at this site
- Tasks where conditions have changed (new equipment, different process, different personnel)
Important
A JSA is a living document. If conditions change during the work, stop, reassess the hazards, update the JSA, and brief all workers before resuming. Never proceed if the controls specified in the JSA are not in place.