Document No: FRM-OHS-GEN-003

Job Safety Analysis Revision: 1.0

Issue Date: 28-Sept-2016

Page: 1 of 3

JSA No. JSA Developed by Reviewed by

Location

Equipment Date

Task Description Risk Rating (highest of individual steps)

Initial (before controls) Residual (after control)

Date

Permit required Special PPE required Special tools or equipment required (gas detection, ventilation fans, lighting, scaffolding etc.)

No Permit Required

Confined Space Excavation

Hot Work Group Isolation

Fire/Emergency equipment requirements (Fire extinguishers, rescue gear etc.) Hazardous materials (List any hazardous materials to be used and attach MSDS)

POTENTIAL HAZARDS / RISKS WHICH MAY BE PRESENT

Heat Confined Spaces Engulfment Interruption to Services

Noise Access/Egress from confined spaces Explosive Atmosphere Lifting Equipment
Asphyxiation Dusts Fire/Explosion Lighting
Atmosphere/Gases Electric Shock Molten Metal Manual Handling
Chemical/Biological Chemicals Weather Conditions Oxy Welding & Cutting
Mobile Equipment Environmental damage Waste Pinch Points
Stored Energy Tools Working at Heights Slips/Trips
Poor Housekeeping Excavations Parked in a Safe Condition Equipment suspended or likely to move
Other

*Uncontrolled* Printed : 10-Jun-17 Review 2 years after issue date

 Document No: FRM-OHS-GEN-003

Job Safety Analysis Revision: 1.0

Issue Date: 28-Sept-2016

Page: 2 of 3

STEP JOB STEP POTENTIAL HAZARD INITIAL HAZARD CONTROL MEASURES RESIDUAL RESPONSIBLE PERSON
No. List the steps required to perform the job For each step list the potential hazards RISK For each hazard identified list the control RISK List the person responsible
in the sequence it is carried out that could cause injury or damage when RATING measures required to eliminate or RATING for implementing the
each job step is carried out minimize the risk of injury or damage After required hazard control
Before
controls measures
controls
1. 1
2. 5
3. 6
4. 7
5. 8
6.
7.
8.
9.

10.
11.
12.
13.
14.

15.
16. 4

17. 5
18.
19.
*Uncontrolled* Printed : 10-Jun-17 Review 2 years after issue date
 Document No: FRM-OHS-GEN-003

Job Safety Analysis Revision: 1.0

Issue Date: 28-Sept-2016

Page: 3 of 3

20.

*Uncontrolled* Printed : 10-Jun-17 Review 2 years after issue date