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JOB SAFETY ANALYSIS
Issued Date:

JOB TITLE: PREPARED BY: DATE:

LOCATION: REVIEWED BY: PAGE: ...OF ......
JOB NO.: APPROVED BY: STATUS: NEW REVISION
PROTECTIVE EQUIPMENT AND SYSTEM REQUIRED TO PERFORM THIS JOB
Hard Hat Leather Gloves Goggles Permit To Work Req.
Safety Shoes Work Vest/ Life Jacket Barricade Other ………….
Safety Glasses Safety Harness Fire Extinguisher
Work Gloves Face Shield Lock Out/ Tag Out

Risk Residual
Sequences of basic Potential hazards Factor Recommended to eliminate or reduce potential Risk Responsible
job steps (Severity x hazards and risks (Severity x Persons
Likelihood) Likelihood)