Completed by

Job Safety Analysis Form

Date of completion

Type something
Company Details
Company name Company address

Name of person responsible for JSA Phone number of person responsible

Email of person responsible Position of person responsible

Job Details
Job number Job name

Job address Client contact name

Client contact phone Client contact email

Equipment to be used Maintence checks required prior to work commencing

Tools required for this work Materials to be used

PPE required Permits required

Staff present on job Licences required

Steps Required to Complete the Job
Step no. Name of the step Hazards involved Risk scrore Control method Person(s) responsible for this step
Steps Required to Complete the Job Continued
Step no. Name of the step Hazards involved Risk scrore Control method Person(s) responsible for this step
 Risk Assessment Use the risk rating table to assess the level of risk for each job step

Potential severity of injury or illness

Likelihood
of hazard Negligible Minor Moderate Major Severe
happening
Almost
Certain 5 10 15 20 25
Likely 4 8 12 16 20
Possible 3 6 9 12 15
Unlikely 2 4 6 8 10
Rare 1 2 3 4 5
Low Risk Medium Risk High Risk