Job Safety Analysis

Analysis Performed By:

First Name

Last Name

Location

Company Name

Specific activity performed at the location

Break down the activity step by step and note what tasks are needed to complete the activity, what the hazards are for the task and what controls are in place to prevent the hazards.

Step #1

Task #1

Hazard #1

Control #1

Is another task necessary?

Yes No

Step #2

Task #1

Hazard #2

Control #2

Is another task necessary?

Yes No

Step #3

Task #3

Hazard #3

Control #3

Is another task necessary?

Yes No

Step #4

Task #4

Hazard #4

Control #4

Is another task necessary?

Yes No

Step #5

Task #5

Hazard #5

Control #5

Is another task necessary?

Yes No

Step #6

Task #1

Hazard #6

Control #6

Is another task necessary?

Yes No

Step #7

Task #1

Hazard #7

Control #7

Is another task necessary?

Yes No

Step #8

Task #1

Hazard #8

Control #8

Is another task necessary?

Yes No

Step #9

Task #9

Hazard #9

Control #9

Is another task necessary?

Yes No

Step #10

Hazard #10

Control #10

Task #9

Signature

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