Job Safety Analysis Template 1Job Safety Analysis Template 1
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Job/Task: ___________________________________________________ Date: ___________
† New
Work Location: _____________________________________
Employee(s): _________________________________________________________________ † Revised



In case of an incident, the following people
will be contacted:
Supervisor:________________________
Safety:___________________________
Other:_____________________________

What is the most hazardous part of this job and what are you going to do to control the hazard?_____________________________________
Are you properly trained to complete these tasks? _____________________________ † SSE___________________ † Mentor __________________
What do you need to ensure this job is completed incident and injury free? _____________________________________________________
What conditions, job changes or distractions could call for the need to use Stop Work Authority?_____________________________________
Recommended Action/Procedure
Examine each step
Sequence of Job