▤ JSA BUILDER

Job Safety Analysis

Walk through the job before you start. Break it into steps. For each step: what could go wrong, and what controls keep it from happening.

JOB INFO

Date / Time *

Location *

Job Title / Task *

First Name *

Last Name *

Crew Members (names, comma separated)

PPE REQUIRED

PERMITS REQUIRED

JOB STEPS

Add a row for each step of the job. Identify hazards and the control to prevent them.

SITE PHOTO (optional)

+ TAP TO CAPTURE

Worksite, equipment, hazards visible

NOTES

SIGNATURE *

Sign above with finger or stylus