JOB SAFETY ANALYSIS (JSA) TEMPLATE Last Updated: February 2026 Provided by support.construction ═══════════════════════════════════════════════════════════════ JOB INFORMATION ═══════════════════════════════════════════════════════════════ Project Name: _________________________ Project Number: _________________________ JSA Number: _________________________ Date Prepared: _________________________ Prepared By: _________________________ Title: _________________ Job/Task Description: _________________________________________ _____________________________________________________________ Location/Area: _________________________ Estimated Duration: _________________________ Number of Workers: _________________________ Subcontractor (if applicable): _________________________ Weather Conditions: _________________________ ═══════════════════════════════════════════════════════════════ RISK ASSESSMENT MATRIX (Use for rating each hazard below) ═══════════════════════════════════════════════════════════════ SEVERITY (S): PROBABILITY (P): 1 = Minor (first aid only) 1 = Rare (very unlikely) 2 = Moderate (medical treatment) 2 = Unlikely (happened in industry) 3 = Serious (lost time injury) 3 = Possible (happened on similar projects) 4 = Critical (permanent disability) 4 = Likely (happened on this project) 5 = Catastrophic (fatality) 5 = Almost certain (expected without controls) RISK SCORE = S x P 1-4 = LOW (standard precautions) 5-6 = MEDIUM (implement controls, monitor) 8-10 = HIGH (controls verified before work, supervisor monitors) 12-25 = EXTREME (stop - redesign task or get safety director approval) ═══════════════════════════════════════════════════════════════ JOB STEPS, HAZARDS, AND CONTROLS ═══════════════════════════════════════════════════════════════ STEP 1: Task Description: ____________________________________________ Potential Hazards: ____________________________________________ Risk Rating: Severity _____ x Probability _____ = Score _____ Controls/Precautions: _________________________________________ _____________________________________________________________ Responsible Person: _________________________ ----------------------------------------------------------------- STEP 2: Task Description: ____________________________________________ Potential Hazards: ____________________________________________ Risk Rating: Severity _____ x Probability _____ = Score _____ Controls/Precautions: _________________________________________ _____________________________________________________________ Responsible Person: _________________________ ----------------------------------------------------------------- STEP 3: Task Description: ____________________________________________ Potential Hazards: ____________________________________________ Risk Rating: Severity _____ x Probability _____ = Score _____ Controls/Precautions: _________________________________________ _____________________________________________________________ Responsible Person: _________________________ ----------------------------------------------------------------- STEP 4: Task Description: ____________________________________________ Potential Hazards: ____________________________________________ Risk Rating: Severity _____ x Probability _____ = Score _____ Controls/Precautions: _________________________________________ _____________________________________________________________ Responsible Person: _________________________ ----------------------------------------------------------------- STEP 5: Task Description: ____________________________________________ Potential Hazards: ____________________________________________ Risk Rating: Severity _____ x Probability _____ = Score _____ Controls/Precautions: _________________________________________ _____________________________________________________________ Responsible Person: _________________________ ----------------------------------------------------------------- STEP 6: Task Description: ____________________________________________ Potential Hazards: ____________________________________________ Risk Rating: Severity _____ x Probability _____ = Score _____ Controls/Precautions: _________________________________________ _____________________________________________________________ Responsible Person: _________________________ ----------------------------------------------------------------- STEP 7: Task Description: ____________________________________________ Potential Hazards: ____________________________________________ Risk Rating: Severity _____ x Probability _____ = Score _____ Controls/Precautions: _________________________________________ _____________________________________________________________ Responsible Person: _________________________ ----------------------------------------------------------------- STEP 8: Task Description: ____________________________________________ Potential Hazards: ____________________________________________ Risk Rating: Severity _____ x Probability _____ = Score _____ Controls/Precautions: _________________________________________ _____________________________________________________________ Responsible Person: _________________________ ----------------------------------------------------------------- STEP 9 (if needed): Task Description: ____________________________________________ Potential Hazards: ____________________________________________ Risk Rating: Severity _____ x Probability _____ = Score _____ Controls/Precautions: _________________________________________ _____________________________________________________________ Responsible Person: _________________________ ----------------------------------------------------------------- STEP 10 (if needed): Task Description: ____________________________________________ Potential Hazards: ____________________________________________ Risk Rating: Severity _____ x Probability _____ = Score _____ Controls/Precautions: _________________________________________ _____________________________________________________________ Responsible Person: _________________________ ═══════════════════════════════════════════════════════════════ ENVIRONMENTAL CONDITIONS ═══════════════════════════════════════════════════════════════ Temperature: ________ Wind Speed: ________ Precipitation: ________ ☐ Heat illness prevention plan in effect (>80°F) ☐ Cold stress prevention plan in effect (<40°F) ☐ High wind plan in effect (>25 mph) ☐ Lightning safety plan in effect (storms within 10 miles) ☐ Wet/slippery conditions — additional controls needed Environmental Notes: __________________________________________ _____________________________________________________________ ═══════════════════════════════════════════════════════════════ PERSONAL PROTECTIVE EQUIPMENT (PPE) ═══════════════════════════════════════════════════════════════ MINIMUM REQUIRED (check all that apply): ☐ Hard Hat (Type: _____) ☐ Safety Glasses (ANSI Z87.1) ☐ Hearing Protection (Type: _____ NRR: _____) ☐ Safety Boots (ASTM F2413 Steel/Composite Toe) ☐ Work Gloves (Type: _____) ☐ High-Vis Vest (ANSI Class: _____) TASK-SPECIFIC PPE (check all that apply): ☐ Fall Protection Harness + Lanyard/SRL ☐ Respirator (Type: _____ Cartridge: _____) ☐ Chemical-Resistant Gloves (Type: _____) ☐ Cut-Resistant Gloves (Level: _____) ☐ Face Shield (Type: _____) ☐ Arc Flash PPE (Cal Rating: _____ cal/cm²) ☐ Voltage-Rated Gloves (Class: _____) ☐ Welding Hood/Goggles (Shade: _____) ☐ Knee Pads ☐ Chaps/Leg Protection ☐ Rubber Boots ☐ Other: _________________________ ☐ Other: _________________________ ═══════════════════════════════════════════════════════════════ PERMITS AND CERTIFICATIONS REQUIRED ═══════════════════════════════════════════════════════════════ ☐ Hot Work Permit (Permit #: _____) ☐ Confined Space Entry Permit (Permit #: _____) ☐ Excavation/Trenching Permit (Permit #: _____) ☐ Critical Lift Plan (Plan #: _____) ☐ Lockout/Tagout Authorization ☐ Energized Work Permit ☐ Other Permit: _________________________ (#: _____) Competent Person Required: ☐ Yes ☐ No If Yes, Name: _________________________ Qualification: _________ Qualified Person Required: ☐ Yes ☐ No If Yes, Name: _________________________ Qualification: _________ ═══════════════════════════════════════════════════════════════ TRAINING REQUIREMENTS ═══════════════════════════════════════════════════════════════ Required Training (check all that apply): ☐ OSHA 10-Hour Construction ☐ OSHA 30-Hour Construction ☐ Fall Protection ☐ Scaffold User ☐ Confined Space Entry ☐ Lockout/Tagout (LOTO) ☐ Electrical Safety / NFPA 70E ☐ Excavation / Trenching Safety ☐ Crane Signaler / Rigger ☐ Hazard Communication (HazCom) ☐ Silica Awareness ☐ Respiratory Protection / Fit Test ☐ First Aid / CPR / AED ☐ Forklift / Equipment Operation ☐ Hot Work / Fire Watch ☐ Other: _________________________ Verify all workers have required training before signing below. ═══════════════════════════════════════════════════════════════ EMERGENCY PROCEDURES ═══════════════════════════════════════════════════════════════ Emergency Contacts: Safety Director: _____________________ Phone: ________________ Site Supervisor: _____________________ Phone: ________________ Project Manager: _____________________ Phone: ________________ 911 for all life-threatening emergencies First Aid Kit Location: _________________________ AED Location: _________________________ Eye Wash Station: _________________________ Fire Extinguisher: _________________________ Spill Kit Location: _________________________ Evacuation Route: _________________________ Muster Point: _________________________ Nearest Hospital: _________________________ Hospital Address: _________________________ Estimated Drive Time: _________________________ ═══════════════════════════════════════════════════════════════ WORKER ACKNOWLEDGMENT ═══════════════════════════════════════════════════════════════ By signing below, I confirm that: - I have reviewed this JSA and understand all identified hazards - I understand the controls and will follow them - I have the required training for this task - I have been provided the required PPE - I will stop work and notify my supervisor if conditions change Name (Print) | Signature | Date | Company/Trade ----------------------|--------------------|----------|--------------- | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | ═══════════════════════════════════════════════════════════════ APPROVAL ═══════════════════════════════════════════════════════════════ Prepared By: _________________________ Date: ___________ Signature: _________________________ Reviewed By: _________________________ Date: ___________ Signature: _________________________ Approved By: _________________________ Date: ___________ Signature: _________________________ ═══════════════════════════════════════════════════════════════ REVISION LOG ═══════════════════════════════════════════════════════════════ Rev # | Date | Description of Change | Changed By ------|------------|------------------------------|--------------- 1 | | | 2 | | | 3 | | | ═══════════════════════════════════════════════════════════════ NOTES ═══════════════════════════════════════════════════════════════ Additional Notes: _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ ═══════════════════════════════════════════════════════════════ Hierarchy of Controls Reminder (apply in this order): 1. ELIMINATION - Remove the hazard entirely 2. SUBSTITUTION - Replace with something less hazardous 3. ENGINEERING CONTROLS - Physically isolate workers from hazard 4. ADMINISTRATIVE CONTROLS - Change how work is done 5. PPE - Personal Protective Equipment (last resort) ═══════════════════════════════════════════════════════════════ Template provided by support.construction Customize with your company name and logo.