Job Safety Analysis Assessment Form
A job safety analysis (JSA) assessment form to review the quality and completeness of a specific JSA. Checkout the Forms Library »
What is a JSA Assessment?
A JSA (Job Safety Analysis) Assessment is a risk assessment process use to determine the effectiveness of a specific JSA as undergone by a team. During this review, questions are asked such as:
- Was the job ready for execution: adequate planning completed with appropriate risk assessment carried out and any associated requirements identified in advance and appropriately addressed?
- Were appropriate personnel involved in the JSA development?
- Is the task description full and clear?
- Was all PPE checked and satisfactory?
- Was the Person In Charge clearly identified and PIC protocol in effect?
- Was all appropriate training completed for job task performed?
- Are appropriate specific written instructions or procedures available?
- Are the instructions adequate?
- Were all potential hazards identified?
- Were all Go-Card questions answered?
- Have all members of the work team signed the JSA?
- Are all persons aware of correct actions to be taken in emergency?
- If any deviation to plan occurred was the job stopped and the JSA appropriately amended for scope change?
This form is a sample report which can be imported into your KPA Flex account. All forms including this one can be easily modified to fit your organization's policies and procedures.
Don't have a KPA Flex account? Download the printable Job Safety Analysis Assessment PDF form so your team can fill out a paper copy.
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