Job Safety Analysis Assessment sample. Edit it or build your own.

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 »

Job Safety Analysis Assessment - Printable PDF
Download a printable Job Safety Analysis Assessment (PDF).

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 iScout account and modified to fit your organization's policies and procedures.

If you don't have an iScout account, download the printable Job Safety Analysis Assessment PDF form so your team can fill out a paper copy.



Check out the forms library.
Check out the forms library.

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