Field Service: Job Safety Analysis (Daily JSA)
Today's Date
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Month
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Day
Year
Date Picker Icon
Plant and Unit(s)
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Plant Emergency Contact
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Plant Emergency Contact Number
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Technician (s)
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Doug Amsler
Nick Saxman
Prince Philip
Other
List the Steps of the Job to be Performed, In Order
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Hazards
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High Fluegas Temperatures
Hot Surfaces
Heavy Lift
Potentially sharp metal
Electricity
Scaffolding
Harness required (Lift or outside of handrails)
Weather Considerations
Positive Pressure Duct
Overhead Objects/Overhead Work
Uncontrolled Pressure
Airborne Dust, Vapors, Chemicals
Excessive Noise
Hot Work
Airborne Liquids
Impact/Pinch Points - Hands and Fingers
Impact/Pinch Points - Feet and Toes
Manual Material Handling
Moving Vehicle/Traffic
Hazardous Chemicals
Sharp Edges/Knives/Blades
Bloodborne Diseases
Rough/Uneven Walking Surface
Snow/Ice
Hazardous Atmospheres
UV Light/Arc Flash/Arc Welding
Cuts/Abrasions to Hands/Arms
Flammable Vapors
Radioactivity
Confined Space Entry
Ladder Use
Struck-by
Caught In-Between
Awkward Body Positions
Worker Behaviors and Attitudes
Inadequate Procedures for the Task Performed
Inadequate or No Planning of the Job or Task
Other
Plan of Action to Eliminate or Control Each Identified Hazard
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Safety Equipment
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Standard PPE (Hard hat, work gloves, steel toed boots, safety glasses, hearing protection)
Hot gloves
Respirator
Fall Protection
High Visibility Vest
Tool Lanyard
Helmet Lanyard
Other
* Confirm with customer if a customer JSA/JHA needs to be filled
Customer JSA Completed?
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YES
NO
If No, please state the reason (eg. no customer JSA/JHA available)
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Submit
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