Job Safety Analysis Form

Site Name:

Job/Ticket #:

Site Location:

Emergency Assembly Point:

eg, Carpark or flagpole etc

Technicians Working on site:

Other

Technicians Working on site:

enter multiple names for multiple people

SEQUENCE OF BASIC STEPS
List the four-eight steps required to complete the job. (Follow the flow of the Product or the Process)

POTENTIAL HAZARDS / RISKS
List the potential hazards and risks beside each step. Focus on what can cause harm and what can go wrong.

HAZARD CONTROL METHOD
List the control methods required to ELIMINATE or MINIMISE each hazard or risk.

Fill in the site specific hazards below:

Rows	Seq. of Basic Steps	Potential Hazards / Risks	Hazard Control Method
1
2
3

PPE Required:

All workers, and visitors are to sign this form. Signing acknowledges that you have been made aware of all identified hazards and risks, the requirement to report any hazards or risks you may create and the requirement to report any accidents or incidents to the site foreman.

Signed:

Signing this box will submit a digital representation of your signature. It is considered a legal equivalent of a handwritten signature so it's strongly advised that you understand what you are signing.