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    All templatesRisk Assessment · 3 pages · Updated 20 October 2026

    Job Safety Analysis (JSA / JHA) Template

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    Three-page JSA / JHA for one job: job details and why it was chosen, a step, hazard, controls and residual-risk table with 14 rows, a 5×5 score grid with bands, the hierarchy of controls, pre-start checks, a review block and worker, supervisor and EHS sign-off. The usual JSA worksheet layout (not reviewed by OSHA). It plans one job: it is not a risk matrix, an observation record or a method statement.

    What's inside

    Page 1: the job and the analysis

    1. Job information: JSA reference and revision, task or job title with the tools or equipment used, date, location or area, supervisor, participants, why the job was chosen (new, changed, done rarely, past incident or near miss, could cause severe harm), how it was analysed (watched, discussed or both), and the permits and documents needed
    2. Task breakdown, hazards and controls: eight numbered rows of step, hazard, risk (L×S) before controls, controls and residual risk (L×S), plus one filled example row

    Page 2: the scales and the differences

    1. 5×5 risk matrix: likelihood 1 Rare to 5 Almost certain against severity 1 Negligible to 5 Catastrophic, with the four bands: 1-4 Low, 5-9 Moderate, 10-15 High, 16-25 Extreme (stop work), and what each band expects
    2. Hierarchy of controls: elimination, substitution, engineering, administrative, PPE, each with an example
    3. How this form differs from the 5×5 matrix, a safety observation record, a task method statement and a permit to work

    Page 3: continuation, start and sign-off

    1. Six more task rows (9 to 14)
    2. Before the work starts: controls in place, people briefed, permits in place, nothing changed
    3. Review of this JSA: reason, date, what changed and the new revision number
    4. Sign-off: two worker lines, supervisor and EHS reviewer, each with name, signature and date

    The section titles, the scales and the tick boxes are ours, to change.

    What requires or shapes this record

    None of the sources opened for this page prescribes a JSA form or says that every task needs one. They describe the method and set general duties around it. CCOHS in Canada sets out the JSA steps and a sample worksheet, and OSHA's recommended practices in the United States treat job hazard analyses as one source of hazard information and as a briefing before nonroutine work. The law behind them is general: an assessment of the risks of the work, a review when the work changes and, in Great Britain, a written record of the significant findings once an employer has five or more employees; and, in United States general industry, a written certification of the assessment for personal protective equipment. How far a JSA can serve as one of those records depends on what it says and on the rules that apply to you, and this form is not evidence that you have met any of them. The European Union rules on prevention are reached here only through the Great Britain schedule that restates them. This is general information, not legal advice.

    • CCOHS (Canada), OSH Answers: Job Safety Analysis, fact sheet last revised 4 January 2024, opened 20 October 2026

      The Canadian Centre for Occupational Health and Safety describes a JSA as a process that assesses a job to identify hazards and the control measures needed, by breaking the job into basic steps; it names job hazard analysis (JHA) as another term. Its five steps are: select the job, break it into a sequence of steps, identify potential hazards, determine preventive measures, and communicate the results. It lists the factors for choosing jobs to analyse first: incident frequency and severity, potential for severe injury or illness, newly established jobs, modified jobs and infrequently performed jobs. It says most jobs can be described in fewer than ten steps, that steps must stay in sequence and be neither too general nor too detailed, that the job should be observed during normal times and situations (a job done at night should be analysed at night), and that the focus is the job, not the person doing it. The breakdown is reviewed by all participants, always including the worker. Preventive measures should follow the hierarchy of controls and be specific: it says not to use general statements such as "be careful". Each JSA needs revision whenever equipment, raw materials, processes or the environment change, and the results must be communicated to all workers who do or will do the job. Its sample worksheet has three columns (steps, potential incidents or hazards, preventive measures) and lines for analysis by, reviewed by and approved by. It adds that health and safety committee members often have a legal obligation to participate; it does not say that a JSA itself is required. CCOHS's separate Hierarchy of Controls fact sheet (https://www.ccohs.ca/oshanswers/hsprograms/hierarchy_controls.html, last revised 14 August 2024, also opened 20 October 2026) ranks controls from elimination, substitution, engineering and administrative controls to PPE, and notes that some sources, for example CSA Z1002, add a layer for warning systems between engineering and administrative controls.

    • OSHA (United States), Recommended Practices for Safety and Health Programs: Hazard Prevention and Control, with its Hazard Identification and Assessment page, both opened 20 October 2026

      These OSHA pages are recommended practices, not a standard. On hazard identification (https://www.osha.gov/safety-management/hazard-Identification) they list the results of job hazard analyses, also known as job safety analyses, among the information to collect about hazards, and say each hazard should be evaluated by the severity of the potential outcomes, the likelihood of an event or exposure and the number of workers who might be exposed. On hazard prevention they say to involve workers, to select controls by a hierarchy that emphasises engineering solutions (including elimination or substitution) first, then safe work practices, administrative controls and finally personal protective equipment, and to avoid controls that introduce new hazards. For nonroutine tasks they say that before the work starts, job hazard analyses and job safety analyses should be reviewed with the workers involved and others notified of the nature of the work, the schedule and any necessary precautions. OSHA's publication 3071, Job Hazard Analysis, is the guidance this form is structured around; the form is not reviewed by OSHA.

    • Management of Health and Safety at Work Regulations 1999 (Great Britain), regulations 3 and 4 and Schedule 1, opened 20 October 2026; HSE, Steps needed to manage risk, page updated 16 October 2026

      In Great Britain, regulation 3(1) requires a suitable and sufficient assessment of the risks to employees and to other people affected by the employer's undertaking. Regulation 3(3) requires a review if there is reason to suspect the assessment is no longer valid or there has been a significant change, and the changes it shows are needed to be made. Regulation 3(6) requires an employer with five or more employees to record the significant findings and any group of employees identified as especially at risk. Regulation 4 says preventive and protective measures are to be implemented on the basis of the principles in Schedule 1. Schedule 1, which states that it sets out the principles in Article 6(2) of Council Directive 89/391/EEC, includes avoiding risks, combating risks at source, replacing the dangerous by the non-dangerous or the less dangerous, giving collective protective measures priority over individual protective measures and giving appropriate instructions to employees: the principles behind the controls column. HSE's page on managing risk (https://www.hse.gov.uk/simple-health-safety/risk/steps-needed-to-manage-risk.htm) describes five steps: identify hazards, assess the risks, control the risks, record your findings and review the controls. It says to take account of non-routine operations such as maintenance, to involve employees, to review the controls when staff, a process, substances or equipment change, to consider a review after accidents or near misses, and that you must do what is reasonably practicable, not eliminate all risks.

    • 29 CFR 1910.132(d)(1)-(d)(2) (United States), eCFR text current to 16 October 2026, opened 20 October 2026

      US general industry employers must assess the workplace for hazards that call for PPE, select and communicate the PPE, and verify the assessment with a written certification naming the workplace evaluated, the person certifying, the date(s) and that the document is a certification of hazard assessment. If your JSA doubles as that record, it needs all four elements; the template's job block and sign-off cover the first three, so add the certification wording yourself. Paragraph (g) limits paragraph (d) to the PPE standards 1910.133, 1910.135, 1910.136, 1910.138 and 1910.140, and says it does not apply to 1910.134 (respiratory protection) or 1910.137.

    • ISO 45001:2018, clauses 6.1.2 and 8.1.2

      In a certified system, task-level JSAs are one way to evidence clause 6.1.2 (hazard identification and assessment of risks and opportunities) and clause 8.1.2 (eliminating hazards and reducing OH&S risks). The standard does not name the JSA format. ISO's catalogue page, opened 20 October 2026, lists the 2018 edition as published and to be revised, with Amendment 1:2024 (climate action changes) and a draft of a new version in development, so check which edition your certification body audits against. ISO text is not reproduced.

    Each source checked on 20 October 2026. Not legal advice; check the text in force for your site.

    Field by field

    Every labelled part of the form is listed here in the order it appears. Page 2 holds reference tables (the score grid, the hierarchy of controls and how this form differs from other records) and has nothing to fill in. One form covers one job. The tick boxes, scales and wording are ours: change them to fit your procedures and keep them the same between forms if you want to compare jobs.

    JSA reference #
    Why: Lets a permit, toolbox talk or incident report cite the exact version the crew worked to. The revision shows which version a signature belongs to.
    Common mistake: Keeping the same number after a revision, so nobody can tell which version was signed.
    Task / job title
    Why: One job per form. CCOHS says a JSA does not suit a job defined too broadly ("overhauling an engine") or too narrowly ("positioning car jack"). The tools and equipment are written here because they are part of the hazard.
    Common mistake: A generic title such as "maintenance" that fits every job and describes none.
    Date
    Why: Dates the conditions the analysis described. CCOHS says a JSA needs revision when equipment, raw materials, processes or the environment change, and a date is how a reader sees that the analysis may be out of step with the job.
    Common mistake: Writing the date the form was typed up, not the date the job was analysed.
    Location / area
    Why: The same task in another place can have other hazards, so a JSA belongs to a job in a place. If the job is done at night, CCOHS says to analyse it at night, so write the shift too.
    Common mistake: Naming the site but not the area, so the crew cannot tell if this is their job.
    Supervisor
    Why: Names the person who answers for the briefing and for revising the JSA when the job changes. CCOHS says the observer is normally the immediate supervisor, and that a second person finds more.
    Common mistake: A supervisor who completed the form at a desk and never saw the job.
    Participants
    Why: CCOHS recommends a small team of experienced workers and supervisors, because the workers have the knowledge to identify actual and potential hazards at each step; OSHA's recommended practices and HSE also say to involve workers.
    Common mistake: Listing only the supervisor, or listing people who have never done the job.
    Why this job was chosen
    Why: Records the reason for the analysis. CCOHS lists the factors for priority: incident frequency and severity, potential for severe harm, new jobs, modified jobs and jobs done rarely. A reason helps decide when to review.
    Common mistake: Ticking nothing, so a reviewer cannot tell whether the job was picked for a reason or because it was easy to write up.
    How the job was analysed
    Why: CCOHS notes that watching the job does not rely on memory and prompts recognition of hazards, and that for new or infrequent jobs watching may not be practical, when a group discussion is the other route. The tick says which it was.
    Common mistake: Describing a job from memory as though it had been watched.
    Permits and documents needed
    Why: A JSA does not authorise work. This box records that a permit, isolation or other document is needed, and its number, so the crew checks it before starting. For US general industry a PPE hazard assessment certification may be one of these.
    Common mistake: Ticking "permit to work" without a number, or treating the signed JSA as the permission to start.
    Step
    Why: One action per row, in the order the work is done, starting with a verb: what is done, not how. CCOHS says a step out of order can make a team miss hazards or invent ones that do not exist.
    Common mistake: Steps so broad ("fix pump") that basic steps disappear, or so fine that the form runs to pages.
    Hazard
    Why: A scenario: what could go wrong, where, to whom and with what harm. CCOHS offers prompts such as being caught in or between objects, slips, trips and falls, strain from lifting, contact with hot or caustic products and dusts or fumes. At this stage the aim is to list hazards, not to solve them.
    Common mistake: Writing a category ("ergonomic") instead of a scenario ("lifting an 18 kg housing from floor level in a tight bay").
    Risk (L×S) before controls
    Why: Ranks the rows so the controls go to the worst first. HSE says to decide how likely harm is and how serious it could be; OSHA's recommended practices add the number of workers exposed, which this two-factor grid does not score, so think about it in the controls.
    Common mistake: Scoring after the controls are chosen, which hides the reason the controls are needed.
    Controls (hierarchy)
    Why: Forces elimination, substitution and engineering to be considered before procedures and PPE, as CCOHS, OSHA and Schedule 1 of the GB regulations each lay out in their own words. CCOHS says to state what action is taken and how, not "be careful".
    Common mistake: A controls cell that says only "PPE, take care", which is the bottom of the hierarchy and a general statement.
    Residual risk (L×S)
    Why: The team's score with the listed controls in place, so a reader can see what each control is expected to achieve. HSE says you must do what is reasonably practicable, not eliminate every risk, and OSHA says to avoid controls that introduce new hazards.
    Common mistake: Lowering the score because a control exists on paper, without saying who checks that it is used.
    Before the work starts
    Why: OSHA's recommended practices say that before nonroutine work, JHAs and JSAs should be reviewed with the workers involved and others notified; CCOHS says results must be communicated to everyone who does the job. The ticks show that the briefing and the checks happened.
    Common mistake: Ticking the boxes in advance, or when a control is not in place.
    Review of this JSA
    Why: A JSA is not finished when signed. CCOHS says it needs revision when equipment, materials, the process or the environment change; GB regulation 3(3) and HSE say to review an assessment after a significant change, and HSE adds to consider a review after accidents or near misses.
    Common mistake: Reviewing only on a calendar date and not when the job, the equipment or the crew changed.
    Sign-off: worker, supervisor, EHS reviewer
    Why: The worker's signature shows the JSA was explained and the worker could ask questions; it does not show the controls are adequate. The reviewer is a check on scoring and on missing steps; CCOHS's sample worksheet also has analysis by, reviewed by and approved by lines.
    Common mistake: Signing before the briefing, one person signing all lines, or a reviewer who wrote the JSA.

    Worked example

    IllustrativeReplacing a pump seal (invented job, site and scores)

    StepHazard scenarioRisk (L×S) before controlsControlsResidual risk (L×S)
    1. Isolate and lock out pump P-12Pump restarted from the control room while the fitter's hands are in the casing2 × 5 = 10 (High)Lock at the motor isolator and both valves, try-start test, one personal lock per fitter1 × 5 = 5 (Moderate)
    2. Drain and flush the casingResidual caustic splashes the fitter's face when the drain plug is opened3 × 4 = 12 (High)Flush to drain before opening, check pH at the drain point; face shield and chemical gloves as the last layer2 × 3 = 6 (Moderate)
    3. Lift the old seal housing (about 18 kg) to the benchLower-back strain lifting from floor level in a tight bay3 × 3 = 9 (Moderate)Use the bay's lifting davit; two-person lift only if the davit is out of service2 × 3 = 6 (Moderate)
    4. Fit the new seal, refit the guard and remove the locksCoupling left unguarded at restart2 × 4 = 8 (Moderate)Guard refitted before any lock comes off; supervisor checks before hand-back1 × 4 = 4 (Low)
    5. Test runSeal flush line sprays hot liquid at first start with the fitter at the casing2 × 4 = 8 (Moderate)Everyone clear of the casing for the first start, started from the control room, leaks checked from outside the guard1 × 4 = 4 (Low)

    Each score is likelihood × severity on the form's example scale: High is 10-15, Moderate 5-9, Low 1-4. Scores before controls are the team's judgement and the residual scores are what the team expects with the listed controls in place, not a calculation. Rows 1 and 2 are High, so on this form's scale their controls are in place before the job starts, not added during it. Row 1's lockout lowers the likelihood of a restart but not how bad one would be, which is why the severity of 5 stays. The job, site and numbers are invented.

    When a spreadsheet stops being enough

    A paper JSA works while one crew does one job. It stops being enough when the same task is analysed at several sites and nobody can see that one site scored the lockout step 4 and another scored it 10, when a permit or an incident report has to point at the exact JSA version the crew signed, and when a changed control must reach every crew that uses the JSA.

    A software record keeps a shared hazard library, versions each JSA and links it to the permit or observation that relied on it. Offline access matters because JSAs are signed where the work is. In a demonstration, ask how a crew's site-specific edit reaches the owner of the approved version without changing it, how approval is tiered so routine low-hazard work is not held for a senior sign-off, and what a worker sees when a control changes mid-task.

    A signature records acknowledgement, not understanding or competence. The list below applies the rule of the JSA software guide to vendor documentation, not to hands-on testing, so build one of your own JSAs in each product you test.

    Same rule for every product: tagged “Risk Assessment”, “Hazard Management”, “Safety Management”, “EHS Management”, “EHS”, “Construction Safety”, “Permit to Work”, “Permits to Work (PTW)” or “Control of Work”, with a sourced job safety analysis (JSA/JHA) or pre-task planning capability in its record, or one the vendor stated to us, labelled as vendor-stated. Documented and conditional capabilities qualify; check the linked scope before treating a module as included.

    Tekmon pays for a sponsored placement (above); its place in this list follows the same rule as every entry. How lists are ordered

    All 15 matching profiles are shown. Documentation review, not hands-on testing or a claim of compliance.

    Reuse and credit

    Licensed CC BY 4.0: copy, adapt and share this template, also commercially, if you credit it, link to the licence and say if you changed it, without suggesting that QHSEtech endorses you. What the licence covers.

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    Job Safety Analysis (JSA / JHA) Template by QHSEtech (https://qhsetech.com/templates/job-safety-analysis-template), licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/)

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