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JSA Format Form

The document outlines a job safety analysis (JSA) for a job. It lists potential hazards, control measures, required personal protective equipment, additional precautions, and certifies that qualified persons will perform the work according to safety rules.

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Mohammad Ataullah
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© © All Rights Reserved
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12 views3 pages

JSA Format Form

The document outlines a job safety analysis (JSA) for a job. It lists potential hazards, control measures, required personal protective equipment, additional precautions, and certifies that qualified persons will perform the work according to safety rules.

Uploaded by

Mohammad Ataullah
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
Download as pdf or txt
Download as pdf or txt
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JSA – Job Safety Analysis

JOB SAFETY ANALYSIS JSA Number: Date:


derg dffgdf
JSA DONE BY: PTW/LWC No sdgdf
Work Instruction#/ JOB PLAN # sdfg

JOB (Brief description)


rfgbfd

JOB LOCATION sdfrgdf DEPARTMENT drfgder


PERSON
JOB PLAN CONTROL RESIDUAL RISK RESPONSIBLE FOR
SL HAZARDS
STEPS MEASURES (High/Medium/Low) CONTROL
MEASURE

2
3

PPE Safety Eye/Face Hearing Respiratory Other Other


Helmet Gloves
REQUIRED Shoes Protection Protection Protection PPE PPE
(Yes/No)
ergrreergewrggg ergrreergewrggg
ergrreergewrggg ergrreergewrggg
ergrreergewrggg ergrreergewrggg
ergrreergewrggg
ergrreergewrgg
ADDITIONALPRECAUTIONS /
CONTROL MEASURES, IF ANY: erg

FURTHER PRECAUTIONS / CONTROL


MEASURES, IF ANY: sdfrg
TOOLBOX TALK / erg

TRAINING TO BE GIVEN BY: erg


This is to certify that all work under the scope of the above Job Plan shall be undertaken
By qualified competent persons with experience of the type of work described above, and in all cases in full accordance with NTPC
safety rules (E&M) and conditions of the safety document. What-If failure scenarios have been considered like failure of
tools, tackles, work equipment in this JSA.
Area Engineer Name erg HOS* Name erg
Signature erg Signature erg

*HOS = Head of Section

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