JOB SAFETY ANALYSIS WORKSHEET

JOB SAFETY ANALYSIS WORKSHEET

No.:

Job:

Section:

Skills Required:

Required Personal Protective Equipment:

Tools & Equipment Required:

Job Preparation:

Analysis By:

Reviewed by:

Date: Approved by:

Hazardous Materials: Sequence of Basic Job Steps

Special Requirements:

Potential Accidents or Hazards

Recommended Safe Job Procedures

1. Struck-By (SB) 2. Struck-Against (SA) 3. Contact-By (CB)

4. Contact-With (CW) 5. Caught-On (CO) 6. Caught-In (CI)

7. Caught-Between (CBT) 8. Foot-Level-Fall (FLF) 9. Fall-To-Below (FB)

10. Over-Exertion (OE) 11. Exposure (E)

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