JOB SAFETY ANALYSIS (JSA) CHECKLIST
The intent of this checklist is to assist in the identification of hazards related to the job and the preparation of the JSA. Prior to performing a JSA, check each item on the list that applies. All applicable items must be addressed in JSA.

	PHYSICAL HAZARDS			ENVIRONMENTAL			ORGANIZATIONAL FACTORS	
 	Slippery Floor		 	Extreme Conditions (e.g. Heat /		 	Training (Competency)	
 	Soft Surface			Cold / Heavy Rain)		 	Language / Communication	
 	Sharp Objects		 	Noise		 	Supervision	
 	Falling Object		 	Radiation		 	Rules & Procedures	
 	Hot Surfaces					 	Controls	
 	Moving Vehicle					 	New Employee	
 	Rotating Parts			HAZARDOUS CONDITIONS		 	Work Permit (Visa)	
 	Collapse (Soil)		 	High Elevation		 	Competent Person	
			 	Poor Lighting				
			 	Extreme Weather				
	PHYSIOLOGICAL & ERGONOMIC			¨Abnormal Temperature			WORK ENVIRONMENT	
 	Wrong Posture			¨High Wind		 	Access / Egress / Escape Routes	
 	Personal Disability			¨Rain / Storm			¨Scaffolds	
 	Claustrophobia			¨Abnormal Humidity			¨Suspended Access	
 	Workplace Fatigue			¨Lightning			¨Mobile Platforms	
	¨Inadequate rest time between 		 	Temporary Facilities			¨Ladders / Lightweight Staging	
	    a work set		 	Non Breathable Conditions (e.g. 			¨Main Storm Drain	
	¨Long hours of work in a			Nitrogen, Above PEL etc.)				
	    single shift		 	Heavy / Abnormal Vibration		 	General Workplace Conditions	
	¨Long hours of work across		 	Limited Access			¨Workspace	
	    a work set		 	Chemical Reaction			¨Light	
	¨Inadequate breaks within a						¨Heat / Cold Stress	
	    single shift						¨Noise & Vibration	
	¨Changes to rosters			HAZARDOUS ACTIVITIES			¨Weather / Atmosphere	
			 	Working in Confined Space			¨Special Workplace Conditions	
			 	Excavation Work			¨At Heights	
	CHEMICAL		 	Lifting			¨Over Water	
 	Hydrocarbon under pressure		 	Climbing / Working at Height			¨In Excavations	
 	Toxic substances		 	Handling Hazardous Chemical			¨On or Near Live Plant	
 	Pyrophoric Materials		 	High Pressure Water Jetting (HPWJ)				
 	Flammable		 	Driving		 	Plant and Equipment	
 	Corrosive (Acid / Alkaline)		 	Manual Handling			¨Portable Tools	
			 	Use of Tools and Machinery			¨Abrasive Wheels	
			 	Walking Through or Standing			¨Cartridge-operated Tools	
	BIOLOGICAL			Close to Moving Object /			¨Hand Tools	
 	Bacteria / Air Borne Virus			Rotating Equipment				
 	Marin Growth		 	Working on Machines and Doing		 	Services & Consumables	
 	Animal (e.g. Dog, Boar, Lizards etc.)			Crushing, Cutting, Tearing,			¨Electricity	
 	Venomous Insect (e.g. Bee, wasp,			Shearing items or equipment			¨Compressed Air	
	Centipede, scorpion etc.)						¨Steam	
							¨Consumables (e.g. LPG, Petrol / 	
				TASK FACTORS			    Gasoline etc.	
	ELECTRICAL		 	Workload			¨Hazardous Substances	
 	High Voltage		 	Workplace, Effort, Exertion			¨Process Fluids and Solids	
 	Electrical Current		 	Skill, Knowledge & Experience			¨Dusts, Mists, Smoke and Fumes	
 	Short Circuit		 	Complexity			¨Construction Materials	
 	Electrical Fire		 	Time, Timing				
 	Static		 	Decision Making				
 	Loss of Power		 	Repetitiveness		 	LEGAL REQUIREMENTS	
 	Radiological					 	Authority Notification	
 	Ionizing Radiation					 	Medical Surveillance	
 	Electromagnetic Field		 	OTHERS		 	Chemical/Noise Exposure Monitoring	
 	Laser Beam			¨		 	Chemical Health Risk Assessment	
				¨		 	Scheduled Waste	
				¨				
								
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