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Job Safety Analysis
Task steps, hazards and controls for a pre-job safety briefing, with crew sign-on.
TURNAROUND QC
Turnaround QC
turnaroundqc.com
Project
Job No.
Client
Sheet ____ of ____
JSA No.
Date
Time
Contractor / Crew
Location / Work Area
Prepared By
Task / Scope of Work
Permits Required
None
Lockout / Tagout
Line Break
Hot Work
Confined Space
Blinding
Radiography
Excavation
Elevated Work
Critical Lift
PPE Required
Hard Hat
Safety Glasses
Face Shield
Hearing
FR Clothing
Cut-Resistant Gloves
Chemical Gloves
Steel Toe Boots
Fall Protection
Gas Monitor
SCBA / SAR
Chemical Suit
Isolation Point(s) / Blind No.
Stored Energy — pressure, residual product, heat, spring
Lift Plan Required / Ref
#
Job Step
Potential Hazard
Controls / Safe Work Practice
1
2
3
4
5
6
7
8
Muster Point
Nearest Hospital
Emergency Contact / Phone
First Aid / AED Location
#
Crew Name (print)
Company
Signature
1
2
3
4
5
6
Prepared by / Date
Supervisor / Competent Person / Date
Safety Representative / Date
TA-JSA-01 | Rev 0
Free blank form from
TURNAROUND QC
— turnaroundqc.com