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Job Safety Analysis (JSA/JHA) Form

Break a task into steps, assess hazards with the people doing the work, and document controls before starting. Use the practical example and editable worksheet below.

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How to use this worksheet

Define the task, equipment, work location and people who may be exposed.
Observe the actual job with workers and break it into meaningful steps.
Record credible hazards at each step, including stored energy, falls, pinch points and simultaneous operations.
Prioritise elimination, substitution and engineering controls; verify permits and other authorisations separately.
Assign owners, brief the team and reassess the analysis if conditions or methods change.

Worked field example

Worked example — Opening a pipe flange: Step: Isolate the line. Hazard: Residual pressure or process fluid release. Control: Approved isolation plan, LOTO, draining and verified zero-energy state; do not open the joint until checks are complete.

SERNEM — FIELD WORKSHEET

Job Safety Analysis (JSA/JHA) Form

Adapt this worksheet to actual site conditions.

Job details

Task descriptionLocation / equipmentDate / shiftTeam / contractorPermit-to-work reference

Task steps, hazards and controls

Job step	Hazard and credible consequence	Required control	Owner / verification
Job step 1	Hazard and credible consequence 1	Required control 1	Owner / verification 1
Job step 2	Hazard and credible consequence 2	Required control 2	Owner / verification 2
Job step 3	Hazard and credible consequence 3	Required control 3	Owner / verification 3
Job step 4	Hazard and credible consequence 4	Required control 4	Owner / verification 4
Job step 5	Hazard and credible consequence 5	Required control 5	Owner / verification 5

Review and change control

Reviewed by / roleTeam briefed and dateConditions requiring stop and reassessment

This worksheet supports field planning. It does not replace an approved risk assessment, PTW, LOTO, competent supervision or applicable local legal requirements.

Frequently asked questions

Are JSA and JHA the same?

The terms are often used interchangeably in practice. Both examine task steps, hazards and controls; use your organisation's terminology.

When should a JSA be reviewed?

When the work method, equipment, people, simultaneous activities or conditions change, and following incidents, near misses or failed controls.

Related SERNEM resources

JSA technical guide →Risk assessment tool →Method statement tool →

Technical sources

This worksheet supports field planning. It does not replace an approved risk assessment, PTW, LOTO, competent supervision or applicable local legal requirements.