Job Safety Analysis

Project No.*

Date*

Contractor

Supervisor Name

Describe The Task Analyzed and Task Location*

Prepared By (Name / Role / Company)*

Section 1: Commonly Applicable Hazards

Supervisor/Foreman should interact with their respective teams before start of work and engage team members using open questions.

Activity Steps / Hazards Involved / Mitigation Measures*

Description

Risks

Mitigations

Applicable *

Yes No

Describe Possible Emergency Situation

Response Plan

Applicable *

Yes No

Load being lifted (A) lbs / kgs

Wt. of rigging / shackle (B) lbs / kgs

Sling, shackles - capacity / rating

Total Load (A+B) lbs / kgs

Lift Capacity (consider reduction factor due to sling/rigging angle) lbs / kgs

% of total load / chart capacity

Add Sketch (if applicable)

Maximum file size: 8MB per photo

Applicable *

Yes No

Section 5 - Other details

By signing/putting initials below, you acknowledge you have understood the task, hazards, and control/mitigation measures.

Print Name

Initial