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Job Safety Analysis
Task steps, hazards and controls for a pre-job safety briefing, with crew sign-on.
SPARKY QC
Electrical QA/QC
sparkyqc.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
Energized Work
Lockout / Tagout
Hot Work
Confined Space
Excavation
Elevated Work
Critical Lift
PPE Required
Hard Hat
Safety Glasses
Face Shield
Hearing
Voltage-Rated Gloves
FR / AR Clothing
Arc Flash Suit
Insulated Tools
Fall Protection
Gas Monitor
Arc Flash Category / Incident Energy
Approach Boundary
Voltage / System
#
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
7
8
Prepared by / Date
Supervisor / Competent Person / Date
Safety Representative / Date
SQ-JSA-01 | Rev 0
Free blank form from
SPARKY QC
— sparkyqc.com