6207 Jim Snow Way · Chattanooga, TN 37421
Office 423.541.3210 · Fax 423.541.3209
www.liquidmetal-solutions.com

JSA

Job Safety Analysis / Pre-Job Briefing · with Site Work Permit information

Job identification
Pre-task planning

Safety Principles: Plan Every Job, Anticipate Unexpected Events, Use Right Tools, Use Procedure, Isolate Equipment, Identify Hazards, Minimize Hazards, Protect Person, Assess Abilities, Audit Principles.

Permits, protective equipment & fire protection

Same information the customer's site work permit asks for. A site permit does not replace this JSA — it gives the plant the details it needs about third-party work. Keep both at the work area.

Required permits / tests / actions
ItemYesNoPermit # / detail
LOTO required
Confined space permit
Gas testing required
Hot work permit
Contractor orientation completed
Other
Protective equipment required
Fire protection required
ItemYesNoDetail
Monitoring system
Fire watch
Fire extinguisher
Other
Identify hazards

Tick every hazard on this job. Pick them once here — the review questions below and each step use this list.

Identify safety hazards
Hazard review — confirm before work starts

Go through these out loud with the whole crew. The questions come from the hazards ticked above, so only what applies to this job shows. A No means fix it first — write what you are doing about it. The crew signs off on these answers below.

Tick the hazards for this job above and the review questions for them will appear here.

Task of job
Crew review & sign-off

Lock in the steps above before the crew signs.

By signing, I confirm I have read the hazards and review answers for this job, I understand the controls for each step, and I will stop work and speak up if conditions change or anything is unclear.

Supervisor approval
Customer / control room authorization

Complete only when the customer site's permit requires a control room or plant sign-off before work starts.

The work scope has been reviewed, and the work may proceed.