JOB SAFETY ANALYSIS WORKSHEET (EXAMPLE)

Department: Dye	Job Analyzed: Dyeing Machine Operator
Occupation: Dyeing Machine Operator	Date Completed:
	Completed By: Name of Supervisor or other person conducting JSA

SEQUENCE OF JOB STEPS	POTENTIAL ACCIDENTS OR HAZARDS	SEQUENCE OF JOB STEPS
1. Places can at jet.	a. Pull muscle when moving.	a.(1) Push cans instead of pulling.
		(2) Ensure wheels are free. P.M. checks and work orders. Remove defective cans.
	b. Mash toe when moving.	b. Same as a.(1) above.
	c. Mash hands between can and other objects.	c. Keep hand away from edge and sides of can.
	d. Slip on wet floor.	d. Use rubber boots. (Check on adequacy of boots).
2. Open doors.	a. Sprayed by steam.	a. Open safety valve.
	b. Mash hand when opening.	b. Be aware of hand position.
3. Locate seams and cut down.	a. Cut hand with knife.	a. Use scissors.
4. Thread unload reel.	a. Pull muscle when throwing cloth over reel.	a. Refer to hiring standards and encourage employee to warm up/stretch prior to work.
5. Monitor unloading of cloth.	a. Has no apparent hazards.
6. Reset controls.	a. Slips and falls when walking.	a. Wear rubber boots.
7. Move can to staging area.	a. Same as Step #1.	a. Have additional worker help move can.
		b. Same as Step #1.

JOB SAFETY ANALYSIS WORKSHEET

Department:	Job Analyzed:
Occupation:	Date Completed:
	Completed By:

SEQUENCE OF JOB STEPS

POTENTIAL ACCIDENTS OR HAZARDS

ACCIDENT PREVENTION MEASURES

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Last updated: October 2003