• The steps involved in performing a specific job.
• The existing or potential safety and health hazards associated with each step.
• The recommended action(s)/procedure(s) that will eliminate or reduce these hazards and the risk of a workplace injury or illness.

• The existing or potential safety and health hazards associated with each step.
• Impact with a falling or flying object.
• Penetration of sharp objects.
• Caught in or between a stationary/moving object.
• Falls from an elevated work platform, ladders or stairs.
• Excessive lifting, twisting, pushing, pulling, reaching, or bending.
• Exposure to vibrating power tools, excessive noise, cold or heat, or harmful levels of gases, vapors, liquids, fumes, or dusts.
• Repetitive motion.
• Electrical hazard.
• Light (optical) radiation (i.e., welding operations, laser surveying, etc.).
• Water (potential for drowning or fungal infections caused by wetness).

1. Select jobs with the highest risk for a workplace injury or illness.
2. Select an experienced employee who is willing to be observed. Involve the employee and his/her immediate supervisor in the process.
3. Identify and record each step necessary to accomplish the task. Use an action verb (i.e. pick up, turn on) to describe each step.
4. Identify all actual or potential safety and health hazards associated with each task.
5. Determine and record the recommended action(s) or procedure(s) for performing each step that will eliminate or reduce the hazard (i.e. engineering changes, job rotation, PPE, etc.).

A sample JSA for "Trash Compacting" is presented below, and includes both a completed form as an example and a blank form that can be downloaded for use. For further information, please refer to OSHA's Publication #3071, or contact the Safety Office at 602-506-8601.

Trash Compacting
Maricopa County Parks

Trash compacting is accomplished at the various Maricopa County Parks by an assigned multi-person ground crews. Each full dumpster is rolled into the liftgate and secured in position. The operator then activates the liftgate to lift/tip the dumpster, which is sprayed clean. After being lowered, the dumpster is rolled to a designated area for placement on the grounds.

When performing this activity, always remember to take the following safety precautions:

Steps:	Always Remember to:
Push/pull full dumpster into hydraulic lift gate.	Use your body weight by pushing the dumpster's to move them. Pull to steer/guide the dumpster. Wear protective canvas or leather gloves. Drain water from dumpster, if possible, to reduce the weight.
Raise hydraulic lift gate to "UP" position, dumping contents.
Spray remaining trash residue from raised dumpster with water hose.	Wear eye or face protection when spraying/cleaning the dumpster.
Lower hydraulic lift gate and emptied dumpster back to ground level.	Stay clear from the lowering area.
Pull the empty dumpster from the lift gate to the designated area for placement on grounds.	Push dumpster's to move, pull to steer/guide. Wear protective canvas or leather gloves.

JSA Forms:

Click on the image to the right to see a full-sized, completed sample JSA form.
Click on the image to to the right to open a new window and retrieve a blank, fully editable Word-97 JSA form that you can save and use for your various JSA needs. Fill in the blanks and then click on 'save as' to save the completed form with your selected file name and place it in the folder/directory of your choice.

To see more examples of JSA's please visit our JSA Library.

SOURCE CREDIT:
The information for the JSA web pages presented here were initially developed by the State of Wisconsin's Risk Management Department at http://www.doa.state.wi.us/docs_view2.asp?docid=2579

Disclaimer: This JSA description and form have been posted as general information for increasing safety awareness. The Safety Division's web site and pages are provided for information purposes only. Information on this web page is subject to change without notice. Maricopa County does not accept any liability to any person for the information or advice (or the use of such information or advice) that is provided, on the basis that all persons accessing the site undertake responsibility for assessing the relevance and accuracy of its content. No liability is accepted for any information or services that may appear in any other format. We make every effort to insure the integrity and validity of the data on the web page, however, we assume no responsibility for any information or services that may appear on any linked web sites. Continued use of this web site signifies that you have accepted the terms of the disclaimer.

Last updated: 16 Mar 2005, jld