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Job Safety Analysis Worksheet <br />Employee Activity: Forklift operation <br />Supervisor: Darryl Strongheart <br />Location of worksite: Bay 1 — 7 <br />Position entails transporting of manufactured goods <br />Description of work: between each bay. Moving and storing of material <br />on the yard. Relocation of transporting of hazardous <br />waste as needed. <br />Date: January 31, 2017 <br />JSA team members: <br />JSA No: HSW-004 <br />Print Name Sign Name <br />........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ <br />Activity <br />Hazards <br />Risk control measures <br />Who is responsible? <br />List the tasks required to perform the activity in the sequence <br />Against each task list the hazards that could cause injury when the <br />List the control measures required to eliminate or minimize the risk of <br />Write the name of the person responsible (supervisor or above) to <br />the are carried out. <br />X........................................................................................................................................................................................P................................................................................................................................................................:.........1....................9......................................................................................................................................................................P............................................................................................................................................................................ <br />task is erformed. <br />in'u arisin from the identified hazard. <br />im lement the control measure identified. <br />Forklift operation <br />1. Hazards associated with <br />1. Prohibit employees who have <br />1. Each employee to implement <br />forklifts <br />not been trained from using the <br />risk control measures <br />2. Hazards from improperly <br />forklifts; perform regular safety <br />2. Shop supervisor to enforce <br />blocked/secured mobile <br />checks of the forklifts. Provide <br />compliance with risk control <br />equipment <br />forklift training to employees. <br />measures. <br />2. Be sure that all equipment <br />have the brake applied and <br />wheels chocked when not in <br />............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................. <br />use <br />SIGNED <br />Supervisor: Darryl Strongheart <br />Heartland Steel <br />Date: ..... I ..... I..... West <br />Representative: <br />Date: ..... 1 ..... 1..... <br />