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Job Safety Analysis <br /> <br /> <br />This JSA must be acknowledged by affected workers every time there is a modification to the form. <br />Name (Printed) Signature Initials Used in <br />Form Date <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Documentation of daily/shift Lessons Learned or JSA modifications (if additional room is needed, continue on back of form): <br />BRIEF Description Date Documented by <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Seed JSA - Well Gauging and Sampling_020714.docx - 4 -