Job Safety Analysis Form

JSA #: Prepared by:

Procedure Reference: Reviewed & Approved by:

Job Description: Changing Light Bulbs/Tube light Unit Name: Date:

Responsibilities:
Tasks: Break the job Hazards: What hazards did you find for
Step Controls: Who will be
down into a logical each task?
# What controls are in place or will you put in place? responsible for each
sequence of steps
of those controls?
Arrange new
bulbs/tubes including Wrong bulb/Tube (Substandard, different Pre use inspection for bulbs/tubes to be performed along with tools
Electrician
tools required for connection, different capacity)
1 change Defective tools
Finger pinched while opening light cover Proper hand and body placement and keep hand clear from pinch point Electrician
for replacement of bulb/tube light while opening the cover.
Electric shock while changing bulb/tube Lockout the light to be worked on as per LOTO procedure.
light Use proper tools for removing lenses and covers.
Slips and fall while using portable ladder Secure the ladder on firm & non slippery surface to avoid slip & fall.
Change the light bulbs Cut lacerations if broken glass. Reassembly light correctly.
2 or tube Burns Incase old bulb/tube is hot
Double check connections & tightness of light replaced. Electrician
Follow LOTO procedure for De-isolation for light.
3 Turn on Lights. Short circuit/loose connections

Tick and discuss

the lifesaving rules
which are related
to the job during
meeting