A JSA template is a fill-in form for a job safety analysis: header fields for the job, then a table listing each step, the hazards at that step, and the controls for them. This one is built for maintenance work. Download it free in Excel (a blank tab plus three filled maintenance examples) or as a printable PDF. No sign-up.
Maintenance JSA template (Excel)
Blank JSA plus three filled examples: pump seal replacement, motor swap, and a gearbox oil change at height. Prints one page wide. Works in Excel and Google Sheets.
Maintenance JSA template (printable PDF)
Two-page blank form for the clipboard: header fields, 14 step rows and a crew sign-off block. US Letter, landscape.
If you're new to JSAs, start with what a JSA is and how to write one. This page is about the form itself and what good entries look like.
What's in the template
Most free JSA forms come from university safety offices or construction software, and it shows. They ask for a department and a supervisor, then go straight to the steps table. A maintenance job needs a few more things on the page, because the JSA is only useful if it's tied to the job a technician is actually doing.
The header fields, and why each one is there:
- Job / task: one specific job, like "replace mechanical seal on P-104," not "pump maintenance."
- Work order / PM number: links the JSA to the job record, so you can find it from the work order and the work order from it.
- Asset / equipment ID: the same JSA rarely fits two different machines. Name the one it was written for.
- Location / area: where the work happens, including access (platform, pit, roof).
- Prepared by / reviewed by, with dates: one person writes it, a supervisor checks it.
- Crew: who does the job, and how many people it takes.
- Energy sources to isolate: electrical, pressure, stored mechanical energy, gravity, heat, chemicals. Listing them here makes the lockout step harder to skip.
- Lockout/tagout required? (Yes / No): if yes, the lockout/tagout procedure for that asset applies.
- Permits required: tick boxes for hot work, confined space, work at height and electrical. The JSA doesn't replace a permit to work; it tells you which ones the job needs.
- PPE required and tools and equipment: the specific items, so the crew brings them to the job.
- Next review / trigger: when this JSA gets looked at again.
Then the steps table, with five columns: #, Job step, Hazards (what could go wrong), Controls (specific and checkable), and Who. The "Who" column is the one most templates leave out. OSHA's own sample forms don't have it either. A control with no owner tends not to happen.
The form ends with a crew sign-off block: name, signature, role and date for everyone who does the job.
How to fill it in
OSHA's job hazard analysis guidance walks through the process step by step. Here it is, mapped onto the template:
- Pick the job. Start with jobs that have hurt people, could cause a severe injury, or are new or recently changed. OSHA's guidance (Publication 3071) lists those as the priorities. In most plants that's isolation-heavy repair work, anything at height, and anything that opens a pressurised system.
- Write the steps. Watch the job being done, or walk it with the technician who does it. Aim for 5 to 10 steps in the order they actually happen. Too many steps and the form becomes a procedure; too few and hazards hide inside a step.
- List the hazards at each step. Ask what could go wrong, what would set it off, and how bad it could get. Be specific: "hand caught between belt and pulley" beats "pinch point."
- Write a control for each hazard. Use the order OSHA gives: engineering controls first (remove, enclose or isolate the hazard), then administrative controls (procedures, permits, training), then PPE. Each control should be something a supervisor could check was done.
- Review it with the crew and sign. Go through it with the people doing the job, adjust anything they flag, and have everyone sign. Review it again when the job or equipment changes, or after an injury or near miss.
Example 1: replacing a pump mechanical seal
Illustrative example. Build yours from your own pump manual and site procedures. This one is also in the Excel file with its full header filled in.
Job: replace the mechanical seal on an end-suction centrifugal pump. LOTO: yes. Permits: none.
| # | Job step | Hazards | Controls | Who |
|---|---|---|---|---|
| 1 | Stop the pump and isolate it | Pump restarted while hands are inside the casing or coupling | Lock and tag the motor starter, one lock per person. Close and lock the suction and discharge valves. Try the start button to confirm it won't run | Technician |
| 2 | Drain and depressurise the casing | Spray of hot or pressurised fluid when the casing is opened | Confirm zero pressure on the gauge. Open the vent, then drain to a container. Face shield on. Check the SDS if it isn't water | Technician |
| 3 | Remove the coupling guard and spacer | Pinch points; shaft turns if isolation failed | Re-check the lockout before reaching in. Turn the shaft by hand only with the coupling bolts loose | Technician |
| 4 | Pull out the rotating assembly | Dropped load; back strain from a heavy lift | Check the assembly weight in the manual. Rated sling and hoist. Nobody under the load | Both technicians |
| 5 | Remove the old seal, clean the sleeve | Cuts from broken seal faces; solvent vapour | Cut-resistant gloves. Site-approved solvent, ventilated area, per its SDS | Technician |
| 6 | Fit the new seal and reassemble | Hand caught between assembly and casing | Guide the assembly on the hoist, hands on the outside faces only | Both technicians |
| 7 | Re-align the coupling, refit the guard | Guard left off at restart | Guard fully bolted before any lock comes off. Supervisor checks before sign-off | Technician / supervisor |
| 8 | Remove lockout, open valves, test-run | Seal leak sprays fluid; someone in the danger zone at startup | Verbal all-clear and visual check. Open the suction valve fully, crack the discharge valve slowly. Stand clear of the seal on the first run | Technician |
Example 2: replacing and aligning a motor
Illustrative example. A dust collector fan motor, swapped like for like.
Job: replace a foot-mounted electric motor on a fan drive. LOTO: yes. Permits: electrical.
| # | Job step | Hazards | Controls | Who |
|---|---|---|---|---|
| 1 | Isolate the motor at the MCC | Electric shock; motor energised while terminals are open | Electrician locks and tags the feeder. Each crew member adds a personal lock | Electrician |
| 2 | Prove the motor is dead | Stored energy in the drive's DC bus; wrong circuit isolated | Wait the discharge time on the drive's label. Test for absence of voltage at the motor terminals, checking the tester on a known live source before and after | Electrician |
| 3 | Stop the fan from turning | Duct draft spins the fan and the motor shaft | Close the damper or block the impeller as the site procedure says | Technician |
| 4 | Disconnect cables, remove the guard | Cables reconnected wrongly later; pinch points | Label each cable before removal. Gloves, two hands on the guard | Electrician / technician |
| 5 | Unbolt and lift out the old motor | Dropped load; fingers crushed between motor and baseplate | Check the nameplate weight. Rated slings on the motor's lifting eyes. Hands never under the motor. Tag line | Both technicians |
| 6 | Set the new motor, shim and align | Fingers trapped under motor feet while shimming | Lower onto blocks first. Shims go in with the motor raised and supported, never fingers under a foot | Technician |
| 7 | Reconnect and check rotation uncoupled | Re-energising for the bump test while someone is at the machine | Follow the site procedure for temporarily removing locks for testing. Coupling off, everyone clear, bump, then re-lock | Electrician |
| 8 | Couple, refit the guard, remove lockout, run | Guard left off; someone in the danger zone | Guard bolted before locks come off. Verbal all-clear. Watch vibration and current on the first run | Electrician / supervisor |
Step 2 and step 3 are the ones generic templates miss. A variable frequency drive can hold a charge after the feeder is off, and a fan can turn on its own when air moves through the duct. Both are energy sources that a "lock out the motor" line doesn't cover.
Example 3: gearbox oil change at height
Illustrative example. A routine PM task that becomes a fall and dropped-object job because of where the gearbox sits.
Job: change the oil in an elevated conveyor head-drive gearbox. LOTO: yes. Permits: work at height.
| # | Job step | Hazards | Controls | Who |
|---|---|---|---|---|
| 1 | Barricade the area below | Dropped tools, oil or parts hitting people below | Barricade and sign the area under the work. Tools on lanyards | Technician |
| 2 | Stop the conveyor and isolate it | Restart while working on the drive; loaded incline belt rolls back | Lock and tag the drive. Run the belt empty first if possible. Confirm the backstop holds or clamp the belt | Technician |
| 3 | Climb to the head platform | Fall from the ladder or the platform edge | Three points of contact, nothing in hand. Guarded platform; if there's no guardrail, harness to a rated anchor | Both technicians |
| 4 | Raise tools and containers | Dropped load; strain carrying oil up a ladder | Haul up with a hand line and bucket, never carry up the ladder | Both technicians |
| 5 | Check oil temperature | Burns from hot oil and casing | Let it cool. Check the casing with an IR thermometer before opening the drain | Technician |
| 6 | Drain the old oil | Slippery platform; oil dripping on people below | Drip tray under the plug, container sized for the full volume. Absorbent on spills straight away | Technician |
| 7 | Refill to the correct level | Skin contact; spills | Nitrile gloves. Pump or funnel. Grade and volume from the nameplate. Check the sight glass | Technician |
| 8 | Remove lockout and test-run | Someone in the drive zone at startup | Everyone off the drive, verbal all-clear, restart, check for leaks | Technician / supervisor |
| 9 | Dispose of the used oil | Spill during handling | Sealed, labelled container, lowered by hand line, to the site's waste point | Technician |
None of the hazards in that table come from the oil change itself. They come from the location and the stored energy in a loaded incline belt. That's why one JSA per job and asset works better than one per task type.
JSA template vs JHA form vs OSHA's worksheet
They're all the same idea. JSA and JHA are two names for the same analysis, and the forms carry the same core columns: steps, hazards and controls.
OSHA publishes two reference forms. The sample form in Job Hazard Analysis (OSHA 3071, 2002 revised) records each task with its hazard type, hazard description, consequence, hazard controls and a rationale. The newer Identifying Hazard Control Options: Job Hazard Analysis worksheet uses a simpler steps, hazards and controls table with a bakery example. Both are general-purpose.
The template here keeps that core and adds the maintenance fields: asset ID, work order number, energy sources, lockout and permits, and a "Who" column on every control.
Mistakes that make a JSA template useless
- Controls you can't check. "Wear appropriate PPE" and "be careful" don't tell anyone what to do. "Face shield on before opening the drain" does.
- One JSA for a whole area. "Pump house JSA" covers nothing in particular. Write it for the job and the asset.
- Written once, never reviewed. Equipment gets modified and procedures drift. A management of change review should send you back to the JSA when equipment changes, and so should every injury or near miss on that job.
- Kept in a binder, away from the job. If the technician only sees the JSA during an audit, it isn't doing anything.
From template to work order
The last mistake is the hardest to fix on paper. The JSA sits in the safety office or a shared drive. The job sits on a work order. At 2 a.m., with a line down, nobody walks to the safety office first.
In MachDatum, each job type carries its own checklist and instructions, and a preventive maintenance plan's checklist goes out on every work order the plan generates. So the key controls from your JSA (lock out and try the start button, confirm zero pressure, guard bolted before the locks come off) can become checklist steps on the work order itself, and completing them leaves a record of who did what, and when. When you revise the JSA, updating the checklist means the next work order carries the new steps. It's the same approach we recommend for a preventive maintenance checklist.
The template still matters: it's where the thinking happens. The software just makes sure the result is in front of the technician when the job starts.
If your work orders are in spreadsheets and your JSAs are in a binder, see how MachDatum CMMS handles work orders and checklists.
