Sample JSA Forms

Source Credit

The information for the JSA web pages presented here were initially developed by the State of Wisconsin's Risk Management Department and can be viewed at their online resource.


This JSA description and form have been posted as general information for increasing safety awareness. The Safety Division's website 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.