Job Safety Analysis (JSA) Form
Job Title: Changing a Tire
Date: [Insert Date]
Job Location: [Insert Location]
Analyst: [Insert Name]
Reviewed by: [Insert Name]
Job Steps, Hazards, and Controls
Job Step |
Potential Hazards |
Recommended Controls |
1. Park the vehicle |
- Vehicle not secure |
- Park on level ground<br>- Engage parking brake |
|
- Traffic hazards |
- Use hazard lights<br>- Place warning triangles/cones |
2. Gather tools and safety equipment |
- Tripping over tools |
- Keep tools organized and close to the work area |
|
- Missing or faulty tools |
- Inspect tools before use |
3. Wear personal protective equipment |
- Injury to hands |
- Wear gloves |
|
- Injury to eyes |
- Wear safety glasses |
4. Loosen the lug nuts |
- Strain from excessive force |
- Use a lug wrench<br>- Use proper body mechanics |
|
- Slipping and falling |
- Maintain a stable stance |
5. Jack up the vehicle |
- Jack failure |
- Use the correct jack for the vehicle<br>- Place jack on solid ground |
|
- Vehicle instability |
- Place wheel chocks on opposite wheels |
6. Remove the flat tire |
- Dropping the tire |
- Use proper lifting techniques<br>- Get assistance if needed |
|
- Injury from sharp objects |
- Be cautious of sharp objects |
7. Mount the spare tire |
- Improper tire placement |
- Align the spare tire properly<br>- Hand-tighten the lug nuts first |
|
- Strain from lifting |
- Use proper lifting techniques |
8. Lower the vehicle |
- Jack slipping or failing |
- Lower the jack slowly and carefully |
9. Tighten the lug nuts |
- Lug nuts not tightened properly |
- Tighten lug nuts in a star pattern<br>- Use a torque wrench if available |
10. Store tools and flat tire |
- Tripping over tools |
- Store tools in the designated area<br>- Secure the flat tire in the trunk |
|
- Back strain from lifting |
- Use proper lifting techniques |
11. Final inspection |
- Missing tools or loose lug nuts |
- Double-check all lug nuts<br>- Ensure all tools are accounted for |
Personal Protective Equipment (PPE) Required:
Additional Recommendations:
- Ensure the spare tire is properly inflated before starting.
- If on a roadside, stay as far away from traffic as possible and be vigilant.
- Keep a charged mobile phone on hand in case of emergency.
Emergency Contact Information:
- Local Emergency Number: [Insert Number]
- Roadside Assistance: [Insert Number]
Analyst Signature: ____________________
Date: ____________________
Reviewed by Signature: ____________________
Date: ____________________