Templates
JSA template – NZ

JSA template – NZ

Create detailed job safety assessments with this easy-to-use JSA template for New Zealand and keep your workplace running smoothly and safely.

Use this template with Lumiform

The Lumiform application helps frontline teams uphold internal standards effortlessly.
  • Customize this template or build your own
  • Fill out templates via mobile app
  • Assign and track corrective actions
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF
JSA template – NZ

Create detailed job safety assessments with this easy-to-use JSA template for New Zealand and keep your workplace running smoothly and safely.

Use this template with Lumiform

The Lumiform application helps frontline teams uphold internal standards effortlessly.
  • Customize this template or build your own
  • Fill out templates via mobile app
  • Assign and track corrective actions
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

This JSA template for New Zealand workplaces guides you through the critical process of hazard identification and risk assessment. It features a detailed competency verification component and emergency preparedness section aligned with NZ safety regulations.

Research confirms that properly implemented JSAs significantly reduce workplace incidents and improve safety outcomes. When facing a WorkSafe inspection or audit, you’ll appreciate how this template helps demonstrate your due diligence in identifying hazards, implementing controls, and ensuring worker competency. These are all key requirements under the Health and Safety at Work Act 2015.

Related categories

Preview of the template
Page 1
Job Details
Job Title
Date
Estimated Job Duration (hours)
Task Breakdown
List the key steps required to complete the job in the order they will be performed
Hazard Identification
Identify all potential health and safety hazards associated with each step of the job
For each hazard identified, assess the risk level
Risk Control Measures
List control measures that will be implemented to eliminate or minimize the risks
Is additional personal protective equipment (PPE) required?
Competency & Authority
Who will be responsible for supervising the job?
What are the required competencies (skills, knowledge, experience) for workers performing this job?
Have all workers been trained and deemed competent to perform the tasks safely?
Emergency Preparedness
What emergency equipment and first aid resources are available on site?
Have workers been trained in emergency response procedures?
Review & Approval
Name of Supervisor/Manager Approving the JSA
Supervisor/Manager Signature
Date of Approval

Frequently asked questions

How do I ensure my JSA complies with New Zealand’s Health and Safety at Work Act?

Your JSA must demonstrate reasonable practicability in identifying and controlling workplace hazards. Document consultation with workers, specify competency requirements, and clearly outline control measures following the hierarchy of controls. Regular reviews and updates show ongoing commitment to safety, which aligns with WorkSafe New Zealand’s expectations for PCBUs.

Who needs to sign off on the JSA before work can begin?

The supervisor or manager responsible for the work must approve the JSA. Additionally, all workers performing the task should review and acknowledge it. For high-risk work in New Zealand, consider having your health and safety representative review it as well. This collaborative approach ensures comprehensive hazard identification and appropriate control measures.

How do I determine if additional PPE is required beyond our standard equipment?

First exhaust higher-level controls like elimination or engineering solutions. Then assess remaining risks to identify gaps in protection. Consider environmental factors like weather conditions, duration of exposure, and task-specific hazards.

What evidence of competency should I document in the JSA template?

Include specific qualifications, certifications, or training records relevant to the task. For specialized work like confined space entry or working at heights in New Zealand, reference the specific unit standards or certifications required. Note experience levels needed and any supervision arrangements for less experienced workers to ensure regulatory compliance.

This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.