This safety analysis sheet documents a job, operation, department, and occupation. It identifies possible injurious contacts like being caught between, striking against, or being struck by something. For each contact possibility, it records the part of the operation involved and recommends how to eliminate the risk. At the bottom is a space for recommended safety procedures for the operation.

1. SAFETY ANALYSIS SHEET
JOB_______________________________________________ DATE_____________________
OPERATION_______________________________________ DEPT______________________
OCCUPATION_________________________________________________________________
INJURIOUS CONTACTS
POSSIBILITIES WHAT PART OF OPERATION HOW TO ELIMINATE
CAUGHT BETWEEN: __________________________________ ________________________
____________________ __________________________________ ________________________
____________________ __________________________________ ________________________
____________________ __________________________________ ________________________
STRIKE AGAINST: __________________________________ ________________________
____________________ __________________________________ ________________________
____________________ __________________________________ _______________________
____________________ __________________________________ _______________________
STRUCK BY: __________________________________ ________________________
____________________ ___________________________________ ________________________
____________________ __________________________________ _________________________
____________________ ___________________________________ _________________________
RECOMMENDED PROCEDURE FOR THIS OPERATION: _______________________________
SIGNATURE