Safetip #115: Review a Job Safety Analysis After an Incident
Include the Review of a JHA/JSA in an Incident Investigation
After an incident, whether it’s a near miss that did not result in harm, or an accident that resulted in injury, an incident investigation must take place that includes a root cause analysis, which helps to prevent future incidents.
As part of the incident investigation, a review of the relevant Job Hazard Analysis (JHA) / Job Safety Analysis (JSA) should be triggered. A JHA/JSA breaks down a job into its basic steps. It then identifies hazards for each step, and determines measures to either eliminate the hazards or mitigate the risks caused by the hazards.
5 Scenarios That Also Give Insights into Safety Performance
When a JHA/JSA is reviewed as part of an incident investigation, 99% of the time one of five scenarios, or a combination of more than one, will apply. The scenario that applies will also give insights into safety performance and the improvements that are required. Let’s look at each scenario.
1) A JHA/JSA Does Not Exist for the Job
This is the worst-case scenario and it’s a clear indication that an occupational safety and health (OSH) program is not advanced and mature. All jobs should have a JHA/JSA. If an incident occurred because there wasn’t one, that is a sign of a bigger problem.
2) A JHA/JSA Exists for the Job, but It Was Not Shared
In this case, one site has a JHA/JSA for the job, but it was not shared with other sites, thus information on hazards and control measures for that job were not communicated to everyone with the same job. This is also a serious flaw in an OSH program. All JHAs/JSAs and information on hazards and risks must be shared across the entire organization. Best practices and lessons learned from one site must also be shared across all sites so that everyone benefits from the collective knowledge.
3) The JHA/JSA Missed an Important Step
The previous two scenarios signal a problem with an OSH program. The next three scenarios signal a problem with the JHA/JSA itself. In this scenario, the incident occurred during a step of the job that was not properly identified in the JHA/JSA. For example, maybe the steps are too general, and an important step was missed, as well as the hazards associated to that step. In this case, the review of the JHA/JSA should break down the steps in a different way to include the step that was missed.
4) Hazards Are Not Correctly Identified for the Job Step
In this scenario, all the proper job steps are identified, including the one where the incident occurred, but hazards are not properly identified for that job step. The hazards associated to that job step should be reviewed and the incident can provide an opportunity to identify a new hazard that was previously unknown, thereby further helping to prevent future incidents.
5) A Control Measure Is Not Effective for the Specific Hazard
In this scenario, the JHA/JSA includes all the proper job steps and correctly identifies all the hazards at each job step, but a control measure is not effective for a specific hazard of a specific job step, which is why the incident occurred. The effectiveness of that particular control measure should be re-assessed, and additional or different measures should be taken to either eliminate the hazard or mitigate the risk caused by the hazard. Also, action plans can track the tasks that would fix a control and ensure that they’re completed by their owners.
In conclusion, when an incident occurs, lessons learned during the incident investigation should be leveraged to review and improve a JHA/JSA, to prevent future incidents. The process can be greatly facilitated by using Job Safety Analysis (JSA) / Job Hazard Analysis (JHA) software to share all JHAs/JSAs across the organization and streamline the analysis time.
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