Israel Institute for Occupational Safety and Hygiene
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Appendix D: JSA workstation analysis – Disabled employees
This form is suited for disabled employees. It should be filed for every task or routine activity
that is performed in the factory. This form should also be filed when a substantial change
occurs in system / device or working method. This form shall be accessible to the employees
involved in the task.
In cases when the employee has a guardian, this guardian’s written approval is required in
order to carry out the interview with the employee.
Dateofformfilling:
Department:
Station / Tas:
Members of the examining team
Executing employee / in charge of the process / activity / machine
Employee’s direct manager / team leader / social worker /
professional accompany
Safety officer / professional / external expert
Short description of the workstation
Regular performance timing of the analyzed task (one cycle): hours
minutes
Employee’s disability
Environmental conditions (mark in each cell: 1- in order, 2- needs to be improved, 3- problematic)
Other
Crowding
Tidiness/cleanliness
Steams/gas
Dust
Ventilation
Trembling
Heat load
Light
Noise
Activities performed near the workstation that can affect the employee? (Fork-lift, levers, etc.):
