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Jsa safety Form: What You Should Know
OR HEALTH AND SAFETY OFFICIAL: (NAME) CERTIFICATE ISSUED: TYPE OF REPORT APPLIED FOR: (NAME OF REPORT):. TYPE OF REPORT REFERRED TO:. THE FOLLOWING REFERENCE NUMBERS WILL BE APPLIED AS FOLLOWS:. 1. Job Title. 2. Supervisor. 3. Safety Official. 4. Worker. 5. Supervisor. 6. Safety Official. 7. Worker. 8. Worker. 9. Workers of each type identified in Item 1 (see above). 10. Supervisor. 11. Worker. 12. Safety Official. 13. Worker. 14. Safety Official. 15. Worker. 16. Safety Official. 17. Worker. 18. Supervisor. 19. Worker. 20. Worker. 21. Worker. 22. Worker. 23. Worker. 24. Worker. 25. Worker. 26. Worker. 27. Supervisor. 28. Worker. 29. Worker. 30. Worker. 31. Worker. 32. Worker. 33. Worker. 34. Worker. 35. Worker. 36. Worker. 37. Worker. 38. Worker. 39. Worker. 40. Worker. 41. Employee. 42. Supervisor. 43. Supervisor. 44. Supervisor. 45. Worker. 46. Supervisor. 47. Worker. 48. Worker. 49. Supervisor. 50. Supervisor. 51. Supervisor. 52. Supervisor. 53. Supervisor. 54. Supervisor. 55. Employer.
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