1. JSA Commencement - Assessment

• Document number

• Date Conducted on

  Date
• Site Location
  Address

• Prepared by

  Select

• Job Number

• Customer Name

Planning and Preparation - (if any task below is deemed unsafe the job must be stopped and further action or information should be sought prior to continuing).

• Have any permits required been authorised and viewed prior to commencing the job?

  Yes

  No

  N/A

• What are the identified hazards for this job task / site?

  Select Chemical (Toxic, Flammable, Corrosive) Explosion (Chemical Reaction, Over Pressurization) Electrical (Shock, Short Circuit, Fire, Static, Loss of Power) Ergonomics (Strain, Sprains, Human Error) Excavation (Collapse) Fall (Slip, Trip) Fire Mechanical (Mechanical Failure, Stuck between objects) Noise Radiation (Alpha, Beta, Gamma, X-rays) Struck by Objects Extreme Temperature Visibility (lack of lighting, Obstructed vision) Weather Other Silica Dust Working from Heights Asbestos on site Not Applicable

  • Chemical (Toxic, Flammable, Corrosive)
  • Explosion (Chemical Reaction, Over Pressurization)
  • Electrical (Shock, Short Circuit, Fire, Static, Loss of Power)
  • Ergonomics (Strain, Sprains, Human Error)
  • Excavation (Collapse)
  • Fall (Slip, Trip)
  • Fire
  • Mechanical (Mechanical Failure, Stuck between objects)
  • Noise
  • Radiation (Alpha, Beta, Gamma, X-rays)
  • Struck by Objects
  • Extreme Temperature
  • Visibility (lack of lighting, Obstructed vision)
  • Weather
  • Other
  • Silica Dust
  • Working from Heights
  • Asbestos on site
  • Not Applicable

• Is this job safe to complete now?

  Safe

  At Risk

  N/A

Tasks, Hazards and Preventive Measures

• 1) If the task is deemed Unsafe, stop the job and seek information
  2) Does the task require a SWMS? If yes, send through to contractor.
  3) If permits are required these should be authorised and viewed prior to commencement of the job.
  4) Have preventive measures and controls for any identified hazards been put in place? If no - stop the job and seek information

Identified Hazards at Site

• Employee, Public / Visitors at site area have been barricaded away from the task?

  Yes

  No

  N/A

• Has the site register been reviewed for Hazards? e.g. asbestos

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is the work area clear to access and aisle / walkways clear?

  Safe

  At Risk

  N/A

• Are there hot surfaces?

  Yes

  No

  N/A

• Chemicals to be used on job? Have you supplied all MSDS' (if yes)

  Yes

  No

  N/A

• Are there loose uneven surfaces / sharp edges?

  No

  Yes

  Not Applicable

• Are there dusty conditions / loose airborne materials like silica?

  No

  Yes

  Not Applicable

• Are there any trip, fall or slip hazards?

  No

  Yes

  Not Applicable

• Is any additional PPE required?

  No

  Yes

  Not Applicable

• Are there any manual handling hazards present?

  No

  Yes

  Not Applicable

• Do you have any tools, equipment or materials that may fall or harm?

  No

  Yes

  Not Applicable

• Are warning signs required?

  No

  Yes

  Not Applicable

• Are there any vehicles / mobile plants in the area?

  No

  Yes

  Not Applicable

• Is there a risk to exposure of loud noise, carcinogenic material etc.

  No

  Yes

  Not Applicable

• Is a ladder required and if so is the ladder in good condition and the correct height?

  No

  Yes

  Not Applicable

• Have circuits been isolated is needed and where applicable?

  Yes

  No

  N/A

• Are tools and equipment in good working order - are portable electric equipment tagged and tested correctly?

  Yes

  No

  N/A

SWMS required for the job / task?

• Have the SWMS for the job been sighted by or given to the customer / site representative?

  Yes

  No

  N/A

Completion - all of the above information has been completed

• Full Name worker

  Select

• Full Name of site representative