Contec - JSA

Site Details

• Date

  Date
• Location
  Address

• Project Number

• Contractor Name

• Location First Aid Kit

• Emergency Assembly Area & Path of Travel to exit

• On-Site Supervisor & Emergency Coordinator

• First Aiders Name

Pre-Work Documentation/Actions

• WMS being used for the day’s activities are :

• ISGM-HSE-NBN-SWMS-0448 Asbestos (ACM)

  Yes

  No

• Notes

• ISGM-HSE-NBN-SWMS-0448 Asbestos (ACM)

  Yes

  No

• Notes

• ISGM-HSE-NBN-SWMS-0450 Pre Site and Site Establishment

  Yes

  No

• Notes

• ISGM-HSE-NBN-SWMS-0452 Safe use of Ladders & Elevated Work Platforms

  Yes

  No

• Notes

• ISGM-HSE-NBN-SWMS-0454 Data and Optical Cable Installing

  Yes

  No

• Notes

Traffic Management

• Do scenario cards cover traffic management requirements

  Yes

  No

  N/A

  Included In SMWS

• Control Measure

• Are all workers on-site inducted into the appropriate SWMS being used today?

  Yes

  No

  N/A

  Included In SMWS

• Control Measure

Plant - EWP

• Is there EWP Equipment being used at the worksite?

  Yes

  No

  N/A

  Included In SMWS

• Control Measure

• Is the operators’ licensed/accredited? (view RTO qualifications)

  Yes

  No

  N/A

  Included In SMWS

• Control Measure

• Has EWP Pre-start checks been carried out?

  Yes

  No

  N/A

  Included In SMWS

• Control Measure

• Is there a person available to Perform EWP Rescue (view RTO qualifications)?

  Yes

  No

  N/A

  Included In SMWS

• Control Measure

• Is a Customer work permit required for work being undertaken? E.g. Work at Heights / Use of Plant etc.

  Yes

  No

  N/A

  Included In SMWS

• Control Measure

Climatic Conditions

• Weather conditions suitable for task to be undertaken - (heat, cold, rain) (Direct sunlight exposure) (Lightning or thunderstorms present)?

  Yes

  No

  N/A

  Included In SMWS

• Control Measure

Site Conditions

• Presence of potentially dangerous animals and fauna (including dogs, snakes or insects)?

  Yes

  No

  N/A

  Included In SMWS

• Control Measure

• Work at heights tasks required? (over 2m or any unprotected ledges on site (Fall hazards)

  Yes

  No

  N/A

  Included In SMWS

• Control Measure

• Electrical hazards?

  Yes

  No

  N/A

  Included In SMWS

• Control Measure

• Will your work activity create Excessive Noise? (be mindful of shift workers in area)

  Yes

  No

  N/A

  Included In SMWS

• Control Measure

Environmental Hazards

• Heritage (Special Requirements – Check Design Plan)?

  Yes

  No

  N/A

  Included In SMWS

• Control Measure

• Detail of Additional Hazards Identified and Subsequent Controls Implemented

• All workers have been involved in the preparation of this JSEA, are aware of the hazards and risks involved in performing the scheduled work and are aware that appropriate control measures have been implemented to reduce the risk of harm from the potential hazard. Your signature below is your declaration that you have arrived on this site “fit for duty.”

worker

• Name

• Date

  Date

• Add signature

  Sign

• All visitors attending work site are to be inducted into this JSEA and sign as an acknowledgement that they have read and understand the associated hazards on the site.

visitor

• Name

• Date

  Date

• Add signature

  Sign