PTO BMA SAFE

• Project

• Conducted on

  Date

• Team

• Location
  Address

• CMW's

How Many BMA SAFEs viewing for Planned Task Observation

• Quantity

  Select 1 2 3 4 5 6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

BMA SAFE 1

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 1

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 2

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 1

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 2

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 3

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 1

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 2

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 3

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 4

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 1

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 2

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 3

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 4

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 5

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 1

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 2

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 3

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 4

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 5

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media

BMA SAFE 6

Details

• BMA Safe Completed

  Yes

  No

• Name

  Yes

  No

• Date

  Yes

  No

• Time

  Yes

  No

• Job Location

  Yes

  No

• Job description

  Yes

  No

FRONT OF BMA SAFE

• Answered Questions 1-15

  Yes

  No

• Answers appropriate to task

  Yes

  No

• Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard

  Yes

  No

• Has 16th Question been answered

  Yes

  No

• Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA

  Yes

  No

• Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

  Yes

  No

  NA

BACK OF BMA SAFE

• Have all Hazards been transferred to Reverse side via Hazard Number

  Yes

  No

• Have Appropriate Controls been put in place for each Hazard

  Yes

  No

• Does CMW believe the controls effectively manage Hazards

  Yes

  No

• If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA

  Yes

  No

  NA

• NOTES

• TAKE PHOTO OF FRONT & BACK OF BMA SAFE

  Media