Daily Pre-Start Safety Inspection

• Document No.

• Pre Task JSA

• Jobsite

• Conducted on

  Date

• Prepared by

• Location - On Jobsite
  Address

Daily Work Summary

• What type(s) of work are being performed today? Select all that apply.

  Select General Scaffold Erection Laying CMU Grouting Crane and rigging Installing rebar Cleanup OTHER

  • General
  • Scaffold Erection
  • Laying CMU
  • Grouting
  • Crane and rigging
  • Installing rebar
  • Cleanup
  • OTHER

• Describe the works to be undertaken today

• Have all crew members been informed of task for today

  Yes

  No

  N/A

Today's Task Breakdown

• Break today's work into individual step-by-step-tasks below. Assess each task for hazards and controls

Work Task

• Describe this task

• What category does this task fall under?

  Select General Scaffold Erection Laying CMU Grouting Crane and rigging Installing rebar Cleanup OTHER

  • General
  • Scaffold Erection
  • Laying CMU
  • Grouting
  • Crane and rigging
  • Installing rebar
  • Cleanup
  • OTHER

• Select potential hazards that may be encountered while completing this task today.

  Select Fall Pinch Slippery / Wet Surfaces Silica exposure Overhead Obstructions Hazardous Substances Working In Isolation Manual Handling Grinding Hazardous Chemicals OTHER

  • Fall
  • Pinch
  • Slippery / Wet Surfaces
  • Silica exposure
  • Overhead Obstructions
  • Hazardous Substances
  • Working In Isolation
  • Manual Handling
  • Grinding
  • Hazardous Chemicals
  • OTHER

• Describe the other potential hazards that may be encountered while completing this task today.

• What categories of hazard control will you apply to this task?

  Select Elimination - Remove the hazard Substitution - Replace the hazard Engineering - Isolate people from the hazard Administrative - Change the way people work PPE - Protect workers with personal protective equipment

  • Elimination - Remove the hazard
  • Substitution - Replace the hazard
  • Engineering - Isolate people from the hazard
  • Administrative - Change the way people work
  • PPE - Protect workers with personal protective equipment

• What specific controls will you apply to the above hazards for this task?

  Select Training Replacement Removal Repair Spotters Respiratory Protection Application of PPE Signage Barricades Fall Arrest Extinguishers Competent Persons Locating Equipment Supervision of Public OTHER

  • Training
  • Replacement
  • Removal
  • Repair
  • Spotters
  • Respiratory Protection
  • Application of PPE
  • Signage
  • Barricades
  • Fall Arrest
  • Extinguishers
  • Competent Persons
  • Locating Equipment
  • Supervision of Public
  • OTHER

• Describe any other specific controls will you apply to the above hazards for this task.

Final Checks

• Does every member of the crew have adequate and appropriate PPE for today's work tasks?

  Yes

  No

  N/A

Crew Sign Off

• Each present team member to sign name and signature acknowledging the above tasks, hazards and controls.

Team Member

• Name & Signature

  Sign