Information
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Client / Site
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Document No.
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Project Number/Job
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Conducted on
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Prepared by
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Location of First Aid Kit and Fire Extinguisher
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Name of First Aider
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Location
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Site Emergency Assembly Area
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Personnel
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Are safe systems of work in place for the following:
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Any work on Asbestos materials? If yes, enter your authority number
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Enter ACM Authorisation Number:
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Ground Breaking / Civils works? If so - lists SWMS that apply below.
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SWMS - CON-HSE-SWMS-0112 - Site Establishment
SWMS - CON-HSE-SWMS-0113 - Use of Tools and Equipment
SWMS - CON-HSE-SWMS-0116 - Excavation and Trenching
SWMS - CON-HSE-SWMS-0119 - Use of Plant and Equipment -
Dial Before You Dig Obtained? Check GeoOp. If no, explain why.
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Enter Number
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Plant on site? Are all Plant Operators licenced and accredited? MUST have tickets ONSITE!
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Operator Name
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SWMS - CON-HSE-SWMS-0119 - Use of Plant and Equipment
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All workers hold current: Construction Awareness Card (white/blue card), ISGM Induction, Asbestos awareness certificate, NBN Safety and Awareness Training?). Workers MUST have tickets ONSITE!
Site Conditions
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Are safe systems of work in place for the following:
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Ground surfaces - is there a risk of trips and falls?
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Dangerous animals and plants. Are there potentially dangerous animals or plants?
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Snake catchers Brisbane http://www.snakecatchers.com.au/
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Electrical hazards. Are there electrical hazards or ignition sources?
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Hazardous substances or dangerous goods. Use of hazardous substances or dangerous goods? If so - refer to MSDS for safe handling and what to do in the event of an emergency.
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Biological hazards - eg syringes, contaminated water?
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Use sharps kit for syringe removal. Call supervisor for contaminated water.
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Confined spaces. Will you be working in confined spaces?
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A confined space permit and qualified person is required.
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Fumes from pits/manholes/ducts. Are you working on or near a service station? Is there a danger of fumes near pit/manhole/ducts?
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Excessive noise. Will you be making excessive noise? Have you informed the neighbours?
Climate Conditions
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Are there safe systems of work in place for the following:
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Lighting. Is there sufficient light for all tasks?
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Weather. Are climate conditions suitable for performing tasks?
Environmental Hazards
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Are there safe systems of work in place for the following:
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Contaminated soil/water?
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Pesticides/Insecticides used?
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Stormwater or sediment controls? Dewatering?
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Air quality? Dust emissions? Noise or vibrations?
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Disturbance to flora/fauna? Potential for spreading of weeds/pests?
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Will you be disposing of waste from site? If so, where/how?
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Enter Disposal Site
Traffic Management
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Traffic/Pedestrian management needed? Refer to Traffic Management Plan.
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Enter Company Used
Plant
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Are there safe systems of work in place for the following:
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Plant/Equipment used? Have the pre-start checks been completed?
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Complete Harmonise Pre-Site plant check
SWMS - CON-HSE-SWMS-0119 - Use of Plant and Equipment -
Gas detection.
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Overhead electrical hazards?
Manual Handling
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Possibility of awkward postures, pushing or pulling?
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Will you be lifting, lowering or will there be sudden body movements?
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Will you be subjected to sustained vibrations?
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SWMS - CON-HSE-SWMS-0113 - Use of Tools and Equipment
Working at Heights
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Is there ladder use?
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Check ladder Condition as per CON-HSE-FRM-107 for cracks, breaks rust and corrosion before use!
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Are there unprotected ledges on site resulting in fall hazards?
Working with Tools
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Are power tools being used for drilling/cutting?
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SWMS - CON-HSE-SWMS-0113 - Use of Tools and Equipment
Other safety concerns/hazards.
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List any other Safety Concerns /Hazards
Sign-on
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Sign on
Worker
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Worker
Visitors
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All visitors attending work site are to be inducted into this JSEA and sign as an acknowledgement that they have read and understand the document.
Visitors
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Name
