Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • ACTIVITY DESCRIPTION:

HAZARDS

  • 1.1. Height

  • 1.2. Equipment

  • 1.3. Power Lines

  • 1.4. Electricity

  • 1.5. Sharp Objects

  • 1.6. Slippery / Wet Surfaces

  • 1.7. Gasses

  • 1.8. Dust

  • 1.9. Underground Utilities

  • 1.10. Overhead Obstructions

  • 1.11. Hazardous Substances

  • 1.12. Working In Isolation

  • 1.13. Ignition Sources

  • 1.14. Manual Handling

  • 1.15. High Pressure

  • 1.16. Lifting Equipment

  • 1.17. Rotating Machinery

  • 1.18. Entry & Exit

  • 1.19. Ground Openings

  • 1.20. Entanglement

  • 1.21. Animals, Pests

  • 1.22. High Voltage

  • 1.23. Confined Space

  • 1.24. Sun Rays / Adverse Weather Conditions

  • 1.25. Pollution

  • 1.26. Grinding

  • 1.27. Public Areas

  • 1.28. Other Hazards

CONTROL MEASURES

  • 2.1. Isolations

  • 2.2. Spotters

  • 2.3. Lighting

  • 2.4. Respiratory Protection

  • 2.5. Application of PPE

  • 2.6. Signage

  • 2.7. Barricades

  • 2.8. Fall Arrest

  • 2.8. Extinguishers

  • 2.9. Screens

  • 2.10. Fire Blankets

  • 2.11. Procedures

  • 2.12. Competent People

  • 2.13. Locating Equipment

  • 2.14. UV Protection

  • 2.15. Gas Detection

  • 2.16. Designated Work Areas

  • 2.17. Supervision of Public

  • 2.18. Other Control Measures

DESCRIPTION OF WORKS & CONTROLS

  • 3.1. Job Steps

  • 3.2. Risk Description

  • 3.3. Controls Description

SIGN OFF

  • Team Member

  • Team Member

  • Team Member

  • Team Member

  • Authorized Person: I have reviewed this JSA and agree that it is a fair assessment of the job and I authorize this work to proceed.

  • Team Leader

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