Information

  • Department

  • Customer Name:

  • Location

  • Conducted on

  • Evaluation Conducted By:

JSEA REVIEW

  • Is the JSEA header filled out completely and reflect the correct date?

  • ALL STOP. JSEA header must be completed before work can continue.

  • Do the JSEA tasks identified match the work being performed?

  • ALL STOP. JSEA must be updated to properly reflect the work being performed before work can commence.

  • Have all hazards associated with each step been properly identified?

  • Have corrective actions been identified for each step?

  • ALL STOP. JSEA Must be updated to ensure that all hazards have been properly addressed.

  • ALL STOP. JSEA must be updated to ensure that all hazards have been properly identified.

  • Have all personnel assigned to the tasks signed the JSEA?

  • Does each corrective action have an individual or group of individuals assigned to it?

  • ALL STOP. JSEA Must be updated to ensure that all hazards have been assigned to at least one person.

  • ALL STOP. JSEA must be updated to ensure that all corrective actions have been assigned to at least one person.

CLOSING

  • Was the JSEA deemed acceptable according to the information provided to the auditor along with observations conducted on the jobsite?

  • ALL STOP until the JSEA is updated to properly reflect the work being performed. Instruction must be provided to the PLW/PIC and crew to ensure understanding of the JSEA process before work is allowed to commence.

  • Final comments:

  • Evaluator signature:

  • PIC/PLW Signature:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.