Job Safety Analysis (JSA)

• Conducted on

  Date

• Menzies name/surname requesting work

• Subcontractor / Employee conducting JSA

• Location
  Address

• Call Menzies Help Desk on 1300 557 511 or the Menzies manager who engaged you if you have any queries

• Scope / Activity performed

Hazard Check

• Is the work area / walkway clear to access?

  Yes

  No

  N/A

• Hazard Control Details

• Are you working near a road?

  Yes

  No

  N/A

• Hazard Control Details

• Are there members of the public or other trades nearby?

  Yes

  No

  N/A

• Hazard Control Details

• Any Trip/Slip/Fall hazards apparent?

  Yes

  No

  N/A

• Hazard Control Details

• Are there dusty conditions/loose airborne materials apparent?<br>

  Yes

  No

  N/A

• Hazard Control Details

• Are there dusty conditions/loose airborne materials apparent?<br>

  Yes

  No

  N/A

• Hazard Control Details

• Does your work involve manual handling?<br>

  Yes

  No

  N/A

• Hazard Control Details

• Is your ladder suitable for use for this work order?

  Yes

  No

  N/A

• Hazard Control Details

• Can tools, equipment or materials fall or harm?<br>

  Yes

  No

  N/A

• Hazard Control Details

• Can tools, equipment or materials fall or harm?<br>

  Yes

  No

  N/A

• Hazard Control Details

• Are there loose uneven surfaces/sharp edges?<br>

  Yes

  No

  N/A

• Hazard Control Details

• Is additional PPE required?<br>

  Yes

  No

  N/A

• Hazard Control Details

• Any other hazards?<br>

  Yes

  No

  N/A

• Detail hazards

• How do you control them?

Work performance

• Were works completed satisfactorily?

  Yes

  No

• Employee Name & Signature

  Sign

• Client Name and Signature

  Sign

• Comments or any further actions required?