• SITE ADDRESS:

  • CONTRACTOR NAME:

  • CONTRACTOR'S JOB TITLE:

  • LOCATION OF JOB ON SITE:

  • BRIEF JOB DESCRIPTION:

  • CLIENT CONTACT NAME:

  • CLIENT CONTACT JOB TITLE:

JOB TASKS

  • ACTIVITY

  • HAZARDS

  • RISK

  • RISK CONTROL MEASURES

  • RESIDUAL RISK

  • RESPONSIBILITY

  • NOTES

  • ACTIVITY

  • HAZARDS

  • RISK

  • RISK CONTROL MEASURES

  • RESIDUAL RISK

  • RESPONSIBILITY

  • NOTES

  • ACTIVITY

  • HAZARDS

  • RISK

  • RISK CONTROL MEASURES

  • RESIDUAL RISK

  • RESPONSIBILITY

  • NOTES

  • ACTIVITY

  • HAZARDS

  • RISK

  • RISK CONTROL MEASURES

  • RESIDUAL RISK

  • RESPONSIBILITY

  • NOTES

  • ACTIVITY

  • HAZARDS

  • RISK

  • RISK CONTROL MEASURES

  • RESIDUAL RISK

  • RESPONSIBILITY

  • NOTES

  • ACTIVITY

  • HAZARDS

  • RISK

  • RISK CONTROL MEASURES

  • RESIDUAL RISK

  • RESPONSIBILITY

  • NOTES

GENERAL - workplace inspection follow up

  • Has there been any significant changes to the workplace / new hazards identified in general since the last workplace inspection was completed?
    E.G. Poor lighting, tripping hazards in walkways, fire exit signs not working, no fire extinguishers, no drinking water available, dangerous power leads, etc.

  • If yes, please list below:

  • AREA

  • HAZARDS

  • RISK

  • RISK CONTROL MEASURES

  • RESIDUAL RISK

  • RESPONSIBILITY

  • NOTES

  • AREA

  • HAZARDS

  • RISK

  • RISK CONTROL MEASURES

  • RESIDUAL RISK

  • RESPONSIBILITY

  • NOTES

  • AREA

  • HAZARDS

  • RISK

  • RISK CONTROL MEASURES

  • RESIDUAL RISK

  • RESPONSIBILITY

  • NOTES

  • AREA

  • HAZARDS

  • RISK

  • RISK CONTROL MEASURES

  • RESIDUAL RISK

  • RESPONSIBILITY

  • NOTES

CONSULTATION ATTENDEES

ORIGINAL

  • I have been consulted in regards to the above Job Safety Assessment (JSA) and am aware of any hazards identified.

  • CLIENT CONTACT:

  • Select date

  • FORSYTHES CONTACT:

  • Select date

  • CANDIDATE:

  • Select date

  • CANDIDATE:

  • Select date

  • CANDIDATE:

  • Select date

  • CANDIDATE:

  • Select date

  • CANDIDATE:

  • Select date

  • CANDIDATE:

  • Select date

REVIEW

  • I agree that there have been no new hazards identified and the original Job Safety Assessment (JSA) applies.

  • CLIENT CONTACT:

  • Select date

  • FORSYTHES CONTACT:

  • Select date

  • CANDIDATE:

  • Select date

  • CANDIDATE:

  • Select date

  • CANDIDATE:

  • Select date

  • CANDIDATE:

  • Select date

  • CANDIDATE:

  • Select date

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