Job Safety Plan (JSA)

• Site conducted

  Select

• Document No.

• Conducted on

  Date

• Prepared by

• Location
  Address

Meeting Details

• Name of the working groups present (trades, subcontractors)

• Topic of the Tool Box Talk

• HSE Responsible

Task description

• Brief description of the tasks for the day

• Description of tasks

Job Type

• Select Job Type

  Select

• Describe

Potential risk or hazard identified while task is being performed

• Select all that apply

  Select

Rate risk/ hazard before control measures

• Risk / Hazard before control measures

  Select Extremely High Risk High Risk Moderate Risk Low Risk

  • Extremely High Risk
  • High Risk
  • Moderate Risk
  • Low Risk

Hazard Control Measures

• Select

  Select

Required PPE

• Select mandatory PPE

  Select

Previous "JSA"

• Are there any open issues on the topic of HSE from the last Toolbox Talk?

  Yes

  No

• Describe

HSE Risk Profile

• Overview

  Media

Situationen

• Have situations and conditions changed

  Yes

  No

• New safety issues arising from this meeting

• Are improvement measures required

  Yes

  No

Generell

• Are there any general open questions on the subject of HSE

  Yes

  No

• Describe?

• Photos or pictures

  Media

Attendance Log

• Name and function of the Toolbox Talk executive

  Sign

• We (the undersigned) have participated in this Tool Box Talk, understand the content, and will comply with the indicated requirements and control measures.

Team Member

• Name & Signature

  Sign