JSA & Hazard Identification

• Conducted on

  Date

• Description of Works:

• Client/Site Contact:

• Client Contact Number:

• Prepared By:

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Client / Site Address:

Job Site Analysis

• Are there any special skills required of the installer to complete this job? Ie. Working at heights, licenses.<br>

  Yes

  No

  N/A

• What special skills are required?

• Does the installer need any special equipment to complete the job? Ie. Respirators, Gloves, Ear Muffs, Welding Shield<br>

  Yes

  No

  N/A

• What special equipment is required?

• Are we required to barricade any areas? Ie. Red cones, flags, tape, spotters

  Yes

  No

  N/A

• Please take note and photos of areas that need barricading and list requirements.

  Media

• Is there any potential for environmental harm?

  Safe

  At Risk

  N/A

• Please note concerns of environmental harm.

• Is any machinery required for works to be completed?

  Yes

  No

  N/A

• What machinery is required?

• Does the client need to clear any areas or access paths?

  Yes

  No

  N/A

• Please note and take photos of areas that need to be cleared.

  Media

• Identify an emergency zone for workers to convene at. Please ensure all workers and subcontractors are aware.

  Media

Hazard Identification

• Is there public access?

  Yes

  No

  N/A

• Please note and take photo of access issues.

  Media

• Yes

  No

  N/A

• Please note issues and take photos of area.

  Media

• Are there any hazardous substances?

  Yes

  No

  N/A

• Please note and take photos of hazardous substances.

  Media

• Is there good ventilation?

  Yes

  No

  N/A

• Please note ventilation issues.

• Are there any sharp objects?

  Yes

  No

  N/A

• Please note and take photos of sharp objects.

  Media

• Are there any hygiene issues?

  Yes

  No

  N/A

• Please note and take photo of hygiene issues.

  Media

• Is any fall arrest equipment required?

  Yes

  No

  N/A

• Specify height in metres and what is required.

• Are there any animals on site?

  Yes

  No

  N/A

• Do these animals pose and issue for installers?

• Will there be any other contractors on site at time of installation?

  Yes

  No

  N/A

• Please specify.