JSA Audit

• Project:

• Conducted on

  Date

• Contractor:

• Prepared by

• Location
  Address

• Crew size

• Type of Work Being performed:

Emergency Contact info and WPA

• Is the completed JSA on site?

  Yes

  No

  N/A

• Comments:

• JSA pictures (front and back)

  Media

• Work location/ rally point identified by address, proximity to nearest intersection, or GPS?

  Yes

  No

  N/A

• Comments:

• Emergency Contact information provided?

  Yes

  No

  N/A

• Comments:

• Nearest medical facility identified along with address and phone number?

  Yes

  No

  N/A

• Comments:

• Is the WPA being held listed? (Including name of person holding WPA)

  Yes

  No

  N/A

• Comments:

• Is the voltage class of the circuit being worked on/ near listed?

  Yes

  No

  N/A

• Comments:

• Is the MAD listed?

  Yes

  No

  N/A

• Comments:

Planning the work

• Are other contractors onsite identified on the JSA?

  Yes

  No

  N/A

• Comments:

• Are the tasks to be performed identified on the JSA?

  Yes

  No

  N/A

• Comments:

• Are the hazards associated with the tasks identified on the JSA?

  Yes

  No

  N/A

• Comments:

• Are the mitigation techniques identified for the listed hazards?

  Yes

  No

  N/A

• Comments:

• Is the required PPE listed for the tasks to be performed?

  Yes

  No

  N/A

• Comments

• Are all crew members signed on to the JSA?

  Yes

  No

  N/A

• Comments:

• Are the crews correctly using the post break and end of shift sign in boxes?

  Yes

  No

  N/A

• Comments:

Executing the Work

• Do the activities being performed match the tasks identified on the JSA?

  Yes

  No

  N/A

• Comments:

• Are the mitigation techniques listed on the JSA being implemented?

  Yes

  No

  N/A

• Comments:

• Is the required PPE listed for the tasks being properly utilized?

  Yes

  No

  N/A

• Comments:

Review and Signatures

• Ameren supervisor signature

  Sign

• Contractor supervisor signature

  Sign