JSA for PO

• Client / Site Contact

• Location
  Address

• Phone Number

• Email Address

• Prepared by

• Select date

  Date

• Invoice #

• Customer Order #

• JOB SAFETY ANALYSIS (JSA) TO BE USED IN CONJUNCTION WITH SAFE WORK METHOD STATEMENT (SWMS)

HAZARD / RISK IDENTIFICATION. IF YES, CONTROL MEASURES REQUIRED

• Personal Injury / Weather

  Yes

  No

  N/A

• Appropriate PPE to be worn - Hi Vis clothing, safety boots, hard hat, earmuffs, eyewear

• Pedestrian / Public Safety

  Yes

  No

  N/A

• Provide safe route in and around worksite

• Traffic Management / Access

  Yes

  No

  N/A

• Use of correct signage and management plan / Use of traffic management company

• Overhead Conductors

  Yes

  No

  N/A

• Refer to green book on distances / Allocate a licensed spotter

• Underground Services

  Yes

  No

  N/A

• MOC’s on site and locating equipment used to verify assets

• Environmental

  Yes

  No

  N/A

• Silt traps in use / Spill kits on hand / Weed control

• Excavation / Ground Support

  Yes

  No

  N/A

• Shoring required if over 1.5m depth / Require mine manager on site

• Tools / Equipment / Plant

  Yes

  No

  N/A

• Plant and equipment checklist to be filled out

• Asbestos / Contaminated Material

  Yes

  No

  N/A

• Jobsite to be made safe and reported / Work to cease

• Critical Users / High Profile Area

  Yes

  No

  N/A

• All affected users to be notified

• Fire

  Yes

  No

  N/A

• Fire extinguisher / CFA Permits

• Noise

  Yes

  No

  N/A

• Use of hearing protection

• Electrical LV & HV

  Yes

  No

  N/A

• Limits of approach, spotter

• Hazardous / Dangerous Leads

  Yes

  No

  N/A

• Stored correctly

• Manual Handling

  Yes

  No

  N/A

• Use of correct manual handling technique

• Slips, Trips and Falls

  Yes

  No

  N/A

• Clean and tidy worksite

• SITE INDUCTION CARRIED OUT COVERING SWMS & ABOVE MATTERS?

  Yes

  No

• Completed By

  Sign

• PLANT OPERATORS DAILY SAFETY CHECKLIST (BEFORE COMMENCING)

MACHINE HOURS

• Visibility - Windscreen, Wipers, Washer, Demister, Mirrors, Window (Visual)

  OK - No Obvious Defect

  Fault Identified

  Item Not Applicable

• PLANT FAULT / DEFECT REPORT

• Cabin - Access / Egress, Seating, Seatbelts, Loose Objects, Control Levers (Check)

  OK - No Obvious Defect

  Fault Identified

  Item Not Applicable

• PLANT FAULT / DEFECT REPORT

• Wheels - Tyres, Nuts, Damage, Wear, Pressure (Visual)

  OK - No Obvious Defect

  Fault Identified

  Item Not Applicable

• PLANT FAULT / DEFECT REPORT

• Guards - In Place, Secure, Warning Signs - Light, Alarms Working (Visual)

  OK - No Obvious Defect

  Fault Identified

  Item Not Applicable

• PLANT FAULT / DEFECT REPORT

• Hydraulics - Rams, Hose, Leaks, Wear (Visual)

  OK - No Obvious Defect

  Fault Identified

  Item Not Applicable

• PLANT FAULT / DEFECT REPORT

• Excessive Wear - Hooks, Chains, Pins, Pivots, Track, Ground Engage, Tools (Visual)

  OK - No Obvious Defect

  Fault Identified

  Item Not Applicable

• PLANT FAULT / DEFECT REPORT

• Miscellaneous - Electrical, Communications (Check)

  OK - No Obvious Defect

  Fault Identified

  Item Not Applicable

• PLANT FAULT / DEFECT REPORT

• Actions Required

• Checklist Performed By

  Sign

• Brakes, Steering Gauges, Lights, Warning Devices (Check)

  OK - No Obvious Defect

  Fault Identified

  Item Not Applicable

• PLANT FAULT / DEFECT REPORT