JSA / Audit

  • Date and time

  • Job Description

  • Work location

  • IS SPECIAL TRAINING REQUIRED?

  • Are All Employees Briefed On The Hazards Of This Job?

  • Will Weather Affect The Safe Execution Of This Work?

PROCEDURES OR PERMITS REQUIRED:

  • Fill Out and Attach Appropriate Tag?

  • Fill Out Confined Space Permit?

  • Fill Out Daily Excavation Safety Checklist

  • Fill out Hot Work Permit

  • Fill Out Barricade Tag

  • OTHER (Enter Description)

COMPETENT PERSON CHECKLIST:

Trench and Excavation:

  • Sloped or Shielded Excavation (Over 5vf)

  • Spoil Pile Greater Than 2lf From Edge of Excavation

  • No Water Present

  • Means of Egress and Access

Confined Space:

  • Air Monitor

  • Confined Space Attendant Sign IN/OUT

  • Ventilation System

  • Retraction (Rescue) Device

Lifting or Rigging:

  • Certified Chains

  • Slings, Hooks, Clevices

  • Identify Weight of Materials Being Lifted

  • Verify Reach and Load Limits of Equipment Doing Lifting (Verify Equipment Specific Lifting Chart)

Fall Protection:

  • Is Work Over 6vf Off The Ground? (If Yes, Fall Protection Required)

  • ADDITIONAL COMMENTS:

EMPLOYEE SIGNATURES:

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  • Add signature

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