JSA (NRG)

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Access permit

• Safe Access

• Information about this type
  Could have a list of PPE typically used for this hazard

• Permit to dig

• Information about this type
  Could have a list of PPE typically used for this hazard

• High voltage

• Information about this type
  Could have a list of PPE typically used for this hazard

• Hot work

• Information about this type
  Could have a list of PPE typically used for this hazard

• Confined space entry

• Information about this type
  Could have a list of PPE typically used for this hazard

• Limited electrical isolation

• Information about this type
  Could have a list of PPE typically used for this hazard

• Floor removal

• Information about this type
  Could have a list of PPE typically used for this hazard

Energy

• Gravity

• Information about this type
  Could have a list of PPE typically used for this hazard

• Steam

• Information about this type
  Could have a list of PPE typically used for this hazard

• Chemical

• Information about this type
  Could have a list of PPE typically used for this hazard

• Electrical (arc flash, shock)

• Information about this type
  Could have a list of PPE typically used for this hazard

• Explosion

• Information about this type
  Could have a list of PPE typically used for this hazard

• Pressure

• Information about this type
  Could have a list of PPE typically used for this hazard

• Noise/Vibration

• Information about this type
  Could have a list of PPE typically used for this hazard

• Radiation

• Information about this type
  Could have a list of PPE typically used for this hazard

Slips/Trips/Falls

• Heights

• Information about this type
  Could have a list of PPE typically used for this hazard

• Ladders//Scaffolds

• Information about this type
  Could have a list of PPE typically used for this hazard

• Slippery Surfaces

• Information about this type
  Could have a list of PPE typically used for this hazard

• Steps

• Information about this type
  Could have a list of PPE typically used for this hazard

• Trip Hazards

• Information about this type
  Could have a list of PPE typically used for this hazard

• Uneven Surfaces

• Information about this type
  Could have a list of PPE typically used for this hazard

Working at heights

Job data information

• Date and time

  Date

• Work Order number - Task e.g. 28141234-01

• Task Description:

Job Safety Check Participants.

• Enter in the names of the Job Safety Check participants - each person must sign.

Name

• Add signature

  Sign

• Is there anyone who is a participant of this job Safety Check not familiar with the task being performed?

  Yes

  No

• You MUST undertake a Safe Work Method Statement (SWMS) with the person/s identified as unfamiliar with the task.
  http://google.com

• Add the name of the person/s who is/are unfamiliar with the task.

unfamiliar persons name.

• Add signature

  Sign

High Risk Task List

• Are you using explosives?

  Yes

  No

• You MUST undertake a Safe Work Method Statement (SWMS)
  http://google.com

• Are you removing a guard?

  Yes

  No

• You MUST undertake a Safe Work Method Statement (SWMS)
  http://google.com

• Are you doing tilt up and precast construction work?

  Yes

  No

• You MUST undertake a Safe Work Method Statement (SWMS)
  http://google.com

• Are you entering a trench more than 1.5 metres down?

  Yes

  No

• You MUST undertake a Safe Work Method Statement (SWMS)
  http://google.com

• Are you working on or near exposed energised electrical installations?

  Yes

  No

• You MUST undertake a Safe Work Method Statement (SWMS)
  http://google.com

• Are you doing any structural alterations that require temporary support to prevent collapse?

  Yes

  No

• You MUST undertake a Safe Work Method Statement (SWMS)
  http://google.com

• Are you working at height where there is a potential to fall from one level to another and sustain serious injury ( mandatory at 2 metres for construction work)?

  Yes

  No

• You MUST undertake a Safe Work Method Statement (SWMS)
  http://google.com

• Are you using any hazardous substances?

  Yes

  No

• You MUST undertake a Safe Work Method Statement (SWMS)
  http://google.com

Identify Hazards and controls.

• Risk Matrix

  

• Hazard/s (Identify hazards in the task/work area)

Hazard

• What do you assess the consequence level to be if the identified risk occurred?

  Extreme

  Major

  Moderate

  Minor

  Concern

• How likely do you think this identified risk for this activity is to occur?

  Almost Certain

  Likely

  Possible

  Unlikely

  Rare

• This is a high risk activity and a Managers decision is required to determine if the risk is acceptable and within current business practices and considered additional controls.

• This is a medium risk activity and a Superintendents decision is required to determine if the risk is acceptable and within current business practices and considered additional controls.

• How likely do you think this identified risk for this activity is to occur?

  Almost Certain

  Likely

  Possible

  Unlikely

  Rare

• This is a high risk activity and a Managers decision is required to determine if the risk is acceptable and within current business practices and considered additional controls.

• This is a medium risk activity and a Superintendents decision is required to determine if the risk is acceptable and within current business practices and considered additional controls.

• Enter any controls that exist or you have implemented to mitigate the risk

Control

• How likely do you think this identified risk for this activity is to occur?

  Almost Certain

  Likely

  Possible

  Unlikely

  Rare

• This is a high risk activity and a Managers decision is required to determine if the risk is acceptable and within current business practices and considered additional controls.

• This is a medium risk activity and a Superintendents decision is required to determine if the risk is acceptable and within current business practices and considered additional controls.

• Enter any controls that exist or you have implemented to mitigate the risk

Control

• How likely do you think this identified risk for this activity is to occur?

  Almost Certain

  Likely

  Possible

  Unlikely

  Rare

• This is a medium risk activity and a Superintendents decision is required to determine if the risk is acceptable and within current business practices and considered additional controls.

• Enter any controls that exist or you have implemented to mitigate the risk

Control

• How likely do you think this identified risk for this activity is to occur?

  Almost Certain

  Likely

  Possible

  Unlikely

  Rare

• This is a medium risk activity and a Superintendents decision is required to determine if the risk is acceptable and within current business practices and considered additional controls.

• Enter any controls that exist or you have implemented to mitigate the risk

Control