Information
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Document No.
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Client / Customer Name
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Conducted on
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Prepared by (Site Supervisor)
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Location
Vehicle
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Is a vehicle/s being used on this job?<br>If YES, note Rego. No. of vehicle.
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Registration number Vehicle 1:
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Registration number Vehicle 2:
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Registration number Vehicle 3:
Machinery
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Are chainsaws required on this job?
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"Chainsaw" SWMS attached
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Is a wood-chipper required for this job?
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"Chipper" SWMS attached
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Is the Vermeer S925TX mini skid-steer loader required for this job?
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"Vermeer S925TX" SWMS attached
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Is a stump-grinder required for this job.
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"Stump Grinder" SWMS attached
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Is any other equipment required for this job.
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Additional equipment:
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Additional equipment:
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Additional equipment:
On - site hazards
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Check for overhead service lines:<br>High voltage power-lines or service lines to property.<br>Staff are trained, regulation distances are maintained, appropriate equipment is on hand.
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Check for underground services:<br>Accurate detection.
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Check for vehicle and pedestrian access:<br>Exclusion zones are set up with signs and cones in place; staff are trained and understand requirements.
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"Working in Public Area" SWMS attached:
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Building and assets - terrain and access:<br>Are the safe working distances maintained, is the equipment appropriate for the location, are staff trained.
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Is there any existing damage? PHOTO IS REQUIRED IN "DROP DOWN" SECTION:<br>Check the work area fully for any existing damage. <br>Identify areas where this job may impact on any structure on the property.
Weather
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Heat / cold / wind / rain:<br>Modify work practises if required, weather protection gear (including sunscreen) is supplied and used.<br><br>
Tree
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Check the tree for defects: PHOTO IS REQUIRED IN "DROP DOWN" SECTION:<br>Is the tree unstable / split / decaying / dead.<br>Are there nails, wire, spikes, vines, nests or insect colonies in the tree.<br>Are the branches diseased, are branches intruding from other trees or is the crown leaning heavily.<br>Identify areas where this job may impact on any structure on the property.<br>Inspect thoroughly, ensure appropriate access methods are chosen and fall path is assessed.
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Is a climber required for this job.<br>If YES, who is climbing.
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Climber #1:
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Climber #2:
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Climber #3:
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Work at Heights Safe Work Method Statement: All workers present have been consulted, inducted and understand the SWMS for their job.
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"Work at Heights - Tree Climbing" SWMS attached:
Safety Equipment required
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Ropes, harnesses and pole belts:<br>Check for wear, damage and safety.<br><br>
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Personal Protection Equipment: <br>Are all staff wearing the appropriate PPE, including chainsaw pants, steel cap boots and hi-vis shirt.<br>
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Aerial Rescue equipment:<br>Check aerial rescue gear is present, fully checked and staff are trained appropriately.
Staff
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Training and task allocation: In signing this Job Site Assessment (JSA), you are agreeing that you have been consulted in, and trained on the agreed controls contained within the attached Safe Work Method Statements, and that you will ensure the risk controls listed in the SWMS will be implemented and complied with. All staff read and understand Workplace Health & Safety (WH&S) rules. Rescue plans have been discussed.
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Site Supervisor to sign Name:
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Name:
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Name:
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Name:
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Name:
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Name:
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Name:
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Name:
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Name:
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Name:
