JSA

• Assessment Date

  Date

• Job

• Site

• Permit to Work Required?

  Yes

  No

• Add Permit details

• Prepared by

• To add details slide finger left to right on screen to move to next section

Hazard Assessment

• Describe task

• What is the hazard Type/s? Select as many as apply Physical, e.g. moving vehicles, falling objects, stairwells Environmental, e.g. chemical exposure, extreme temperature, noise, weather Chemical, e.g. ammonia, gas Biological, e.g. fungus, virus, legionnaire’s disease Psychological e.g. stress, fatigue, relationships Ergonomic e.g. work station, equipment, locations of task and users

  Select Physical Environmental Chemical Biological Psychological Ergonomic

  • Physical
  • Environmental
  • Chemical
  • Biological
  • Psychological
  • Ergonomic

• 

• Risk Before - move slider to determined pre-control risk level

• 

• 

• 
Enter Hazard/s

• Add media

  Media
Enter Control Measures

• Add media

  Media

• Risk After - - move slider to determined controlled risk level

• 

• 

• 

• List the hazards that the contractor is introducing to site

• Has contractors JSA been received and recviewed

  Yes

  No

  N/A

• Assigned Workers

  Media

• contractor JSA

  Media

• Has a Risk review completed

  Yes

  No

• add risk report

  Media

• Finalised Date

  Date

• Has Review of Task been completed?

  Yes

  No

  N/A

• Review Date

  Date

• Has task been completed?

  Yes

  No

  N/A

• Completion Date

  Date