• Permits Required

  • Please Specify

  • JSEA Team Members

  • Name:
  • NAME:

EMERGENCY RESPONSE INFORMATION:

  • INTERNAL PHONE:

  • EXTERNAL PHONE:

  • EMERGENCY SERVICES: 000

  • INTERNAL RADIO SYSTEM:

Hazards to Consider (Controls must be identified)

  • Working at Height

  • Electrical

  • Human Factors

  • Mechanical

  • Pressure

  • Thermal

  • Mobile Plant

  • Manual Handling (Ergonomic)

  • Chemical

  • Workplace

  • Environmental

  • Radiation

JOB STEPS - List the steps required to perform the task in the sequence they are carried out.

  • Job step tasks

  • JOB STEP
  • Is there any Hazards associated with this task?

  • Hazard Scenario - For each Job Step list the hazards that could cause injury when the task is performed.

  • Raw Risk Score associated with Hazard.

  • RISK CONTROL MEASURES - List the control measures required to eliminate or minimise the risk of injury arising from the identified hazard.

  • RISK CONTROLS.JPG
  • Risk Score after control

  • Further controls are required.

  • Risk Matrix

    Risk Matrix.JPG

Sign Off

Job Safety and Environmental Analysis Work Team Sign-On

  • The undersigned acknowledge that they have been consulted in respect to the hazards of the job and how the job is to be completed safely, that they have read, understood and will adhere to the requirements of this JSEA. Any changes to hazards, conditions, work environment or job steps requires modification of the JSEA and communication of changes.

  • Work Team Sign-On

  • Name
  • Add signature

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