JSEA

• JSEA for a Site Visit, Inspection or Traffic Count

  Yes

  No

  N/A

• Job No:

• Location:
  Address

• Date:

  Date

• Project Manager

  Select Alastair Black Naomi McMinn Mel Parsons Vinish Prakash Reid Meiklejohn Darryl Woodhouse Darryl Mills Maria George Jim Redmond Simon Devoy Harrison Wilson

  • Alastair Black
  • Naomi McMinn
  • Mel Parsons
  • Vinish Prakash
  • Reid Meiklejohn
  • Darryl Woodhouse
  • Darryl Mills
  • Maria George
  • Jim Redmond
  • Simon Devoy
  • Harrison Wilson

• Reviewed and Approved by Supervisor :

  Select Alastair Black Naomi McMinn Mel Parsons Vinish Prakash Reid Meiklejohn Darryl Woodhouse Darryl Mills Maria George Jim Redmond Simon Devoy Harrison Wilson

  • Alastair Black
  • Naomi McMinn
  • Mel Parsons
  • Vinish Prakash
  • Reid Meiklejohn
  • Darryl Woodhouse
  • Darryl Mills
  • Maria George
  • Jim Redmond
  • Simon Devoy
  • Harrison Wilson

• JSEA Team Members

  Select Alastair Black Naomi McMinn Mel Parsons Vinish Prakash Reid Meiklejohn Darryl Woodhouse Darryl Mills Maria George Jim Redmond Simon Devoy Harrison Wilson

  • Alastair Black
  • Naomi McMinn
  • Mel Parsons
  • Vinish Prakash
  • Reid Meiklejohn
  • Darryl Woodhouse
  • Darryl Mills
  • Maria George
  • Jim Redmond
  • Simon Devoy
  • Harrison Wilson

EMERGENCY RESPONSE INFORMATION:

• MOBILE PHONE:

  Select Alastair Black 021889994 Naomi McMinn 0272357707 Melanie Parson 02102749684 Vini Prakash 02102350704 Reid Meiklejohn 0279205378 Darryl Woodhouse 021551943 Darryl Mills 0212467575

  • Alastair Black 021889994
  • Naomi McMinn 0272357707
  • Melanie Parson 02102749684
  • Vini Prakash 02102350704
  • Reid Meiklejohn 0279205378
  • Darryl Woodhouse 021551943
  • Darryl Mills 0212467575

• NEAREST MEDICAL CENTRE

  Select Anglesea Clinic - 078580800, 1 Thackeray Street Victoria Urgent Care 07 8340333 173 Anglesea Street Tui Medical Care Te Rapa 0800175175 26 Bryant Road Waikato Hospital 07 8398899 183 Pembroke St

  • Anglesea Clinic - 078580800, 1 Thackeray Street
  • Victoria Urgent Care 07 8340333 173 Anglesea Street
  • Tui Medical Care Te Rapa 0800175175 26 Bryant Road
  • Waikato Hospital 07 8398899 183 Pembroke St

Or

• EMERGENCY SERVICES: 111

• EMERGENCY ASSEMBLY POINT

QUESTIONS

• What is the traffic speed?

• What is the traffic volume level

  Select Level LV - less than 500 vpd Level 1 - 500 - 10,000 vpd Level 2 - greater than 10,000 vpd Level 3 - high speed multilane road

  • Level LV - less than 500 vpd
  • Level 1 - 500 - 10,000 vpd
  • Level 2 - greater than 10,000 vpd
  • Level 3 - high speed multilane road

• What is the relevant COPTTM inspection Activity?

  F3.5 Level LV

  F4.10 Level 1

  Other - please attach

• COMPTTM Inspection Activity

• What are you inspecting?

  Select Observations from the footpath Counting Traffic Road Inspection Visual Road Inspection - entering traffic for less than 5 minutes Road inspection - entering traffic for greater than 5 minutes

  • Observations from the footpath
  • Counting Traffic
  • Road Inspection Visual
  • Road Inspection - entering traffic for less than 5 minutes
  • Road inspection - entering traffic for greater than 5 minutes

• Who is your traffic spotter?

  Select Alastair Black Naomi McMinn Mel Parsons Vinish Prakash Reid Meiklejohn Darryl Woodhouse Darryl Mills Maria George Jim Redmond Simon Devoy Harrison Wilson

  • Alastair Black
  • Naomi McMinn
  • Mel Parsons
  • Vinish Prakash
  • Reid Meiklejohn
  • Darryl Woodhouse
  • Darryl Mills
  • Maria George
  • Jim Redmond
  • Simon Devoy
  • Harrison Wilson

• Is the Road Inspection sign erected and the Beacon Light on?

  Yes

  No

  N/A

• What PPE is required?

  Select Boots Eye Protection Sun Hat Hard Hat Gloves Hearing Protection Beacon Signage Safety Pole High Vis

  • Boots
  • Eye Protection
  • Sun Hat
  • Hard Hat
  • Gloves
  • Hearing Protection
  • Beacon
  • Signage
  • Safety Pole
  • High Vis

• Have you checked?

  Select Environmental Conditions Driving Conditions Your Surroundings The Traffic is as expected Your mobile is fully charged Have the correct PPE

  • Environmental Conditions
  • Driving Conditions
  • Your Surroundings
  • The Traffic is as expected
  • Your mobile is fully charged
  • Have the correct PPE

• What is the visibility like?

  Good

  Fair

  Poor

  N/A

• Is a TMP required?

  Yes

  No

  N/A

• Have you applied to council using a short form TMP? If Yes stop and save JSEA until TMP is received.

  Yes

  No

  N/A

• What Hazards are present?

  Select Traffic Movements Air Emissions - dust, fumes Falling Objects Slippery Surfaces Trip Hazards Reduced Visibility Blind Visibility Weather

  • Traffic Movements
  • Air Emissions - dust, fumes
  • Falling Objects
  • Slippery Surfaces
  • Trip Hazards
  • Reduced Visibility
  • Blind Visibility
  • Weather

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

• Review the JSEA Checklist

• Review the Traffic Risk Matrix

• Further controls are required.

New Hazards

• Are there new hazards associated with this task?

  Yes

  No

  N/A

• HAZARD SCENARIO - 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 Score after control

Add photos from inspection

• Add media

  Media

• Add media

  Media

• Add media

  Media

• Add media

  Media

• Add media

  Media

• Add media

  Media

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

• undefined

  Select Alastair Black Naomi McMinn Mel Parsons Vinish Prakash Reid Meiklejohn Darryl Woodhouse Darryl Mills Maria George Jim Redmond Simon Devoy Harrison Wilson

  • Alastair Black
  • Naomi McMinn
  • Mel Parsons
  • Vinish Prakash
  • Reid Meiklejohn
  • Darryl Woodhouse
  • Darryl Mills
  • Maria George
  • Jim Redmond
  • Simon Devoy
  • Harrison Wilson

• Add signature

  Sign