Title Page
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Location
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Task
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Conducted on
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Prepared by
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Date
Select Responses Below
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Have the Fatality Risk(s) been identified reflective of task being undertaken?
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Have all controls been identified?
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Has the team reviewed and signed onto the JSEA?
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Is the task being undertaken with the Isolation/ Isolation Boundary in place?
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Have all workers placed their red personal danger lock on the PCB Level 2 isolation or Isolator Level 1 isolation?
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Are the required permits for the task authorised and active?
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Are the rescue plans current ( In Date) and reflective of task being undertaken?
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Does the nominated stand by person for the above permits understand their roles and responsibilities? (CSC, Fire Watch)
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Do the workers have current training permits/cards to undertake task?
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Is the team aware of all other works being completed around them and the subsequent hazards created? Are the hazards adequately controlled and positive communication established with the other teams?
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Are the correct barricading, signage and information tags for the task, including above and below, in place?
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Has the Supervisor attended the work front today?
Sign Off
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