NPE-Tech-JSA-0-Rapid

• Date:

  Date

• Job Description:

• Job No:

• Customer/Client/Contract:

• Location
  Address

• Other Contractors

• PPE Required:

  Select Hard Hat Glasses Hearing Protection Face Shield Hi-Vis Clothing Full Body Clothing Gloves Safety Boots Harness Respiratory Protection Coveralls

  • Hard Hat
  • Glasses
  • Hearing Protection
  • Face Shield
  • Hi-Vis Clothing
  • Full Body Clothing
  • Gloves
  • Safety Boots
  • Harness
  • Respiratory Protection
  • Coveralls

Site Supervisor

Name:

• NAME:

• Supervisor

  Select Ross Kronfeld-027 667 3760 Andrew Carter-027-222-3341 Gary Oliver-027-355-6131 Paul Soffe-027 299 9020 Allan Richards-027 603 0999 Jason Gibbs-027 445 4336 Kate Fitzgerald-027 276 4308 Ted Glasgow-021 981 016 Mike Thompson-027 445 4195 Thomas Tanoa-027 555 2797 Albert Rodrigues-027 742 8365 Ben Hills-027 555 4177 Greg McCutchan-027 269 0337

  • Ross Kronfeld-027 667 3760
  • Andrew Carter-027-222-3341
  • Gary Oliver-027-355-6131
  • Paul Soffe-027 299 9020
  • Allan Richards-027 603 0999
  • Jason Gibbs-027 445 4336
  • Kate Fitzgerald-027 276 4308
  • Ted Glasgow-021 981 016
  • Mike Thompson-027 445 4195
  • Thomas Tanoa-027 555 2797
  • Albert Rodrigues-027 742 8365
  • Ben Hills-027 555 4177
  • Greg McCutchan-027 269 0337

• Branch Phone:

  NP-06 758 7755

  PN-06 353 7554

  TGA-07 578 1424

  HAM-07 856 2431

EMERGENCY SERVICES: 111

• First Aid Kit

  Yes

  No

• Fire Extinguisher

  Yes

  No

• Spill Kit

  Yes

  No

  N/A

• Height Rescue Kit

  Yes

  No

  N/A

Identify Critical Risk Activities to be managed on site - Tick applicable

• Identify Critical Risk Activities to be managed on site - Tick applicable

  Select Driving Working at height Working Near Live Electricity Working with or near Mobile Plant Hazardous Substances Working around others Manual Handing Cranes & Lifting Working with or near Traffic Working around Underground Services Working Alone Confined Space Work

  • Driving
  • Working at height
  • Working Near Live Electricity
  • Working with or near Mobile Plant
  • Hazardous Substances
  • Working around others
  • Manual Handing
  • Cranes & Lifting
  • Working with or near Traffic
  • Working around Underground Services
  • Working Alone
  • Confined Space Work

• What are your controls for driving/parking?

• Residual Risk:

  High

  Moderate

  Low

• What are your controls for working at height?

• Residual Risk:

  High

  Moderate

  Low

• What are your controls for working near electricity?

• Residual Risk:

  High

  Moderate

  Low

• What are your controls?

• Residual Risk:

  High

  Moderate

  Low

• What are your controls for working with hazardous substances?

• Residual Risk:

  High

  Moderate

  Low

• What are your controls for working around others?

• Residual Risk:

  High

  Moderate

  Low

• What are your controls for manual handling?

• Residual Risk:

  High

  Moderate

  Low

• What are your controls for cranes and lifting?

• Residual Risk:

  High

  Moderate

  Low

• What are your controls for working near traffic?

• Residual Risk:

  High

  Moderate

  Low

• What are your controls for working around underground services?

• Residual Risk:

  High

  Moderate

  Low

• What are your controls for working alone?

• Residual Risk:

  High

  Moderate

  Low

• What are your controls for working in confined spaces?

• Residual Risk:

  High

  Moderate

  Low

Job Safety Analysis - Sign-On

• The undersigned acknowledge that they have read and understood the safe work controls identified in the JSEA and will report any changes in site safety to the Site Supervisor .

Job Safety Analysis - Sign-On

• Full Name and PCBU

  Sign
Job Safety Analysis - Sign-Off

• Name

  Sign