Title Page
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Date:
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Job Description:
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Job No:
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Division:
- Electrical Servicing
- Fire Servicing
- Networks-NP
- Networks-TGA
- Networks-PN
- Networks-HAM
- Civil Works-NP
- Civil Works-HAM
- Streetlighting
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Customer/Client/Contract:
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Location
Site Supervisor
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Name:
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NAME:
EMERGENCY RESPONSE INFORMATION:
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Supervisor
- 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
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Branch Phone:
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EMERGENCY SERVICES: 111
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First Aid Kit
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Fire Extinguisher
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Spill Kit Location
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Height Rescue Kit
Hazards / Risks
Permit Requirements
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Permits Required
- None
- TMP
- Confined Space
- Excavation
- Hot Work
- Isolation/Electrical
- HV NAPA
- LV NAPA
- Live LV Permit
- Other
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Please Specify
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Critical Risks Activities to consider
- 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
Step 1 -Planning
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Are there any hazard controls required with this step?
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Identify the hazard controls
- Scope of work identified
- Authorization to work
- Client notification completed
- Resources available-(time/people/tools)
- Correct job information
- Other
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Initial risk assessment
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Residual risk assessment
Step 2- Site Setup
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Are there any hazards associated with this step?
- Yes
- No
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Identify Hazard
- Roles and responsibilities not assigned
- Inexperienced workers
- Inadequate traffic management
- No Signage and Barriers
- Work area not defined
- Permits not ready
- Other PCBU's not consulted
- Public at work site
- Visitors at work site
- Not signed onto the site
- Environmental conditions
- Other
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Please specify
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Initial risk assessment
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Hazard control summary
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Residual risk assessment
Step 3- During the work
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Are there any hazards associated with this step?
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Identify Hazards
- Traffic
- Height Work
- Electricity
- Mobile Plant
- Hazardous Substances
- Working around others-public/contractors/visitors
- Manual Handling-lifting/carrying
- Lifting operations
- Underground services
- Lone working
- Confined spaces
- Other
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Please specify
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Initial risk assessment
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Hazard control summary
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Residual risk assessment
Step 4- Job completion / Quality Assurance
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Are there any hazards associated with this step?
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Identify Hazards
- Unfinished work
- Incomplete job notes
- Incorrect test results
- Incorrect As-builts
- Incomplete Certification
- Permits not closed out/returned
- Defects not reported
- Uncontrolled site
- Other
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Please specify
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Initial risk assessment
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Hazard control summary
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Residual risk assessment
Changing Conditions
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Identify changes in the workplace
- None
- Change of site?
- Job methodology?
- Site supervision?
- Resources: people /equipment / time?
- Weather conditions ?
- Other contractors?
- Site controls?
- Other
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Please specify
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Initial risk assessment
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Hazard control summary
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Residual risk assessment
Risk assessment matrix
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Risk assessment matrix
Sign Off
Job Safety and Environmental Analysis Work Team Sign-On
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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 .
Work Team and Visitor Sign-On
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Daily Sign On / Off
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Date
Name and Role
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Name and Role of Team Member / Contractors/ Visitors
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Sign On
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Sign Off
Sign on
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Name and Role
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Sign On
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Sign Off
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Name and Role
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Sign On
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Sign Off
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Name and Role
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Sign Off
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Name and Role
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Name and Role
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Name and Role
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Name and Role
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Sign On
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Sign Off
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Name and Role
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Sign Off
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Name and Role
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Sign On
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Sign Off
