NPE-Tech - JSEA

• Date:

  Date

• Job Description:

• Job No:

• Division:

  Select Electrical Servicing Fire Servicing Networks-NP Networks-TGA Networks-PN Networks-HAM Civil Works-NP Civil Works-HAM Streetlighting

  • Electrical Servicing
  • Fire Servicing
  • Networks-NP
  • Networks-TGA
  • Networks-PN
  • Networks-HAM
  • Civil Works-NP
  • Civil Works-HAM
  • Streetlighting

• Customer/Client/Contract:

• Location
  Address

Site Supervisor

Name:

• NAME:

EMERGENCY RESPONSE INFORMATION:

• 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 Location

  Yes

  No

  N/A

• Height Rescue Kit

  Yes

  No

  N/A

Permit Requirements

• Permits Required

  Select None TMP Confined Space Excavation Hot Work Isolation/Electrical HV NAPA LV NAPA Live LV Permit Other

  • None
  • TMP
  • Confined Space
  • Excavation
  • Hot Work
  • Isolation/Electrical
  • HV NAPA
  • LV NAPA
  • Live LV Permit
  • Other

• Please Specify

• Critical Risks Activities to consider

  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

Step 1 -Planning

• Are there any hazard controls required with this step?

  Yes

  No

• Identify the hazard controls

  Select Scope of work identified Authorization to work Client notification completed Resources available-(time/people/tools) Correct job information Other

  • Scope of work identified
  • Authorization to work
  • Client notification completed
  • Resources available-(time/people/tools)
  • Correct job information
  • Other

• Initial risk assessment

  High

  Medium

  Low

• Residual risk assessment

  High

  Medium

  Low

Step 2- Site Setup

• Are there any hazards associated with this step?

  Select Yes No

  • Yes
  • No

• Identify Hazard

  Select 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

  • 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

• Please specify

• Initial risk assessment

  High

  Medium

  Low

• Hazard control summary

• Residual risk assessment

  High

  Medium

  Low

Step 3- During the work

• Are there any hazards associated with this step?

  Yes

  No

• Identify Hazards

  Select 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

  • 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

• Please specify

• Initial risk assessment

  High

  Medium

  Low

• Hazard control summary

• Residual risk assessment

  High

  Medium

  Low

Step 4- Job completion / Quality Assurance

• Are there any hazards associated with this step?

  Yes

  No

• Identify Hazards

  Select Unfinished work Incomplete job notes Incorrect test results Incorrect As-builts Incomplete Certification Permits not closed out/returned Defects not reported Uncontrolled site Other

  • Unfinished work
  • Incomplete job notes
  • Incorrect test results
  • Incorrect As-builts
  • Incomplete Certification
  • Permits not closed out/returned
  • Defects not reported
  • Uncontrolled site
  • Other

• Please specify

• Initial risk assessment

  High

  Medium

  Low

• Hazard control summary

• Residual risk assessment

  High

  Medium

  Low

• Identify changes in the workplace

  Select None Change of site? Job methodology? Site supervision? Resources: people /equipment / time? Weather conditions ? Other contractors? Site controls? Other

  • None
  • Change of site?
  • Job methodology?
  • Site supervision?
  • Resources: people /equipment / time?
  • Weather conditions ?
  • Other contractors?
  • Site controls?
  • Other

• Please specify

• Initial risk assessment

  High

  Medium

  Low

• Hazard control summary

• Residual risk assessment

  High

  Medium

  Low

Risk assessment matrix

• Risk assessment matrix

Job Safety and Environmental Analysis Work Team 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 .

Work Team and Visitor Sign-On

Daily Sign On / Off

• Date

  Date
Name and Role

• Name and Role of Team Member / Contractors/ Visitors

• Sign On

  Date

• Sign Off

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Sign on

• Name and Role

• Sign On

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• Sign Off

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• Name and Role

• Sign On

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• Sign Off

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• Name and Role

• Sign On

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• Sign Off

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• Name and Role

• Sign On

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• Sign Off

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• Name and Role

• Sign On

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• Sign Off

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• Name and Role

• Sign On

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• Sign Off

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• Name and Role

• Sign On

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• Sign Off

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• Name and Role

• Sign On

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• Sign Off

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• Name and Role

• Sign On

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• Sign Off

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