Pookie Pooks -jsa

• Site conducted

  Select

• JSA No.

• Conducted on

  Date
• ADDRESS
  Address

APPLICABLE SWMS

• SWMS-018 INSPECTION, CONNECTION OR ADVICE AT A CUSTOMERS PREMISES

  Yes

  No

  N/A

• SWMS-001 DISTRIBUTOR HVI INSPECTIONS

  Yes

  No

  N/A

• SWMS-002 DISTRIBUTOR INSPECTION OR ADVICE AT A CUSTOMERS PREMISES

  Yes

  No

  N/A

• SWMS-003 DISTRIBUTOR SHOCK INVESTIGATIONS

  Yes

  No

  N/A

• SWMS-004 DISTRIBUTOR REVENUE PROTECTION INVESTIGATIONS

  Yes

  No

  N/A

• SWMS-019 WORKING FROM HEIGHTS

  Yes

  No

  N/A

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INSTRUCTIONS, PPE & TOOLS

• Have you considered and implemented your COVID-19 hazard controls?

  Safe

  At Risk

  N/A

• If 'At Risk' do not proceed with the inspection and notify your Manager immediately

  Yes

  No

  N/A

• Do you fully understand all instructions relating to the task?

  Yes

  No

  N/A

• Is your PPE suitable for the task?

  Yes

  No

  N/A

• Has all your test equipment been checked and in working order?

  Yes

  No

  N/A

GENERAL HAZARDS IDENTIFIED (tick if appropriate)

• Live work

• Manual handling

• Slips. trips & falls

• Traffic hazards

• Weather

• Restricted access

• SAD's as per the Green Book

• Hard hat area

• Unsafe worksite

• Other hazards

GENERAL HAZARDS CONTROL MEASURES (tick if appropriate)

• Visual inspection only

• Isolate supply

• Clear access

• Suitable PPE

• Eye & hearing protection

• LV & hard working gloves

• Traffic management

• Signs, labels, tags or barriers

• Hard hat

• Safety observer

• Other control measures

LIVE WORK HAZARDS IDENTIFIED (tick if appropriate)

• Working with and in the vicinity of live equipment

• Damaged equipment

• Reverse polarity

• Back feed from alternative supply

• Other live work hazards

LIVE WORK HAZARDS CONTROL MEASURES (tick if appropriate)

• Isolate supply

• SAD's as per Green Book

• LV mats

• Tags, labels or barriers

• LV gloves

• Suitable PPE

• Eye protection

• Insulated tools

• Visual inspection only

• Other control measures

WORKING FROM HEIGHTS (tick if appropriate)

• Are you working from a height greater than 2 metres or closer than 2 metres from an edge?

WORKING FROM HEIGHTS HAZARD CONTROLS (HIERARCHY) (tick if appropriate)

• 1 - Complete the task on the ground

• 2 - EWP or guarding or scaffold

• 3 - Restraint system

• 4 - Lanyard, harness or belt

• 5 - Ladder

• 6 - Observer or Temporary barrier (warning signs, cones, tape etc)

ENVIRONMENTAL HAZARDS (tick if appropriate)

• Asbestos

• Weed or erosion

• Possible fires from your vehicle

• Oil or fluid spills

• RF antenna

ENVIRONMENTAL HAZARD CONTROL MEASURES (tick if appropriate)

• Asbestos - isolate & report

• Wash vehicle, take alternative route

• Maintain clearance from undergrowth & have fire prevention equipment accessible

• Hazardous substance procedure

ADDITIONAL COMMENTS

• Additional comments or notes

• Add photos

  Media

MANDATORY SIGNATURE SECTION

• The risk assessment has been completed in accordance with the appropriate Safe Work Method
  Statement (SWMS), and all mandatory tests have been performed in accordance with EIV procedures.
  By signing this form you acknowledge that you understand the Work Instructions and are authorised to
  carry out this work.
  

Signature

• Signature

  Sign