Title Page
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Site conducted
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Prepared by
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Other persons working on task
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Date
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Description of work
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Location
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Are you fit to work today?
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Do you have approval to perform your task?
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Do you have the correct tools, equipment and PPE? Are they in good condition and within test dates?
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Ensure you have all required equipment and that it is in good condition before undertaking your task. If this is not possible, contact your supervisor/manager.
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Are there any new hazards on site today?
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State the hazard and your method of control.
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Is there any other new hazards on site today?
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State the hazard and your method of control.
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Are permits still open for work if required?
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If permit was closed, open a new permit for the work to be conducted and upload a photo via JSA/ permit record template.
Sign Off
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Confirm that the work is safe to undertake and that all practicable steps have been taken to reduce risks.
If there are outstanding hazards, contact your supervisor/manager. -
Employee Signature
