Scott Automation - Job Safety Analysis

• Client

• Job Number

• Job Description

• Person In Charge

• Date

  Date

• JSA conducted by

• Site Address
  Address

• Instructions
  
  1. Choose the best response for each of the items and fill out the blank spaces provided.
  2. Add photos and notes by clicking on the paperclip icon
  3. To add corrective actions, click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date
  4. Complete the audit by providing digital signature
  5. Share your report by exporting as PDF, Word, Excel or Web Link

General JSA Details

• Is a permit to work required?

  Yes

  No

  N/A

• Can the job proceed?

  Yes

  No

  N/A

Safety Equipment

• Choose the applicable safety equiipment required

  Select Protective clothing / Overalls Gloves Face / Eye protection Sun Protection Insulating glove / Matting Respiratory protection Hi-Vis Vest Fall protection equipment (harness) Hard hats Safety footwear First aid kit Asbestos kit Restricted area access notice board (RAAB) Low voltage rescue kit Barricades. signs, danger tape Testing equipment Hearing protection Spill Kit

  • Protective clothing / Overalls
  • Gloves
  • Face / Eye protection
  • Sun Protection
  • Insulating glove / Matting
  • Respiratory protection
  • Hi-Vis Vest
  • Fall protection equipment (harness)
  • Hard hats
  • Safety footwear
  • First aid kit
  • Asbestos kit
  • Restricted area access notice board (RAAB)
  • Low voltage rescue kit
  • Barricades. signs, danger tape
  • Testing equipment
  • Hearing protection
  • Spill Kit

• • Notes

Equipment Check

• Choose all the AVAILABLE and IN WORKING CONDITION equipment

  Select Communication / 2 way / mobile Power tools / leads / RCDs Ladders / EWPs / scaffolds Lock out / danger tags Fall protection equipment Vehicle / plant Hand tools / test tools Fire extinguisher

  • Communication / 2 way / mobile
  • Power tools / leads / RCDs
  • Ladders / EWPs / scaffolds
  • Lock out / danger tags
  • Fall protection equipment
  • Vehicle / plant
  • Hand tools / test tools
  • Fire extinguisher

• • Notes

• Choose all the UNAVAILABLE and NON-WORKING CONDITION equipment

  Select Communication / 2 way / mobile Power tools / leads / RCDs Ladders / EWPs / scaffolds Lock out / danger tags Fall protection equipment Vehicle / plant Hand tools / test tools Fire extinguisher

  • Communication / 2 way / mobile
  • Power tools / leads / RCDs
  • Ladders / EWPs / scaffolds
  • Lock out / danger tags
  • Fall protection equipment
  • Vehicle / plant
  • Hand tools / test tools
  • Fire extinguisher

• • Notes

Licenses / Qualifications / Training

• Choose the APPLICABLE LICENSES / QUALIFICATIONS / TRAINING

  Select Forklift Working at Heights Confined Spaces Other

  • Forklift
  • Working at Heights
  • Confined Spaces
  • Other

• • Specify

• • Notes

Additional Checks

• Choose the APPLICABLE CHECKS that are relevant

  Select Emergency Evacuation Plan Inductions completed Authority to Proceed Exit Routes identified and clear Other

  • Emergency Evacuation Plan
  • Inductions completed
  • Authority to Proceed
  • Exit Routes identified and clear
  • Other

• • Specify

• • Notes

• A. Job Tasks

• B. Identifiable Hazards

• • Area Hazards

  Select People / Vehicles Noise Trip / Slip / Slippery Surfaces Adverse Weather Lighting Temperature / Humidity Oxygen Deficiency

  • People / Vehicles
  • Noise
  • Trip / Slip / Slippery Surfaces
  • Adverse Weather
  • Lighting
  • Temperature / Humidity
  • Oxygen Deficiency

• • Height Hazards

  Select Work Above Two Metres Work with a Cherry Picker Forklift with a Safety Cage Using a Scissor Lift Erecting / working on Scaffold Ladder Work RADIATION Radioactive Isotopes Infrared Radiation(Welding,Laser) Solar

  • Work Above Two Metres
  • Work with a Cherry Picker
  • Forklift with a Safety Cage
  • Using a Scissor Lift
  • Erecting / working on Scaffold
  • Ladder Work
  • RADIATION
  • Radioactive Isotopes
  • Infrared Radiation(Welding,Laser)
  • Solar

• • Mechanical Hazards

  Select Moving /Rotating Parts Pressurised Fluid / Gas Steam Hot / Cold Metal Entanglement Friction / Abrasion Cutting Crushing Election Manual Handling Falling Objects

  • Moving /Rotating Parts
  • Pressurised Fluid / Gas
  • Steam
  • Hot / Cold Metal
  • Entanglement
  • Friction / Abrasion
  • Cutting
  • Crushing
  • Election
  • Manual Handling
  • Falling Objects

• • Environmental Hazards

  Select Discharge to air / land / drains Odour / emmissions

  • Discharge to air / land / drains
  • Odour / emmissions

• • Process Hazards

  Select Tnp / Alarm Functions (Plant) Overrides / Manual Controls Commissioning Process Upset / Programming Over / Under Ranging Equip Emergency Equipment Work

  • Tnp / Alarm Functions (Plant)
  • Overrides / Manual Controls
  • Commissioning
  • Process Upset / Programming
  • Over / Under Ranging Equip
  • Emergency Equipment Work

• • Hazardous Substance

  Select Flammable Vapours / Liquids Flammable Solid / Dust Toxic / Carcinogens Corrosive / Eco-Toxic Other Gases

  • Flammable Vapours / Liquids
  • Flammable Solid / Dust
  • Toxic / Carcinogens
  • Corrosive / Eco-Toxic
  • Other Gases

• • Fibres Dusts Hazards

  Select Abrasion of Skin / Eyes Respiratory Damage Asbestos

  • Abrasion of Skin / Eyes
  • Respiratory Damage
  • Asbestos

• • Biological Hazards

  Select Bacterial / Viral / Fungal Other

  • Bacterial / Viral / Fungal
  • Other

• • Specify

• • Other Hazards

  Select Cranes Wall / Roof Penetrations Specific

  • Cranes
  • Wall / Roof Penetrations
  • Specific

• • Specify

• C. Initial Risk Level

  Minimal

  Low

  Medium

  High

• D. Control Measures

• E. Residual Risk Level

  Minimal

  Low

  Medium

  High

Other Notes

• Provide relevant notes on this current job safety analysis

Worker Sign-Off & Completion

• I, the undersigned, acknowledge, that I have been consulted regarding the content of the JOB SAFETY ANALYSIS & HAZARD / RISK ASSESSMENT and the relevant hazards, control measures, rules and requirements have been explained to me and are clearly understood by me.

SIGNATORY

• Name and Signature

  Sign