Title Page
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Audit Title
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Document No.
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Address
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Consult owner/site manager before proceeding with work to mitigate against any unseen hazards that may exist
Equipment check
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Tools in serviceable condition
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PPE in serviceable condition
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Test equipment correctly operating and in serviceable condition
Working at height
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Is Ladder access required
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Consult Working at Heights SWMS/005
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Is Roof access required from ladder
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Consult Working at Heights SWMS/005
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Is access onto roof via internal means or not from a ladder
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Assess incline of roof, use harness if risk of sliding off roof- Consult Working at Heights SWMS/005
Maintain at least 2 meters clearance from any live edge
General hazard(s) identified
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Is protection required against UV radiation
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Apply Sunscreen wear neck to toe clothing and hat
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Is there extraordinary risk of slips, trips or falls
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Ensure access/egress paths to work areas are clear, clean and stable. Choose safest pathway to worksite
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Is there danger from vehicular traffic
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Wear high visibility clothing. Maintain adequate distance from any worksite vehicles
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Are there unrestrained animals that may be a danger to people
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Assess risk from animal, proceed if risk is negligent. Have owner suitably restrain animal.
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Is risk from animal still to high to complete task
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Cancel job and inform manager
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Managers name and response
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Is any work area lighting inadequate
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Use torch or other artificial light source
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Is there inclement weather
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Wear appropriate clothing for climatic conditions . Do not expose electrical equipment to excessive damp or wet conditions
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Is there risk from airborne contaminates/particles
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Use dust mask. Assess whether goggles required
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Does the worksite require to be delineated from the public
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Ensure worksite delineated. Do not leave exposed live parts unattended
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Are you working near network distribution assests
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Observe PSSR minimum clearances
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Is there a risk of falling objects
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Wear safety helmet and steel cap boots
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Is there excessive noise pollution
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Wear hearing protection
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Are there any people acting in a dangerous or threatening manner
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Cancel job contact manager
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Managers name and response
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Is the worksite or area unsafe for any reason
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Cancel job contact manager
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Managers name and response
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Are you required to enter an area that may be a confined space
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Is the area designed or intended primarily to be occupied by a person
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Is the area designed or intended to be at a normal atmospheric pressure while any person is in the space
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Is the area likely to be a risk to health and safety from;<br>1⃣ an atmosphere that does not have a safe oxygen level, or <br>2⃣ contaminants including airborne gases vapours and dusts that may cause injury from a fire or explosion, or <br>3⃣ harmful concentrations of any airborne contaminants, or <br>4⃣ engulfment
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Area is deemed a confined space. Report to manger. Enter managers response
Live works hazard(s) identified
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Working with and/or in the vicinity of live electrical apparatus
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Consult Working With Live Electrical Installations SWMS/006
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Working with and/or in the vicinity of a metal switchboard or meter enclosure
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Test enclosure for any unsafe voltages
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Alternate generator site
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Consult Working With Live Electrical Installations SWMS/006
Environmental Hazard(s) Identified
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Is there any chance asbestos particles could be inhaled
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Wear a P2 rated dust mask.
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Is risk still too high
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Does the area need to be entered to complete the task?
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Cancel job contact manager
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Managers name and response
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Is it likely your presence will could transfer of noxious weeds or erosion
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Take alternate route, Wash car, Clean soil off footwear
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Vehicle use-is there risk of grass fire, fluid spills or carbon monoxide poisioning
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Take alternate route. Locate and check fire extinguisher. Use only in well ventilated areas. Ensure vehicle in serviceable condition
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Is there risk of flooding in the area of work
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Plan for emergency evacuation
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Is there any risk from RF radiation
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Maintain suitable distance from transmitter/receiver
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Are there hazardous substances near work site that could be a danger to health
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Consult MSDS
Seek particular hazardous substance advice
Manual handling
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Will you be carrying a heavy or awkward load
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Assess size and weight before attempting lift
Reduce carrying distance as much as possible
Do not lift load greater than individual strength
When lifting or lowering keep back straight, with head up and chin in
Carry objects close to body
Face the intended direction of travel when carrying
Move deliberately keep pace steady and even
Do not twist body when lifting, lowering or carrying load
Use second person for heavy loads
Other hazards
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Detail other site hazards and risk measures
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JSA sign off
Additional visit JSA sign off
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JSA reviewed for additional hazards
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Signature
Inspection Details
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Address
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Inspector/s
- Chris Broad
- Clayton Davies
- Damian Grubb
- David Lynch
- Grant Watkins
- Graeme Loosmore
- Martin Daniel
- Nigel Allen
- Paul Jones
- Phillip Whitmore
- Richard Tattersalls
- Tim Hopper
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Job type
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TSA job number
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CEC number
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Faults Rectified or additional CEC number
CEC number
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Add CEC number
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General Photos
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Notes/comments
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Inspection result
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Contractor
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Defect Details
Defects
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Standard
- AS/NZS 3000:2007
- AS/NZS 5033:2012
- AS/NZS 4777.1:2005
- AS/NZS 3012:2010
- AS/NZS 5033:2014
- AS/NZS 3003:2011
- Other
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Standard
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Rule Number and Defect description
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Photo
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Defect rectified upon 'Faults Rectified Inspection'
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Signature
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Additional inspection Signature
Signature
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Signature