Regan McCarthy

Temporary Machinery Repairs JSA

Use this form when putting temporary fixes in place. Any failed responses will require the equipment to be placed in a inoperable state until the equipment is repaired.

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Print as PDF

Use this Template

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Title Page

Site conducted
Audit Number
Conducted on
Prepared by

Area
- Despatch
- Dye House
- Blending
- Carding
- Spinning
- Winding
- Twisting
- Finishing
- Other
Asset
Type of temporary works
Reason for temporary works
Description of work completed
Is all safety guarding still in place
Are all safety interlocks still operational
Are any additional hazards created by the temporary works
Have all operators and shift managers been made aware of the changes
Expected time frame for temporary works
Add images
Enter date for temporary works to be removed

Regan McCarthy

Temporary Machinery Repairs JSA

Use this form when putting temporary fixes in place. Any failed responses will require the equipment to be placed in a inoperable state until the equipment is repaired.

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.