JSA

Address

  • Address

If working alone, monitoring control to be:

  • Working Alone Controls

SWMS Applicable

  • Select the SWMS Relevant to the task

COES Sighted

  • Has a COES been made available and sighted? (If Applicable)

General Hazard(s) Identified (Tick if applicable)

  • Working with live equipment

  • Trips, slips & falls

  • Restricted (site) access

  • Inclement weather

  • Hard hat site or area

  • Other 1 - General Hazards Identified (Tick is applicable)

General Hazard Control Measures

  • Visual inspection

  • Clear access obtained

  • Full PPE in serviceable condition - Reflective Vest + LV Gloves + Eye Protection

  • Safety helmet

  • Other 1 - General Hazard Control Measures

Environmental Hazard(s) Identified (tick if applicable)

  • Are there Any Environmental Hazards Identified?

Environmental Hazard(s) Identified (tick if applicable)

  • Asbestos

  • Weeds, erosion, etc.

  • Vehicle use - grass fires, emissions

  • Oil and fluid spills

  • Flora, water and minerals

  • RF antenna

Environmental Hazard Control Measures

  • Asbestos - isolate and report

  • Wash car, take alternate route

  • Maintain clearance

  • Location of fire prevention equipment

  • Site evacuation plan and emergency process

  • Hazardous substance procedure

Live Works Hazard(s) Identified (tick if applicable)

  • Working with and in the vicinity of live electrical apparatus

  • Electrocution

  • Damaged assets

  • Reverse polarity

  • Back feed

  • Alternate generator supply

  • Metal meter box

  • Surge Arrestors (identified during Faults and HVI's)

Live Works Hazard Control Measures

  • Isolate supply

  • Appropriate clearance

  • Full PPE in serviceable condition - Reflective Vest + LV Gloves + Eye Protection

  • Insulated tools

  • Visual inspection

  • Surge Arrestors - Isolate and make safe prior to energisation

  • Other - Live Works Hazard Control Measures

Additional Hazard(s) identified

  • Are there Additional Hazards to be Identified?

Additional Hazard (s) Identified

Additional Hazard Control Measures

Working From Heights

  • Is Working at Heights involved with the Job?

  • Fall from heights greater than 2 meters or over 2 meters near edge

Working from Heights Hazard Controls (Hierarchy)

  • 1st - Complete Task on Ground

  • 2nd - EWP or Guarding/Scaffold

  • 3rd - Restraint System

  • 4th - Lanyard/Harness/Belt

  • 5th - Ladder

  • 6th - Observer / Temporary Barrier (eg. Signs, witches hats, barricade tape)

Additional Comments / Notes

  • Comments

Mandatory Section - Signature Required

  • 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 TSA procedures

    By signing this form you acknowledge that you understand the Work Instructions and are authorised to carry out this work

  • Signature

  • Signature

  • Signature

  • Signature

  • Signature

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