POINT OF WORK RISK ASSESSMENT: S/# ACTIVITY IDENTIFIED HAZARDS PROPOSED CONTROL MEASURES RESPONSIBILITY (Eng., Sup., FM, etc.) Residual Risk L S RR _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

1. JOB SAFETY ENVIRONMENTAL ANALYSIS
Page 1 of 3 Form # HSEQ - JSEA Rev 2 - Mar 23
DETAILS:
Ref Number & Date:
Location:
Project:
Scope Of Work:
PERIOD
MONTH: YEAR:
1st
Week : ☒
2nd
Week : ☒
3rd
Week : ☒
4th
Week : ☒
WORK AREA LAYOUT (attached)
Yes ☒ No ☐ N/A ☐
PLAN & CONTINGENCY MEASURES
Access Plan ☐
Emergency Plan ☐
Lifting Plan ☐
First Aid Arrangements ☐
Fire Suppression Arrangements ☐
Fire Watch ☐
☐
☐
COMMENTS
PLANT & EQUIPMENT
Back Hoe Loader ☒
Bending Machine ☐
Excavator ☐
Fork Lift ☐
Generator ☐
Generator ☐
Jack Hammer ☐
MEWP ☐
Mobile Crane ☐
Mobile Diesel Tanker ☐
Road Roller ☐
Skid Steer Loader ☐
Telehandler ☐
Tipper Truck ☐
Tower Crane ☐
Welding Machine ☐
Wheel Loader ☐
☐
☐
☐
PORTABLE POWER TOOLS
Air Blower ☐
Air Blower ☐
Angle Grinder ☐
Circular Saw ☐
Circular Saw ☐
Combination Hammer ☐
Cordless Impact Wrench ☐
Demolition Hammer ☐
Diesel Vibrator ☐
Drill Machine ☐
Electrical Poker ☐
Jack Hammer ☐
Jig Saw Machine ☐
Jigsaw Machine ☐
Mechanical Poker ☐
Power Float (Petrol) ☐
Rotary hammer ☐
Wooden Cutter ☐
☐
☐
HANDS TOOLS
Hammer ☐
Leveler ☐
Mallet ☐
Plier ☐
Saw ☐
Screw driver ☐
Spanner ☐
Trowel ☐
Wooden Cutter ☐
Wrench ☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
PPE REQUIRMENTS
Dust Masks ☐
Ear Muffs ☐
Ear Plugs ☐
Face Visor ☐
Full Body Harness ☐
Hand Glove ☐
Hard Hat ☐
Hi Visibility Jacket ☐
Retractable Lanyard ☐
Safety Goggles ☐
Safety Shoes ☐
Welding Face Visor ☐
☐
☐
☐
☐
☐
☐
☐
☐
PERMIT TO WORK
Cold Work ☐
Confined Space Entry ☐
Cradle W.P ☐
Electrical W.P ☐
Excavation ☐
Hot Work ☐
Hydro Testing ☐
Lifting Permit ☐
LOTO ☐
Scaffolding Permit ☐
Temporary W.P ☐
Work at height ☐
☐
☐
☐
☐
☐
☐
☐
☐
OTHER CONSIDERATIONS
POINT OF WORK RISK ASSESSMENT:
S/# ACTIVITY IDENTIFIED HAZARDS PROPOSED CONTROL MEASURES RESPONSIBILITY
(Eng., Sup., FM, etc.)
Residual Risk
L S RR
_ _
_ _
_ _
_ _
_ _
_ _
_ _
_ _
_ _
_ _
_ _
_ _
_ _

2. JOB SAFETY ENVIRONMENTAL ANALYSIS
Page 2 of 3 Form # HSEQ - JSEA Rev 2 - Mar 23
Name of Engineer Date: Sign: Name of CM /PM (approver) Date: Sign:
Note:
 JSEA to be used in all activities as a secondary layer of assurance after Method statement & Risk assessments ,Procedures.
 To be authorized by Construction Manager or Project Manager.
 JSEA should not be considered as an alternate to Method statement & Risk assessments
 Ensure personnel engaged in the activity are well aware of their job responsibility.
 Make sure relevant crew is aware of the emergency requirements of the task.
 Before commencing any task ensure JSEA is communicated.

3. JOB SAFETY ENVIRONMENTAL ANALYSIS
Page 3 of 3 Form # HSEQ - JSEA Rev 2 - Mar 23
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