JOB SAFETY ENVIRONMENTAL ANALYSIS Form # HSEQ - JSEA Rev 2 -.docx
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POINT OF WORK RISK ASSESSMENT: S/# ACTIVITY IDENTIFIED HAZARDS PROPOSED CONTROL MEASURES RESPONSIBILITY (Eng., Sup., FM, etc.) Residual Risk L S RR _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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JOB SAFETY ENVIRONMENTAL ANALYSIS Form # HSEQ - JSEA Rev 2 -.docx
- 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 I have read and understand the content of this JSEA: Name Signature Date Click here to enter text. Click here to enter a date. Click here to enter text. Click here to enter a date. Click here to enter text. Click here to enter a date. Click here to enter text. Click here to enter a date. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.