Job Safety & Environmental Analysis (JSEA)
फारम - Version 8
JSEA Template · FORM-30010
- Site name
- —
- Job address
- —
- Prepared by
- —
- Date
- —
- Job number
- —
- Job task
- —
Planning and preparation
Have all workers been informed of the site safety rules and procedures?
Has a site-specific induction and toolbox meeting been conducted with all workers?
Have supervisory arrangements and reporting structures been confirmed?
Have traffic management plans and no-go zones been identified?
Are work and entry permits completed and signed?
Licensing and training
Do all workers have a construction white card (or approved alternative)?
Have all workers undertaken training and/or received instruction in the use of health and safety control measures including, SOP, SWMS and this JSEA?
Are workers licensed as required for the task?
Personal protective equipment (PPE)
Is site-specific PPE available and in good condition?
High-risk construction work
Do you have a SWMS on-site that addresses risks of the high-risk construction activity/s?
Environmental hazards
Other hazards
Are there any additional hazards not identified in existing SWMS/Standard Operating Procedures?
Hazard | Controls |
|---|---|
Will additional SWMS, SOP or training be required to assist workers in managing the risk?
Risk matrix
| Consequence → | |||||
|---|---|---|---|---|---|
| Likelihood ↑ | InsignificantNo effect, or so minor that the effect is acceptable | MinorMinor first aid treatment, minimal business disruption, minimal environmental effect | ModerateSerious injuries, medium business interruption, medium environmental impact | MajorExtensive injuries or fatality, significant business interruption, environmental harm, prosecution | CatastrophicMultiple permanent disabilities or fatalities, business failure, substantial environmental harm, prosecution or imprisonment |
| Almost certainExpected in most circumstances | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute | 4 A4 Acute |
| LikelyWill probably occur in most circumstances | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute | 4 A4 Acute |
| PossibleCould possibly occur at some time | 1 L1 Low | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute |
| UnlikelyUnlikely but possible | 1 L1 Low | 1 L1 Low | 2 M2 Moderate | 3 H3 High | 4 A4 Acute |
| RareHighly unlikely to occur | 1 L1 Low | 1 L1 Low | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High |
- 1 L1 LowRecord and monitor. Proceed with work, and review the risks regularly.
- 2 M2 ModerateMaintain control measures. Be cautious when working, and monitor and review regularly.
- 3 H3 HighReview before commencing work. Introduce new controls or maintain high-level controls to lower the risk level, and monitor the controls frequently.
- 4 A4 AcuteDo not proceed until the risk level is reduced. Immediately introduce high-level controls, and re-assess before proceeding.
What is the overall risk rating after controls?
View SWMS / safe operating procedures (SOP)
Have all relevant SWMS/SOP been reviewed and understood by workers undertaking the task?
Enter Workers names and have them sign-off
This JSEA/SWMS/SOP has been developed in consultation and cooperation with the following workers. I have read the above JSEA/SWMS/SOP, and I understand its contents. I confirm that I have the skills and training, including relevant certification, to conduct the task as described. I agree to comply with safety requirements within this JSEA/SWMS/SOP including risk control measures, safe work instructions and PPE described.
| Worker’s name | Date | Signature |
|---|---|---|
| - | - | - |
| - | - | - |
| - | - | - |
यसको मार्गदर्शन र नमुना प्रविष्टिहरू लक गरिएका छन्
फारमको बनावट कस्तो छ तपाईं देख्न सक्नुहुन्छ। जुनसुकै डिभाइसमा भर्न, प्रिन्ट गर्न वा आफ्नो बनाउन यो लिनुहोस्।
JSEA Template · FORM-30010