टेम्प्लेट कागजातहरू अंग्रेजीमा लेखिएका छन्।

प्रणाली · 48 कागजातHealth and Safety Manual को भाग

JSA Template

फारम · FORM-31549

संस्करण 2

The JSA Template, ready to fill in, with your business's details on every copy.

It is part of the Health and Safety Manual, whose documents refer to each other.

Written by SafetyDocs safety experts, who have been writing safety documents since 2004.

यो प्रणालीमा मात्र

JSA Template

फारमVersion 2

Site name: —
Job address: [Site address]
Prepared by: —

Date: —
Job number: —
Job task: —

Planning and preparation

Have all workers been informed of the site safety rules and procedures?

YES
NO. If NO check with the Site Manager or immediate supervisor to find out what OHS rules are applicable on site.
N/A

Has a site-specific induction and toolbox meeting been conducted with all workers?

YES
NO. If NO check with the Site Manager or your immediate supervisor to find out what OHS inductions and toolbox meetings are required on site. Make sure that all relevant workers attend before starting work.
N/A

Licensing and training

Personal protective equipment (PPE)

High-risk construction work

Other hazards

Hazard	Controls

Risk matrix

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
	Consequence →
Almost certainExpected in most circumstances	2 Moderate	2 Moderate	3 High	4 Acute	4 Acute
LikelyWill probably occur in most circumstances	2 Moderate	2 Moderate	3 High	4 Acute	4 Acute
PossibleCould possibly occur at some time	1 Low	2 Moderate	2 Moderate	3 High	4 Acute
UnlikelyUnlikely but possible	1 Low	1 Low	2 Moderate	3 High	4 Acute
RareHighly unlikely to occur	1 Low	1 Low	2 Moderate	2 Moderate	3 High

1 LowRecord and monitor. Proceed with work, and review the risks regularly.
2 ModerateMaintain control measures. Be cautious when working, and monitor and review regularly.
3 HighReview before commencing work. Introduce new controls or maintain high-level controls to lower the risk level, and monitor the controls frequently.
4 AcuteDo not proceed until the risk level is reduced. Immediately introduce high-level controls, and re-assess before proceeding.

View SWMS / safe operating procedures (SOP)

Workers’ sign-off

This JSA/SWMS/SOP has been developed in consultation and cooperation with the following workers. I have read the above JSA/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 JSA/SWMS/SOP including risk control measures, safe work instructions and PPE described.

Worker’s name	Date	Signature
-	-	-
-	-	-
-	-	-

Enter workers’ names and have them sign off.

थप 6 खण्ड, Licensing and training देखि View SWMS / safe operating procedures (SOP) सम्म

पूरा लेखिएको, तपाईंको व्यवसायको विवरण थप्न तयार।

एडिटर निःशुल्क चलाएर हेर्नुहोस्यो प्रणाली लिनुहोस्

ब्राउजरमा यो कस्तो देखिन्छ

यो प्रणाली लिनुहोस्

निःशुल्क साइन अप गर्नुहोस्, अनि कसरी लिने छान्नुहोस्। हरेक कागजात तपाईंको लाइब्रेरीमा, प्याकको नाम दिइएको फोल्डरमा जान्छ।

सशुल्क प्लानहरूमा समावेश
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एडिटर निःशुल्क चलाएर हेर्नुहोस्निःशुल्क साइन अप गर्नुहोस्

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यसले के समेट्छ

8 फिल्ड

Site name
Job address
Prepared by
Date
Job number
Job task
Hazard
Controls

टेम्प्लेटहरू कसरी काम गर्छन्

यसलाई पैसा तिर्नुअघि नै चलाएर हेर्नुहोस्।

निःशुल्क पूर्वावलोकन
हरेक टेम्प्लेटका कामका चरण, खतरा र पहिलो काम पढ्न खुला छन्। साइन अप चाहिँदैन।
एडिटर चलाएर हेर्नुहोस्
कम्प्युटर वा फोनमा, डेमो SWMS लाई आफ्नो कम्पनी, काम र साइटअनुसार मिलाउनुहोस्।
निःशुल्क साइन अप गर्नुहोस्
तपाईंको विवरण र लोगो सर्छन्। यो टेम्प्लेट विवरण भरिएरै खुल्छ।
क्रेडिट प्रयोग गर्नुहोस् वा एकपटक किन्नुहोस्
सशुल्क प्लानहरूमा हरेक महिना टेम्प्लेट क्रेडिट आउँछ। वा सधैँका लागि यो एउटा किन्नुहोस्।

JSA Template

JSA Template को पूर्वावलोकन

Planning and preparation

यो प्रणाली लिनुहोस्

सशुल्क प्लानहरूमा समावेश

एकपटक किन्नुहोस्

यसले के समेट्छ

8 फिल्ड

यसलाई पैसा तिर्नुअघि नै चलाएर हेर्नुहोस्।

निःशुल्क पूर्वावलोकन

एडिटर चलाएर हेर्नुहोस्

निःशुल्क साइन अप गर्नुहोस्

क्रेडिट प्रयोग गर्नुहोस् वा एकपटक किन्नुहोस्