Appendix E Job Safety Environment Analysis (Refer section 3.5) – Project Name / Site Address: ___________________________________________________________________________ Task Details: ________________________________________________________________________________________ Permits / Plan Required: Clearance to Work Permit Hot Work Permit Complex Isolation Permit Rescue Plan Other:_____________ Confined Space Entry Permit Grid Mesh Reinstatement Permit Hazardous Gas Zone Permit Traffic Management Plan Equipment Used Qualifications, Licenses, Training Required All site specific actions, identified hazards and control measures are to be detailed and assessed below: Action/Step What harm me or the environment? Initial Risk What can I do to reduce risk? (control Residual Risk Person Responsible for control Eg Clearing land surface (Hazard) Low measure) Low Bill Mac Supervisor – Mod Bill Mac Supervisor Dust Schedule work for low wind conditions Med – High Joe Water Cart Op Damage to Traditional Land Obtain clearing permit High – Noise Suppress with use of water carts Risk to the Public Team Sign On Responsible person / Supervisor / Line Manager Review I have read the contents of and agree to work in accordance with this JSEA. Role Name Signature Contractor Reviewed by Date Sign Induction Card # Responsible person Need more Simply add another sign on page
Appendix E – Job Safety Environment Analysis (Refer section 3.5) Project Name / Site Address: ___________________________________________________________________________ Task Details: ________________________________________________________________________________________ Permits / Plan Required: Clearance to Work Permit Hot Work Permit Complex Isolation Permit Rescue Plan Other:_____________ Confined Space Entry Permit Grid Mesh Reinstatement Permit Hazardous Gas Zone Permit Traffic Management Plan Equipment Used Qualifications, Licenses, Training Required All site specific actions, identified hazards and control measures are to be detailed and assessed below: Action/Step Eg Clearing land surface What harm me or the environment? (Hazard) Dust Damage to Traditional Land Noise Risk to the Public Initial Risk Low Mod High What can I do to reduce risk? (control measure) Schedule work for low wind conditions Obtain clearing permit Suppress with use of water carts Residual Risk Low Med High Person Responsible for control Bill Mac – Supervisor Bill Mac – Supervisor Joe – Water Cart Op Team Sign On I have read the contents of and agree to work in accordance with this JSEA. Responsible person / Supervisor / Line Manager Review Role Name Signature Contractor Induction Card # Reviewed by Date Sign Responsible person Need more Simply add another sign on page