JSA Job Safety Analysis
Company / Trading Name
*
Contact Name
*
First Name
Last Name
Phone Number
*
Email
Farm / Property Name
Farm / Property Address
*
Street Address
Street Address Line 2
City
State
Post Code
Property Entrance
eg; Enter off Coleraine Rd
Dumpsite Location
Leave blank if unknown
Emergency Meeting Point
If other than main gate.
Are there any steep areas or definite NO-GO areas?
*
YES
NO
Please give more details
Are there any creek crossings / farm bridges / culverts to be aware of?
*
YES
NO
Please give more details
Are there any washouts / tunnel erosion / landslips?
*
YES
NO
Please give more details
Are there any rocks / stumps / old fencelines / steel posts to be aware of?
*
YES
NO
Please give more details
Are there any other obstacles, eg access to certain paddocks / lambing ewes / pasture harrows / sharp drains?
*
YES
NO
Please give more details
Are there any steep clay/gravel access tracks or crossings that could get slippery when wet?
*
YES
NO
Please give more details
Are there any low powerlines, or powerlines near dumpsites?
*
YES
NO
Please give more details
Any other comments or safety issues to be raised, ie spread width distance required off creeks, plantations, boundaries
Topography - Select all that apply
*
Obstacles - Select all that apply
*
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*
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