Tutukaka Marina JSA

Tutukaka Marina JSA
A JSA ensures everyone involved has an understanding of the task, the hazards, control measures required and an opportunity to discuss any health and safety issues before the job begins.
TASK*
LOCATION*
Person Completing JSA*
COMPANY*
Contact No*
Date*

MonthDayYear
Date
Signature*

Clear
TAKE 5
Before you start the job, STOP:

1. Step back and have a look

2. Think about the job

3. Look for the hazards

4. What else is happening in the area?

5. Can you do the job safely?

Ask yourself, "can you"
Strain or sprain your back or other muscle?

YesNo
Be caught in, on or between anything?

YesNo
Slip, trip or fall from Height?

YesNo
Be injured by poor plant or job design?

YesNo
Be struck by or against anything?

YesNo
Fall in water?

YesNo
Come in contact with a hazardous substance or an energy source?

YesNo
Name
Company
Date

MonthDayYear
Date
Name
Company
Date

MonthDayYear
Date
SEQUENCE OF BASIC STEPS
List the steps required to complete the job. (Follow the flow of the Process

List the potential hazards beside each step.

List the control methods required to ELIMINATE or MINIMISE each hazard.
Sequence of Basic Steps
Potential Hazards
Risk Rating before Controls (L=Low; M=Moderate; H=High; E=Extreme)
Hazard Control Method
Risk Rating after Controls (L=Low; M=Moderate; H=High; E=Extreme)
Sequence of Basic Steps
Potential Hazards
Risk Rating before Controls (L=Low; M=Moderate; H=High; E=Extreme)
Hazard Control Method
Risk Rating after Controls (L=Low; M=Moderate; H=High; E=Extreme)
Sequence of Basic Steps
Potential Hazards
Risk Rating before Controls (L=Low; M=Moderate; H=High; E=Extreme)
Hazard Control Method
Risk Rating after Controls (L=Low; M=Moderate; H=High; E=Extreme)
Sequence of Basic Steps
Potential Hazards
Risk Rating before Controls (L=Low; M=Moderate; H=High; E=Extreme)
Hazard Control Method
Risk Rating after Controls (L=Low; M=Moderate; H=High; E=Extreme)
Sequence of Basic Steps
Potential Hazards
Risk Rating before Controls (L=Low; M=Moderate; H=High; E=Extreme)
Hazard Control Method
Risk Rating after Controls (L=Low; M=Moderate; H=High; E=Extreme)
Sequence of Basic Steps
Potential Hazards
Risk Rating before Controls (L=Low; M=Moderate; H=High; E=Extreme)
Hazard Control Method
Risk Rating after Controls (L=Low; M=Moderate; H=High; E=Extreme)
Sequence of Basic Steps
Potential Hazards
Risk Rating before Controls (L=Low; M=Moderate; H=High; E=Extreme)
Hazard Control Method
Risk Rating after Controls (L=Low; M=Moderate; H=High; E=Extreme)
Sequence of Basic Steps
Potential Hazards
Risk Rating before Controls (L=Low; M=Moderate; H=High; E=Extreme)
Hazard Control Method
Risk Rating after Controls (L=Low; M=Moderate; H=High; E=Extreme)
Sequence of Basic Steps
Potential Hazards
Risk Rating before Controls (L=Low; M=Moderate; H=High; E=Extreme)
Hazard Control Method
Risk Rating after Controls (L=Low; M=Moderate; H=High; E=Extreme)
Should be Empty:

Tutukaka Marina JSA

TAKE 5

SEQUENCE OF BASIC STEPS