Job Safety Assessment (JSA) Late Arrival Review
Job & Site Information
I confirm that I have reviewed the JSA already completed for the jobsite I am arriving at. I will clarify any questions I have with the arborist in charge.
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Yes
No
Date
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-
Month
-
Day
Year
Date
Client name
*
Address Search & Preview
*
Nearest hospital
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Central/South/SW Seattle: Harborview Cap Hill: 325 9th Ave, Seattle, WA 98104
Burien/NP/SSW Seattle St Anne ER: 16251 Sylvester Rd SW, Burien, WA 98166
Northwest Seattle: UW NW Campus ER, 1550 N 115th St Fl 1, Seattle, WA 98133
Northeast Seattle: UW Medical Ctr, UW Campus: 1959 NE Pacific St Fl 2, Seattle, WA 98195
Ballard/Magnolia Seattle: Swedish ER, 5350 Tallman Ave NW, Seattle, WA 98107
Bellevue: Overlake Medical ER, 1035 116th Ave NE, Bellevue, WA 98004
Renton: Valley Medical ER, 400 S 43rd St 1st Floor, Renton, WA 98055
Other
Emergency plan: Call 911 for all life threatening emergencies
I confirm that all required personal protective equipment has been inspected prior to use, is in good working condition, properly fitted, and free from defects that could affect safe performance.
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Yes
No
Crew Acknowledgement and Electronic Signatures
Crew Member 1 Name
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Daniel Wiener
Andrew Haggarty
Adam Keene
Sophia Nickerson
Allen Taylor
Elias Ditto
Other
Name if Other
Position
*
Crew Lead
Arborist
Arborist Trainee
Ground Worker
Equipment Operator
Other
Signature
Crew Member 2 Name
Daniel Wiener
Andrew Haggarty
Adam Keene
Sophia Nickerson
Allen Taylor
Elias Ditto
Other
Name if Other
Position
Crew Lead
Arborist
Arborist Trainee
Ground Worker
Equipment Operator
Other
Signature
Crew Member 3 Name
Daniel Wiener
Andrew Haggarty
Adam Keene
Sophia Nickerson
Allen Taylor
Elias Ditto
Other
Name if Other
Position
Crew Lead
Arborist
Arborist Trainee
Ground Worker
Equipment Operator
Other
Signature
Crew Member 4 Name
Daniel Wiener
Andrew Haggarty
Adam Keene
Sophia Nickerson
Allen Taylor
Elias Ditto
Other
Name if Other
Position
Crew Lead
Arborist
Arborist Trainee
Ground Worker
Equipment Operator
Other
Signature
Crew Member 5 Name
Daniel Wiener
Andrew Haggarty
Adam Keene
Sophia Nickerson
Allen Taylor
Elias Ditto
Other
Name if Other
Position
Crew Lead
Arborist
Arborist Trainee
Ground Worker
Equipment Operator
Other
Signature
Crew Member 6 Name
Daniel Wiener
Andrew Haggarty
Adam Keene
Sophia Nickerson
Allen Taylor
Elias Ditto
Other
Name if Other
Position
Crew Lead
Arborist
Arborist Trainee
Ground Worker
Equipment Operator
Other
By entering my name below, I acknowledge that I participated in this job safety briefing, understand the hazards and controls, and agree to follow all applicable safety procedures.
Signature
Crew Member 7 Name
Daniel Wiener
Andrew Haggarty
Adam Keene
Sophia Nickerson
Allen Taylor
Elias Ditto
Other
Name if Other
Position
Crew Lead
Arborist
Arborist Trainee
Ground Worker
Equipment Operator
Other
Signature
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