JSA – Use of Mobile plant – Andersons Scaffolding Services Pty Ltd

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This JSA is completed in conjunction with the Safe Work Method Statement (SWMS) for Erecting, Altering and Dismantling Scaffolding, and Operation of Mobile Plant as well as any other Safe Operating Procedures in place.

Acknowledgement of Risk Matrix*

I/we have read the Risk Assessment Matrix and understand it's content.

What Mobile Plant are you using?*

Forklift

Truck Mounted Crane

Has a Pre-start checklist been completed?

Yes

What PPE is required for this site and task you are about to complete?*

Please select all that apply

Gloves

Hard Hat

Foot Protection

Hi-Vis Clothing

Hearing Protection

Safety glasses

Fall Arrest system/Safety Harness

Face Mask

Sun Protection

Client Name:*

Client Email (if they require a copy of this JSA)

Address*

Street Address

Date*

Day

Month

Year

Job Owner*

Joshua Prior

Scott Willis

Unknown

Have you contacted the site foreman to confirm any site specific safety information?

Yes

Not applicable at this site

Are there any hazards or risks specific to this site?*

What control measures will be put in place to minimise the risk of injury?*

With these control measures put in place, what is the risk of an injury occurring?*

Low (Proceed with work and monitor)

Moderate (Proceed with work and monitor)

High (Review and introduce more controls before starting work)

Major (Do not start work, further control measures are needed)

Control measures must be continuously monitored throughout the day to ensure they remain adequate. If an incident or injury occurrs, you must follow incident response procedures first, then control measures MUST be reviewed and amended accordingly to reduce the likelihood of the same or similar injury happening again.

Acknowledgement*

I agree to abide by the control measures put in place by the Principal Contractor and those within this JSA.

This risk assessment process has been developed in consultation and cooperation with employee/workers and relevant Employer/PCBU. I/we have participated in the above risk assessment and understand its contents. I/we confirm that I/we have the skills and training, including relevant certification to conduct the task as described. I/we agree to comply with safety requirements within this risk assessment including risk control measures, safe work instructions and Personal Protective Equipment described.

Signed and acknowledged by:

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JSA - Use of Mobile plant

This JSA is completed in conjunction with the Safe Work Method Statement (SWMS) for Erecting, Altering and Dismantling Scaffolding, and Operation of Mobile Plant as well as any other Safe Operating Procedures in place.

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