Daily JSEA · Tool Belt

Site & project

Site conducted*

Date / time

Document #

Client / Site*

Prepared by*

Location*

Nearest medical facility / hospital*

Emergency equipment location*

COX049 (MS)1YU1GV (ML)2CX5FW (GB)

Weather forecast (preview only in this version)

PPE & site hazards

1.0 How are identified site-specific hazards to be managed?

Additional PPE

Is all worksite signage available, suitable, clear and legible?*

YesNoN/A

Plant & equipment checks

Pre-start inspection completed on mobile plant? (N/A if none used)

YesNoN/A

Large mobile plant checklist

Pre-start inspection completed on 2 & 4-stroke small plant? (N/A if none used)

YesNoN/A

Small mobile plant checklist

Tasks

Image of pre-commencement works area (typical)* (preview only in this version)

2.1 Chemicals in use? (record volumes on works report)*

YesNoN/A

2.2 Spill kit available and fully stocked*

YesNo

2.3 Has Emergency Services Victoria been advised (Ph 1800 668 511)?

YesNo

Competencies & SWMS

All workers inducted, trained and competent to complete all tasks?*

YesNo

Have all staff licences been validated on the corporate skills matrix?

YesNoN/A

Have all staff onsite signed on to corporate SWMS?*

YesNoN/A

Toolbox discussion & risk

Is the site free from hazards/incidents/alerts requiring clarification, discussion or recording?*

YesNoN/A

Please clarify

Emergency response plans communicated and understood by all workers onsite?*

YesNo

Have changes to approved design/construction plans been assessed for risk and communicated to workers?*

YesNoN/A

1.0 Describe changes in works plan/design

Pre-mitigation risk of operations (likelihood › consequence › result)

Likelihood*

Consequence

Result

Residual risk after mitigation (likelihood › consequence › result)

Likelihood*

Consequence

Result

Pre-start sign on

I, the undersigned, certify I have been inducted to this job site by the Site Supervisor, actively participated in hazard identification and risk control via this pre-start briefing, and agree to implement the control measures identified including appropriate PPE.

Sign-on

After action review

Comments on daily works as delivered

Issues / interactions / hazards identified during the works*

I certify this form was completed prior to commencing work on this site, and that all workers and visitors have been inducted to site.

Name*

Authorising signature*

Date*