Jsa checklist
Coughlan drilling
What does this form include?
This form contains 31 sections:
Location:
Activity or task:
Photo of job task:
Describe the first step involved in the work
Work Step 1
- Can someone be struck or contacted by anything?
- Can someone strike against or make contact with any physical hazards.
- Can someone be exposed to any hazardous conditions?
- Can someone slip, trip or fall?
- Can someone fall into anything?
- Can someone strain or over exert?
- Can damage to equipment occur?
- Can someone be caught in anything?
- Can someone injure someone else?
Safety controls for this step
Describe the next step involved in the work
Work Step 2
- Can someone be struck or contacted by anything?
- Can someone strike against or make contact with any physical hazards.
- Can someone be exposed to any hazardous conditions?
- Can someone slip, trip or fall?
- Can someone fall into anything?
- Can someone strain or over exert?
- Can damage to equipment occur?
- Can someone be caught in anything?
- Can someone injure someone else?
Work Step 3
- Can someone be struck or contacted by anything?
- Can someone strike against or make contact with any physical hazards.
- Can someone be exposed to any hazardous conditions?
- Can someone slip, trip or fall?
- Can someone fall into anything?
- Can someone strain or over exert?
- Can damage to equipment occur?
- Can someone be caught in anything?
- Can someone injure someone else?
Work Step 4
- Can someone be struck or contacted by anything?
- Can someone strike against or make contact with any physical hazards.
- Can someone be exposed to any hazardous conditions?
- Can someone slip, trip or fall?
- Can someone fall into anything?
- Can someone strain or over exert?
- Can damage to equipment occur?
- Can someone be caught in anything?
- Can someone injure someone else?
Work Step 5
- Can someone be struck or contacted by anything?
- Can someone strike against or make contact with any physical hazards.
- Can someone be exposed to any hazardous conditions?
- Can someone slip, trip or fall?
- Can someone fall into anything?
- Can someone strain or over exert?
- Can damage to equipment occur?
- Can someone be caught in anything?
- Can someone injure someone else?
A - ALMOST CERTAIN - Is expected to occur in most circumstances
B - LIKELY - Will probably occur in most circumstances
C - POSSIBLE - Might occur at some time
D - UNLIKELY - Could occur at some time
E - RARE - May occur only in exceptional circumstances
1 - INSIGNIFICANT - No injuries
2 - MINOR - First aid treatment, any spills contained on site
3 - MODERATE - Medical treatment required, spills contained on site but with outside help
4 - MAJOR - Extensive injuries, loss of production
5 - CATASTROPHIC - Death, toxic chemicals released
CONSEQUENCES
LIKELIHOOD INSIGNIFICANT MINOR MODERATE MAJOR CATASTROPHIC
A (almost certain) H H E E E
B (likely) M H H E E
C (possible) L M H E E
D (unlikely) L L M H E
E (rare) L L M H H
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