${header}

---

	Job Safety, Quality & Environmental Analysis
	Customer Name: Job #: JSA #: Date ${jobDetails.ClientName} ${jobDetails.JobNumber} ${jobDetails.jsa_number} ${jobDetails.jsa_date_created}
	Activity:

Amertec Representatives
Amertec Team Members:		Contact :
Assessed By: Sign : Sign Date :

Customer Representatives: * Customer to check and sign prior to work commencing *
Customer Team Members:		Contact :
Assessed By: Sign : Sign Date :

1. Hazards: (tick as applicable)
Consider Personal Safety and the Safety of Others, Product and The Environment.
H1 - Live Elect. Testing  H2 - Equipment  H3 - Poor Lighting  H4 - Electricity  H5 - Sharp Objects  H6 - Gases  H7 - Machinery  H8 - Compressed Air  H9 - Dust  H10 - Vibration	H11 - Sun Rays  H12 - Flammable  H13 - Burns  H14 - Temperature Extremes  H15 - Overhead Obstructios  H16 - Entanglement  H17 - High Voltage  H18 - Hazardous Substances  H19 - Working in Isolation  H20 - Inhalation	H21 - Unauthorised Persons  H22 - Ignition Sources  H23 - Material Handling  H24 - High Pressure  H25 - Corrosives  H26 - Noise  H27 - Lifting Equipment  H28 - Access / Egress  H29 - Ground Openings  H30 - Air Emissions	H31 - Stormwater Contamination  H32 - Soil Contamination  H33 - Toxicity Activities Requiring Permits:  H34 - Confined Space  H35 - Restricted Access  H36 - Expanded Polystyrene Panel Work  H37 - Hot Work  H38 - Heights  H39 - Grinding
A control measure must be implemented for every box ticked above and the hazard recorded next to the hazard description below

2. Control Measure (Tick as applicable)
C1 - Isolation (permit required)  C2 - Danger Tagging  C3 - Temporary Lighting  C4 - Respirators / BA  C5 - Engineering  C6 - PPE	C7 - Signage  C8 - Barricades  C9 - Fall Arrest  C10 - Lifting Aid  C11 - Access Platform  C12 - Scissor Lift	C13 - Ventilation / Exactration  C14 - Rescue Equipment  C15 - Fire Extinguishers  C16 - Fire Blankets  C17 - Welding Screens  C18 - Communications	C19 - MSDS's  C20 - Competent People  C21 - UV Protection  C22 - Gas Protection  C23 - Temporary Bunding  C24 - Other Controls Including any Special PPE

3. Permits completed (if identified above) Permit must be signed off by a Customer team Member
Hot Work	Confined Space	Restricted Access	Isolation	Working at Heights	Expanded Polystyrene Sandwich Panel

4. Applications Of Controls (record the hazard, Control measure and description)
Hazard ID (e.g. H40)	Hazard Description (e.g. removing gearbox on tank 300)	Control Measure (e.g. C13)

5. Job Completion Sign Off:
Isolations Removed    Equipment Area Clean / tidy    Tools and Equipment removed    Machine returned to service    Permits signed off and finalised    CIP organised / completed where necessary    Customer repsentative Informed
Name: ${loggedUser}	Signed: Sign	Date:

Customer Email Address :