JSA — 3S PULSE

Submission Details

Date*

Duration (hours)

Project*

Only projects currently in the Installing stage are shown.

Tower S/N*

Location

Work Scope*

Emergency Contacts

Two ICE (In Case of Emergency) contacts. Both optional.

Contact 1

Name

Affiliation

Phone

Contact 2

Name

Affiliation

Phone

Environmental Conditions

Temperature (°F)

Weather Outlook

General Hazards

Geography Hazards

Wildlife Hazards

Other Notable Conditions/Hazards

Safety Equipment & Training

PPE Available*

Other PPE Available

Required Training

Other Required Training

Inspections Completed

Other Inspections Completed

Equipment Usage*

Confirm equipment is fit for use today. List potential hazards and how you'll prevent incidents.

Potential Hazards

Incident Prevention Methods

I confirm equipment usage acknowledgement.

Cutting Tools*

Potential Hazards

Incident Prevention Methods

I confirm cutting tools have been inspected and are safe to use.

Buddy Check*

Potential Hazards

Incident Prevention Methods

I confirm buddy check has been completed.

Rigging Check*

Potential Hazards

Incident Prevention Methods

I confirm rigging has been inspected and is safe.

Function Test & Final Buddy Check*

I confirm function test and final buddy check have been completed.

Signatures*

Each person signs in turn on this device. Add as many signers as you need (up to 8 total). Or use Other Methods to send the JSA to someone not here.

Submission Details

Emergency Contacts

Contact 1

Contact 2

Environmental Conditions

Safety Equipment & Training

Equipment Usage*

Cutting Tools*

Buddy Check*

Rigging Check*

Function Test & Final Buddy Check*

Signatures*

Send to Someone Else