Competence/ Qualific’n req’d to complete work safely JSA approved by person responsible i.e.
Name:
Position / Competence/ License:
Date:
Codes of Practice & Legislation that are applicable:
Team Leader / Tradesman
2. HAZARD IDENTIFICATION
3. PRECAUTIONS: hard hat, safety glasses, safety boots
Identify hazards that may be present by ticking items on the list below.
compulsory
WORK LOCATION Difficult Entry/Exit Oxygen Deficiency Oxygen Excess Engulfment (trench collapse) Poisonous Gas Present Temperature Extremes Defined Confined Space Explosive Gas Present
HAZARDOUS AREA Hazardous Substances - attach MSDS to JSA Working at Heights Remote Area Motor Room Hazards Toxic Substances Potential for Difficult Rescue
Suspended loads Poor Visibility Inhalable Dusts/Fibres High Noise Levels Use of Chemicals Elevated Work Platform Difficulty to Communicate amongst workers
Manual Handling Sharp Materials
Moving Machinery Tools & Equipment
Ladders used in the task Working at Heights Working near Crane & Crane Runways
Heat/ Sunlight/ Radiation Traffic Movement Working near Operation Processing Lines
Rail Movement Pressurised Fluids Flamm. Materials Present
Live Rails Pneumatics
PERMITS
ADDITIONAL PRECAUTIONS Gloves: type …………………. Goggles Full Face Shield High Visibility Vest Harness Fire Extinguishers Barricades Ventilation Lighting Erect Scaffolding to access
Hot Work Excavation Confined Space Hazardous Work Clearance Access to Area High Voltage Access Scaffolding Other?
Permit Number
-attach MSDS Respirator or Dust mask Erect Warning signs Personal Locks or Tag system Group isolation Welding screen Fall Arrest systems Welding Face Shield
4. ENVIRONMENTAL HAZARDS – (IMPACTS) tick those identified Air Pollution (dust, fumes)
RISK RATING TABLE This table is used to calculate whether the hazard you have identified is Extreme: 9-10 High: 7-8, Medium: 5-6 or Low: 3-4
Likelihood: How likely is it to be that bad? Almost Certain Expected to Occur
Likely – could The objective of rating the risk is to lower the risk by initiating risk control measures. The score is
happen sometime
Moderate – could happen but not likely
Unlikely – could happen but very rare
Revision Date: March 2005
………. of …………..
Rare - could happen but probably never will
Consequences: how severe an injury? Death
Serious Injuries
Medical Treatment Req’d
1st Aid req’d
10
9
8
7
9
8
7
6
8
7
6
5
7
6
5
4
6
OHS-03-F01 5 4
3
POWER
JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT noted in the JSA risk score column on the next page – both before & after risk control measures have been nominated.
Safety / Emergency Equip’t
JSA Number:
NAME OF TASK: Scaffolding (Erection and Dismantling)
Step No. Logical sequence
1
Sequence of Basic Job Steps Break down Job into steps. Each step should accomplish a major task and be logical. Environmental Aspects
Site Inspection
2
Raise Permit
3
Transport scaffold equipment to site
4
Erect scaffolding
Revision Date: March 2005
Potential Safety & Environmental Hazards/Impacts
Risk Rating
Identify the hazards (health and safety or Use table on environmental) associated with each step, the previous examine each to find all possible risk factors page to score risk
Injury as a result of exposure to substances released due to equipment failure Slips, Trips and Falls due to slippery surfaces, obstructions, restricted access. Injury due to equipment failure, moving equipment, activity Stress and frustration due to incorrect information misdirecting efforts Injury/damage related to vehicle operation and equipment handling Injury / damage due to collision / impact with other workgroups / equipment Injury / damage as a result of dropping tools and scaffold components Hot and cold burns as a result of contact with pipework Injury due to limited egress in emergency Injury / damage as a result of dropping tools and scaffold components
………. of …………..
G20
Rev:
Recommended Corrective Action or Procedure Determine what actions are necessary to eliminate or minimise all hazards that could lead to an accident, injury, illness or environmental incident. The risk must be reduced or controlled to a level that is acceptable before work commences. Indicate who is to perform the action where applicable against each action
Risk Rating Of the risk following corrective action
Be aware of and plan escape routes. Be aware of wind.
Due care and attention.
Liaise with permit authority / operations to minimize exposure to and creation of hazards. Ensure all information supplied is as accurate and understandable as possible. Use correct vehicle and handling procedures Plan route to avoid other personnel and equipment
Use appropriate barricades and bunting to protect personnel and equipment Adequate PPE with correct instruction and use. Ensure scaffold has adequate egress for any situation. Use appropriate barricades and bunting to protect personnel and equipment
Injury / damage due to scaffold collapse Injury / damage due to damaged components causing equipment failure Injury / damage caused by scaffold collapse due to excessive load on scaffold Injury / damage due to scaffolding erected by unauthorized personnel Injury / damage caused by scaffolding erected by persons with limited competency Injury / damage caused by personnel falling from scaffolding Injury / damage caused by persons falling whilst working outside scaffolding Injury as a result of incomplete scaffold, loose boards, kickplates, etc causing slips,trips and falls Excess scaffold components cause clutter. Injury results. Injury results from untidy worksite Injury / damage caused by falling objects Injury / damage caused by incorrect sequence of dismantling
Revision Date: March 2005
………. of …………..
Erect and dismantle all scaffold to comply with all legal and site requirements. All components to be checked prior to installation
Check specified limits of scaffold before utilization
Scaffold must only be erected by trained personnel Licenced scaffolder to supervise apprentices at all times
Use appropriate barricades and bunting to protect personnel and equipment. Use IFAS harness. Use independent fall arrest system. 1.8m fall limit and standby person precautions Check scaffold properly before attaching scafftag. Tag must be signed by qualified person. Use scaffold checklist. Stack scaffold gear in stillage and remove from site. Keep site clean Keep worksite clean and tidy at all times to reduce hazards to a minimum Inspect scaffold to ensure it is clear of debris before turning boards and dismantling Correct procedure for dismantling of scaffold is adhered to.
OHS-03-F01
POWER
JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) CONSULTATION & SIGN-OFF RECORD I confirm by my signature below, that I have attended a briefing on the requirements of the attached Job Safety & Environment Analysis and agree to perform the work in the manner detailed on it. I confirm that copies of the relevant Permits, MSDS's, Isolation Plans etc. have been reviewed. JSA NAME
JSA No:
NAME
(Please print)
SIGNATURE
Rev: DATE
THIS SAFE WORK BRIEFING / TRAINING WAS CARRIED OUT BY (responsible person at that location) : Name: Signature: Date: Client sign off (where applicable) Site / Project Manager sign off (document reviewed)
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