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 Identify hazards that may be present by ticking items on the list below.
3. PRECAUTIONS: hard hat, safety glasses, safety boots
compulsory
WORK LOCATION Difficult Entry/Exit
HAZARDOUS AREA
HIGH RISK
HIGH RISK
ADDITIONAL PRECAUTIONS
PERMITS
Falling Objects
Suspended loads
Gloves: type ………………….
Hot Work
Working at Heights
Poor Lighting Slippery Surfaces
Poor Visibility Inhalable Dusts/Fibres
Goggles Full Face Shield
Excavation Confined Space
Engulfment (trench collapse)
Remote Area
Multiple Electrical Feeds
High Noise Levels
High Visibility Vest
Hazardous Work Clearance
Poisonous Gas Present Temperature Extremes
Motor Room Hazards Toxic Substances
Trip Hazards Electrical Hazards - LV
Use of Chemicals Elevated Work Platform
Harness Fire Extinguishers
Access to Area High Voltage Access
Defined Confined Space
Potential for Difficult Rescue
Electrical Hazards - HV
Difficulty to Communicate amongst workers
Barricades
Scaffolding Other?
Oxygen Deficiency Oxygen Excess
Hazardous Substances - attach MSDS to JSA
Explosive Gas Present
HAZARDOUS SUBSTANCES in work area / to be used
Manual Handling Sharp Materials
Moving Machinery Tools & Equipment
Ladders used in th the task Working at Heights Working near Crane & Crane Runways
Heat/ Sunlight/ Radiation Traffic Movement Working near Operation Processing Lines
Ventilation Lighting Erect Scaffolding to access
PERMIT NUMBER
-attach MSDS
Rail Movement
Live Rails
Pressurised Fluids Flamm. Materials Present
Pneumatics
Respirator or 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 Air Pol Pollu luti tion on (dus (dust, t, fume fumes) s)
Spil Spills ls to grou ground nd
No is ise ( pl pl an an t & eq equ ip ip me me nt nt )
S oi oil Er Er os os io n
Spil Spills ls to drai drains ns/w /wat ater erwa ways ys
Haza Hazard rd to Flor Flora a /Fau /Fauna na
RISK RATING TABLE
Other:
This table is used to to calculate whether the hazard you have identified is Extreme: 9-10 High: 7-8, Medium: 5-6 or Low: 3-4
5. EQUIPMENT REQUIRED: Static Plant & Equipment
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
Mobile Plant & Equipment
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
O 5 HS-034-F01
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: LIFTING CONTAINERS WITH CRANE
Step No. Logical sequence
Sequence of Basic Job Steps
Risk Rating
Identify the hazards (health and safety or Use table on Break down Job into steps. Each step should accomplish a major task and environmental) associated with each step, the previous page to examine each to find all possible risk factors be logical. score risk Environmental Aspects
1
Obtain PTW
2
Identify work area
3
Heavy Lifts with Crane
4
Potential Safety & Environmental Hazards/Impacts
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
Injury / damage as a result of incorrect information Risk of injury due to low awareness of work environment Objects falling from lifted load:
Obtain correct PTW. Training in PTW system.
Electrocution
Equipment SHALL NOT BE operated where any of the load will come within 6.4m of any electrical distribution or power line. Cranes shall be inspected prior to use and at weekly intervals. Records or test inspections shall be maintained at the site. Equipment must not be operated above its safe rated capacity. Manufacturers specifications shall be observed by all crane operators. Only certified riggers to be used to dog loads and give signal to driver. All crane operators shall be appropriately certified - records of certification shall be maintained at site. Rated load capacity, operating speeds, special hazard warnings and instructions shall be visible to the operator while at the control station.
Heavy Lifts with Cranes (any Lift over 5 Failure of equipment: Tonne or of Unknown Weight or Using 2 Cranes is Considered a Heavy Lift)
Revision Date: March 2005
JSA G17
………. of …………..
Risk Rating Of the risk following corrective action
Take 5, be aware of hazards The area of the swing radius of cranes shall be barricaded where necessary. Employees shall not be permitted to work under the load of cranes. Lifts MUST NOT be swung over the top of where other people are working. Riggers to ensure and double check for correct slinging method and everything on load is secure prior to taking lift. Tag lines MUST BE USED to control loads.
Risk of load shifting due to incorrect rigging, exceeding working radius
Use qualified riggers to assess correct chain length. Crane operator to avoid exceeding working radius.
Risk of equipment failure due to overloading
Monitor container weight and do not exceed crane lifting limits
Risk of damage due to truck size mismatch
Check truck size matches container size prior to lift
Risk of injury / damage due to high wind
Crane operator to check weather conditions
Risk of damage / injury due to poor visibility related to large load
Use spotter and correct signals to assist crane operator.
………. of …………..
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)
