Client WHS Assessment (JSA only) 2023

• Conducted on

  Date

• Prepared by (name and title)

• It is important to note that a separate Job Safety Analysis (JSA) must be created for each distinct job that will be performed at the host site. This is necessary because each job may have its own unique hazards and safety considerations that need to be addressed. Having a separate JSA for each job ensures that all potential dangers are identified and addressed, and helps to ensure a safe working environment for all employees.

Client + Job Information

• Client Name

• Client Representative

• Location of the job

• Workers' job title

• Description of job

• Work schedule

• Plant and machinery to be used e.g., tractor, forklift

• Qualifications, licenses, skills required

• Vaccinations required

  Yes

  No

• What vaccinations are required?

• Name of the person who will supervise the worker

• Who should the worker raise health and safety issues with?

• Is there a Health and Safety Representative onsite?

  Yes

  No

Personal Protective Equipment

• Types of personal protective equipment required for this job

• Hi-visibility drill shirt

  Select Required Not Required

  • Required
  • Not Required

• Who will supply the hi-visibility drill shirt?

  MADEC

  Host Employer

  Other

• Long drill pants/denim jeans

  Required

  Not Required

• Who will supply the long drill pants/denim jeans?

  MADEC

  Host Employer

  Other

• Steel capped boots

  Required

  Not Required

• Who will supply the steel capped boots?

  MADEC

  Host Employer

  Other

• Safety glasses

  Required

  Not Required

• Who will supply the safety glasses

  MADEC

  Host Employer

  Other

• Gumboots

  Required

  Not Required

• Who will supply the gumboots

  MADEC

  Host Employer

  Other

• Face shield (clear)

  Required

  Not Required

• Who will supply the face shield

  MADEC

  Host Employer

  Other

• Welding helmet, jacket and hood

  Required

  Not Required

• Who will supply the welding helmet, jacket and hood?

  MADEC

  Host Employer

  Other

• Hard hat

  Required

  Not Required

• Who will supply the hard hat?

  MADEC

  Host Employer

  Other

• Gloves

  Required

  Not Required

• Who will supply the gloves?

  MADEC

  Host Employer

  Other

• Sun hat, and sunscreen

  Required

  Not Required

• Who will supply the sun hat and sunscreen?

  MADEC

  Host Employer

  Other

• Dust mask

  Required

  Not Required

• Who will supply the dust mask?

  MADEC

  Host Employer

  Other

• Respirator

  Required

  Not Required

• Type of respirator required

  Select Non-powered air-purifying respirator Powered air-purifying respirator Supplied-air respirator

  • Non-powered air-purifying respirator
  • Powered air-purifying respirator
  • Supplied-air respirator

• Who will supply the respirator?

  MADEC

  Host Employer

  Other

• Other (please specify)

• Who will supply this PPE?

  MADEC

  Host Employer

  Other

• Other (please specify)

• Who will supply this PPE?

  MADEC

  Host Employer

  Other

Hazards associated with the Job

• For any of the hazards that you select yes to, that cannot be validated in the Client WHS Assessment, create an action under the applicable hazard or refer to the corresponding action created in the Client WHS Assessment.

• Areas where pedestrians and vehicles interact

  Yes

  No

• Asbestos

  Yes

  No

• Silica Dust

  Yes

  No

• Manual tasks

  Yes

  No

• Use of tools and/or knives

  Yes

  No

• Confined spaces

  Yes

  No

• Plant, and Machinery

  Yes

  No

• Electrical

  Yes

  No

• Falling objects

  Yes

  No

• Fatigue

  Yes

  No

• Hazardous chemicals

  Yes

  No

• High Job Demand

  Yes

  No

• Bacterial diseases e.g., leptospirosis

  Yes

  No

• Slips, trips and fall hazards

  Yes

  No

• Work that requires a High Risk Work (HRW) Licence

  Yes

  No

• Working at heights

  Yes

  No

• Working in hot or cold environments

  Yes

  No

• Working remote or isolated work

  Yes

  No

Validation of Risk Control Measures

• In order to confirm that the hazards relevant to this JSA are effectively managed, please review the completed Client Work Health and Safety Assessment to validate the implemented risk controls.

• Has the Client WHS Assessment validated risk controls for all hazards deemed relevant to the job in this JSA?

  Select Yes, the Client WHS Assessment has validated the risk controls for all hazards deemed relevant to the job in the JSA No, the Client WHS Assessment has not yet validated the risk controls for all hazards deemed relevant to the job in the JSA

  • Yes, the Client WHS Assessment has validated the risk controls for all hazards deemed relevant to the job in the JSA
  • No, the Client WHS Assessment has not yet validated the risk controls for all hazards deemed relevant to the job in the JSA

• Escalate to the Regional Manager for discussion with the WHS Consultant, HR Manager and/or Director Labour Hire.

• Next review date

  Date

• Has the review been set as a reminder in the email calendar?

  Yes

  No