Dirgsua HAC

HAC - Identify - Assess - Control - Monitor - Re-Assess

• Document No.

• Supervisor

• Conducted on

  Date

• Site Assessment led by

• Section

• Asset Location i.e. Pole no., sub name, kiosk name, etc.

• Location
  Address

Talk about the job! Use the section below to sketch a plan vies of the worksite. Or take a picture. Everybody involved! Does anything on this site change the way we normally do our work?

• Take a photo of the site

  Media

• Describe the site in writing

• Describe the job/tasks to be completed: (identify the major steps & who is doing the work).

Safe Work Method Statement (SWMS)

• Enter SWMS information

SWMS

• SWMS Number

• Summary of SWMS name

• Applicable tasks

STOP! After a work break, team membership changes, site conditions change or something causes you to change your work processes. THINK! About current and additional controls and re-assess the job. DO! If the Pre-Work Discussion highlights safety issues, they must be resolved with you Supervisor before commencing work.

Mandatory Discussion Prompts (refer to Blue Folder - Be Safe Pro10.2F and Be Safe Pro10.5F

• Emergency contact numbers

• Evacuation Point

• First Aid Kit Location

  Ausgrid Vehicle Yes

  Other

• Other First Aid Kit location

• Job Packet Information on site?

  Yes

  N/A

• Will we affect other people on site or they affect us?

  Yes

  No

• What will we do?

• Asset/Dial Before You Dig plans on site?

  Yes

  N/A

• Additional Supervision?

  Select Contractor Apprentice Visitor Other N/A

  • Contractor
  • Apprentice
  • Visitor
  • Other
  • N/A

• The responsible person (RP) that is providing supervision will be?

• Transmission HV

  Energised

  Isolated

  N/A

• Access Permit no.

• Distribution HV

  Energised

  Isolated

  N/A

• Access Permit no.

• Low Voltage

  Energised

  De-energised

  De-energised & shorted

  Isolated

  N/A

• Permit No. (If applicable)

Job Discussion - Fatal Risk Assessment Table. Refer to the Blue Folder for Hazard Prompts and HAC Instructions.

• 1. Uncontrolled discharge or contact with electricity

  Yes

  No

• Describe Fatal Risk

• Take Photo/s of Fatal Risk.

  Media

• Assess Risk No.

• Control

• Residual Risk No.

• 2. Exposure to Hazardous Materials

  Yes

  No

• Describe Fatal Risk

• Take Photo/s of Fatal Risk.

  Media

• Assess Risk No.

• Control

• Residual Risk No.

• 3. Fall from Heights

  Yes

  No

• Describe Fatal Risk

• Take Photo/s of Fatal Risk.

  Media

• Assess Risk No.

• Control

• Residual Risk No.

• 4. Motor Vehicle Accident

  Yes

  No

• Describe Fatal Risk

• Take Photo/s of Fatal Risk.

  Media

• Assess Risk No.

• Control

• Residual Risk No.

• 5. Unintended contact with Mobile Powered Plant

  Yes

  No

• Describe Fatal Risk

• Take Photo/s of Fatal Risk.

  Media

• Assess Risk No.

• Control

• Residual Risk No.

• 6. Struck by falling/moving object

  Yes

  No

• Describe Fatal Risk

• Take Photo/s of Fatal Risk.

  Media

• Assess Risk No.

• Control

• Residual Risk No.

• 7. Incident whilst undertaking lifting operations

  Yes

  No

• Describe Fatal Risk

• Take Photo/s of Fatal Risk.

  Media

• Assess Risk No.

• Control

• Residual Risk No.

• 8. Uncontrolled collapse of excavation work

  Yes

  No

• Describe Fatal Risk

• Take Photo/s of Fatal Risk.

  Media

• Assess Risk No.

• Control

• Residual Risk No.

• 9. Breach of controlled worksite when working near or around traffic

  Yes

  No

• Describe Fatal Risk

• Take Photo/s of Fatal Risk.

  Media

• Assess Risk No.

• Control

• Residual Risk No.

Job Discussion - Additional Risk Assessment Table. Refer to the Blue Folder for Hazard Prompts and HAC Instructions.

• Are there any key specific site hazards?

  Yes

  No

• Key Site Specific Safety Hazards

Site Specific Hazard

• Describe Site Specific Risk

• Take Photo/s of Site Specific Risk.

  Media

• Assess Risk No.

• Control

• Residual Risk No.

Monitor Ongoing monitoring of hazards and controls is required for the duration of the work. Has anything changed?

• Do you need to re-assess any new hazards?

  Yes

  No

• Re-Assess any New Hazards below

New Hazards

• Describe New Hazard Risk

• Take Photo/s of New Hazard

  Media

• Assess Risk No.

• Control

• Residual Risk No.

• Have the risks been reduced to As Low As Reasonably Practicable (ALARP)?

  Yes

  No

• Do not commence work and contact your supervisor. (For multi site ALARP see multi site address box)

WORKSITE STAFF All persons signing on this form declare that they are fit for work and all staff, contractors and others involved with this work activity must discuss the hazards, implement risk controls and sign on to accept this hazard check prior to commencing work. All work conducted will be in accordance with the identified SWMS. If you are an apprentice (A), an inexperienced contractor (C), visitor (V), or other (O) - additional supervision is required and you must initial (A, C, V or O) next to your signature. The responsible person on site must sign the Responsible Persons box next to the person(s) they are "looking after"

• Worksite Staff

Name

• Name

  Sign

• Are you an Apprentice, Inexperienced Contractor, Visitor, or Other?

  Contractor

  Apprentice

  Visitor

  Other

  N/A

• Responsible Person in charge of supervising this person

  Sign

Multi Site HAC

• Is this a multi site HAC?

  Yes

  No

• Address Details

Address

• Asset Location i.e. Pole no., sub name, kiosk name, etc.

• Take photo of the new location/task

  Media
• Site Location
  Address

• Multi site ALARP

  Yes

  No

• If you cannot control the risk to As Low As Reasonably Practicable then do not commence work and contact supervisor