GRM BMA Safe Template

• Document No.

• Name

• Conducted on

  Date

• Job location

• Job description

• Personnel involved in task

• If more than one person involved in task - STOP and do a JSA

Checklist

• 1. Can I be injured by being caught in, on or between anything?<br>Pinch points, rotating machinery, conveyors, caught between vehicles or machinery, roof and rib conditions.

  Yes

  No

  N/A

• Can I manage this hazard?

  Yes

  No

  N/A

• List controls put in place to manage this hazard

• Will controls effectively manage the hazard?

  Yes

  No

  N/A

• STOP the job and contact your Supervisor. A JSA is required for this task.

• 2. Can I strain or overexert myself?<br>Does the task require repetitive movement, pushing, pulling, lifting, awkward postures, sustained postures?

  Yes

  No

  N/A

• Can I manage this hazard?

  Yes

  No

  N/A

• List controls put in place to manage this hazard

• Will controls effectively manage the hazard?

  Yes

  No

  N/A

• STOP the job and contact your Supervisor. A JSA is required for this task.

• 3. Can I fall onto, into or from anything?<br>Working above 1.8m, fall onto sharp objects, fall from machinery

  Yes

  No

  N/A

• Can I manage this hazard?

  Yes

  No

  N/A

• List controls put in place to manage this hazard

• Will controls effectively manage the hazard?

  Yes

  No

  N/A

• STOP the job and contact your Supervisor. A JSA is required for this task.

• 4. Can I slip or trip on anything?<br>Tools / Equipment, wet / slippery surfaces, poor housekeeping, uneven surfaces

  Yes

  No

  N/A

• Can I manage this hazard?

  Yes

  No

  N/A

• List controls put in place to manage this hazard

• Will controls effectively manage the hazard?

  Yes

  No

  N/A

• STOP the job and contact your Supervisor. A JSA is required for this task.

• 5. Can I be struck by a moving object?<br>Moving vehicles, projectiles, moving machinery

  Yes

  No

  N/A

• Can I manage this hazard?

  Yes

  No

  N/A

• List controls put in place to manage this hazard

• Will controls effectively manage the hazard?

  Yes

  No

  N/A

• STOP the job and contact your Supervisor. A JSA is required for this task.

• 6. Can I come into contact with or be exposed to something that may harm me? (E.g. electricity, gas, heat, acid, grease, hazardous substances or stored energy.)

  Yes

  No

  N/A

• Can I manage this hazard?

  Yes

  No

  N/A

• List controls put in place to manage this hazard

• Will controls effectively manage the hazard?

  Yes

  No

  N/A

• STOP the job and contact your Supervisor. A JSA is required for this task.

• 7. Does anything need to be isolated and tested for dead?<br>Electrical, water, hydraulic, high pressure

  Yes

  No

  N/A

• Can I manage this hazard?

  Yes

  No

  N/A

• List controls put in place to manage this hazard

• Will controls effectively manage the hazard?

  Yes

  No

  N/A

• STOP the job and contact your Supervisor. A JSA is required for this task.

• 8. Can something fall on me or can I cause something to fall onto someone else?<br>Falling tools / equipment

  Yes

  No

  N/A

• Can I manage this hazard?

  Yes

  No

  N/A

• List controls put in place to manage this hazard

• Will controls effectively manage the hazard?

  Yes

  No

  N/A

• STOP the job and contact your Supervisor. A JSA is required for this task.

• 9. Can I be injured by nearby activities or can my activities injure others nearby?<br>People working above / below me, dust or fumes, noise, sparks, projectiles

  Yes

  No

  N/A

• Can I manage this hazard?

  Yes

  No

  N/A

• List controls put in place to manage this hazard

• Will controls effectively manage the hazard?

  Yes

  No

  N/A

• STOP the job and contact your Supervisor. A JSA is required for this task.

• 10. Could there be any uncontrolled movement, like ground movement, machine movement?<br>Ground failure, high wall / low wall failure, roof / rib failure, runaway vehicle

  Yes

  No

  N/A

• Can I manage this hazard?

  Yes

  No

  N/A

• List controls put in place to manage this hazard

• Will controls effectively manage the hazard?

  Yes

  No

  N/A

• STOP the job and contact your Supervisor. A JSA is required for this task.

• 11. Can I spill or pollute anything?<br>Oil spill, release into waterways, pitwater release

  Yes

  No

  N/A

• Can I manage this hazard?

  Yes

  No

  N/A

• List controls put in place to manage this hazard

• Will controls effectively manage the hazard?

  Yes

  No

  N/A

• STOP the job and contact your Supervisor. A JSA is required for this task.

• 12. Can weather conditions, work environment or poor lighting affect job safety?<br>Extreme temperatures, lack of lighting, fog storm

  Yes

  No

  N/A

• Can I manage this hazard?

  Yes

  No

  N/A

• List controls put in place to manage this hazard

• Will controls effectively manage the hazard?

  Yes

  No

  N/A

• STOP the job and contact your Supervisor. A JSA is required for this task.

• 13. Do I need a sub-permit?<br>Hot work, confined space, working at heights, asbestos, radiation, drilling, cutting and excavating near concealed services

  Yes

  No

  N/A

• Can I manage this hazard?

  Yes

  No

  N/A

• List controls put in place to manage this hazard

• Will controls effectively manage the hazard?

  Yes

  No

  N/A

• STOP the job and contact your Supervisor. A sub-permit is required for this task.

• 14. Will I be working below, on or near a highwall or crest?<br>Within 5m of the crest, 10m of the toe of a <60m continuous highwall slope or 15m of the toe of a >60m continuous highwall slope in an open pit.

  Yes

  No

  N/A

• Refer to Site Geotechnical Guidelines

• Can I manage this hazard?

  Yes

  No

  N/A

• List controls put in place to manage this hazard

• Will controls effectively manage the hazard?

  Yes

  No

  N/A

• STOP the job and contact your Supervisor. A JSA is required for this task.

• 15. Are there any other hazards present?

  Yes

  No

  N/A

• Can I manage this hazard?

  Yes

  No

  N/A

• List controls put in place to manage this hazard

• Will controls effectively manage the hazard?

  Yes

  No

  N/A

• STOP the job and contact your Supervisor. A JSA is required for this task.