IAS_JHA Work Sheet

• Client / Site

• Conducted on

  Date
• Location
  Address

• Personnel Involved In Completing JHA (please list)

TASK REQUIREMENTS

• JHA NUMBER

• Task Description

• Minimum Persons Required

EQUIPMENT Description of Equipment (Tools, Vehicles and Machinery) to be used for the duration of this JHA.

• Required Equipment

Equipment

• Tools/Plant/Machinery

  Select Compactor/Roller Dozer Dump Truck EWP/Scissor Lift Excavators Generator Grader Hand Tools I.T. Light Truck Lighting Plant Loader Moxy Scraper Water Cart Other

  • Compactor/Roller
  • Dozer
  • Dump Truck
  • EWP/Scissor Lift
  • Excavators
  • Generator
  • Grader
  • Hand Tools
  • I.T.
  • Light Truck
  • Lighting Plant
  • Loader
  • Moxy
  • Scraper
  • Water Cart
  • Other

• Please specify

• Qualification/Certificate to operate the Equipment (if required)

  VOC'ed

  VOC'ed with High Risk Ticket

  N/A

  Other

• Please specify

• Details of Special Precautions to be taken (including environmental/heritage considerations)

• Pre-Task Training/Instruction Required (permit training, clearing training, etc.)

Type of Permit/Special Procedures Required for this JHA (Please indicate by selecting at least one option from the lists below) NOTE: Associated paperwork or permits are to be attached

• Please indicate all responses below

  Select Clearing Permit Excavation/Dig Permit Hot Work Permit Critical Crane Lifts Spotters Traffic Management Plan Mobile Plant MSDS Fumigation Proximity to Train Line Flora/Fauna Dust Confined Space Entry Work at Heights Grid Mesh/Floor Removal Electrical Isolation Mechanical Isolation Gas Testing Work Box - Man Cage Permit Scaffolding Inclement Weather Other

  • Clearing Permit
  • Excavation/Dig Permit
  • Hot Work Permit
  • Critical Crane Lifts
  • Spotters
  • Traffic Management Plan
  • Mobile Plant
  • MSDS
  • Fumigation
  • Proximity to Train Line
  • Flora/Fauna
  • Dust
  • Confined Space Entry
  • Work at Heights
  • Grid Mesh/Floor Removal
  • Electrical Isolation
  • Mechanical Isolation
  • Gas Testing
  • Work Box - Man Cage Permit
  • Scaffolding
  • Inclement Weather
  • Other

• Please Specify

PPE/Other Requirements (Please indicate by selecting at least one option from the lists below)

• Select All That Apply

  Select Barricading Face Shield Fall Arrest Extinguisher Fall Protection Fire Blankets Gloves Hearing Protection Hi Visibility Vst Mono-googles P2 Dust Mask P2 Dust Overalls PVC Pants/Boots/Coat Radio/Phone Respirator Type Safety Footwear Safety Glasses Safety Helmet Signage Other

  • Barricading
  • Face Shield
  • Fall Arrest
  • Extinguisher
  • Fall Protection
  • Fire Blankets
  • Gloves
  • Hearing Protection
  • Hi Visibility Vst
  • Mono-googles
  • P2 Dust Mask
  • P2 Dust Overalls
  • PVC Pants/Boots/Coat
  • Radio/Phone
  • Respirator Type
  • Safety Footwear
  • Safety Glasses
  • Safety Helmet
  • Signage
  • Other

• Please specify

Once this section is complete, move onto the 'Job Steps' section.

JOB STEPS AND RISK ANALYSIS Refer to the Risk Matrix below to evaluate the 'Risk' and 'Residual Risk' for each hazard and control.

• Basic Job Steps

Step

• Job Step

• Hazard and Control

Hazard

• Existing/Potential Hazard

• Recommended Corrective Measure

• Residual Risk

  Extreme

  High

  Moderate

  Low

• Reviewed by - Contractor Supervisor

  Sign

• Approved by - Senior Manager

  Sign

Once signed off by both parties, move onto the next section for employees to sign onto the JHA.

SIGN ON SHEET

• Persons Working Under the Direction of this JHA

Employee

• In signing this form, I understand the work procedures/methods as described in the JHA, and have been given the opportunity to ask questions.

• Full Name and Signature (date will update automatically once signed)

  Sign

REMEMBER to undertake a Take 5 before commencing any new task.

Email a copy of this JHA to the Safety Department team on site.