Job Safety Analysis (JSA) - Brook Template

• JSA No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by WIC (Worker In Charge)

• Location
  Address

• Job Safety Analysis (JSA) is to be completed upon arrival on site with the purpose of identifying any site-specific hazards present on the day.

Site Assessment

Primary Contractor or Site Owner details

• Business Name

  Green Energy Technologies

• Yes

  No

• Phone:

  0749402900

• Address:

  Select 12 Valley Street North Mackay 1/2 Myer Lasky Drive Cannonvale 1/41 Charters Towers RoadHermit Park 3/471 Tufnell Road Banyo

  • 12 Valley Street North Mackay
  • 1/2 Myer Lasky Drive Cannonvale
  • 1/41 Charters Towers RoadHermit Park
  • 3/471 Tufnell Road Banyo

Emergency Management

• Emergency Contact Numbers

  000

• Evacuation Point / Assembly Area

  Truck

• First Aid Kit Location/s

  Truck Cab

• EMERGENCY
  • In an emergency
  ↓
  • evacuate all persons on site to designated assembly area
  ↓
  • Lock down the site if possible
  ↓
  • Contact Emergency Services

Job Description and Work Procedures

• List the main tasks that will be performed on this site.

Task

• Job Steps

  Solar Installation

• List of SWMS in use for this job (if applicable):

  Select 1.1 Solar Installation 2.1 Energised Electrical 2.2 Heights 2.3 Overhead Power 2.4 Confined Space 2.5 On or Near Roads 2.6 Asbestos 2.7 Plant

  • 1.1 Solar Installation
  • 2.1 Energised Electrical
  • 2.2 Heights
  • 2.3 Overhead Power
  • 2.4 Confined Space
  • 2.5 On or Near Roads
  • 2.6 Asbestos
  • 2.7 Plant

• Have all relevant workers read the SWMS?

  Safe

  At Risk

  N/A

• Have all workers been trained in the SWMS?

  Yes

  No

  N/A

COVID-19 Checklist

• Have you completed the pre checks for the client to ensure there is no at risk person on premise?

  Yes

  No

• Are all team members free of symptoms of COVID-19 in line with updated symptom guidelines

  Yes

  No

• Have all team members washed hands prior to attending site in line with COVID-19 guidelines

  Yes

  No

• Has the client been notified of social distancing practices and non contact installation if deemed required

  Yes

  No

• Are you comfortable with the site and locations of works will be distanced in line with COVID-19 guidelines

  Yes

  No

Working At Heights

• Work above 3mtrs

  Yes

  No

• Fall Protection & SWMS required please adhere to SWMS 1.1 Solar Panel Installation. Particular attention to steps 11-13

  Yes

  No

• Work 2mtrs - 3mtrs

  Yes

  No

• SWMS required please adhere to SWMS 1.1 Solar Panel Installation. Particular attention to steps 11-13

  Yes

  No

• Work Below 2 mtrs

  Yes

  No

• SWMS not required however still adhere to SWMS 1.1 Solar Panel Installation

  Yes

  No

Site Permits or Register Documentation required

• Yes

  No

• Work/Entry Permit/s completed and signed

  Yes

  No

  N/A

• Chemical Register / manifest / Safety data sheets on site

  Yes

  No

  N/A

• Yes

  No

Over Head Power Lines in play

• Yes

  No

• Energised

  Yes

  No

  N/A

• Do not work without appropriate measures in place

  Yes

  No

• De-Energised

  Yes

  No

  N/A

• Test as off and confirmations prior to proceeding

  Yes

  No

• Yes

  No

Underground Services in play

• Yes

  No

• Dial Before You Dig plan

  Yes

  No

  N/A

• Electrical Services

  Yes

  No

  N/A

• Gas Services

  Yes

  No

  N/A

• Water Services

  Yes

  No

  N/A

• Communications

  Yes

  No

  N/A

• Yes

  No

Does the work involve any of the following High Risk Construction Work? (Tick if applicable)

Where there is risk of drowning, Asbestos, Artificial temp extreme

• Yes

  No

• Drowning

  Yes

  No

  N/A

• Disturbing asbestos

  Yes

  No

  N/A

• Artificial extremes of temperature

  Yes

  No

  N/A

• Contaminated or flammable atmosphere

  Yes

  No

  N/A

• Yes

  No

• Add Hazard

Key Site Specific Safety Hazards

• List all Hazards identified during the JSA.

Hazard

• Risk Level

• Controls in place.

• Residual Risk Level

• Is it safe for work to proceed?

  Yes

  No

• Have all risks been reduced to the lowest acceptable level?

  Yes

  No

• DO NOT COMMENCE WORK, contact your supervisor.

• Do any workers require additional supervision?

  Yes

  No

• If YES, who are they and who will provide the supervision?

• Re-assess Any new hazards identified during the work are to be assessed and controls put in place

• Person Responsible:

• Monitoring On-going monitoring of hazards and risks is required for the duration of the work.

• Person Responsible:

JSA participants confirmation

• I have read the above JSA and I understand its contents. I confirm that I have the skills and training, including relevant certification to conduct the tasks I have been allocated to complete. I agree to
  comply with safety requirements within this JSA including identifying and monitoring hazards and adhering to risk control measures, relevant SWMS and permit requirements.

• Participants/ workers names.

Worker

• Michael Brook

  Sign

• Date

  Date

RISK ASSESSMENT MATRIX

• HB 436:2004 Risk Management Guidelines Tables 6.3 – 6.8 reproduced with permission from SAI Global under licence 1210-c062. Standards may be purchased at http://www.saiglobal.com
  References: Safe Work Australia (2011) - Code of Practice: How to Manage Work Health and Safety Risks, AS/NZS 31000 -2009 Risk Management Principles and Guidelines.

• 

• 

• 

• - 4A: Acute DO NOT PROCEED > requires immediate attention. Introduce further high-level controls to lower the risk level.
  
  - 3H: High > Review before commencing work. Introduce new controls and/or maintain high-level controls to lower the risk level. Monitor frequently to ensure control measures are working.
  
  - 2M: Moderate > Maintain control measures. Proceed with work. Monitor and review regularly, and if any equipment/people/materials/work processes or procedures change.
  
  - 1L: Low > Record and monitor. Proceed with work. Review regularly, and if any equipment/people/materials/work processes or procedures change.

Hierarchy of Risk Controls

• • Elimination - Risk will be eliminated where possible
  ↓
  • Substitution Isolation Engineering - Where risk remains, one/combination of controls will be used
  ↓
  • Administrative - Where risk remains, administrative controls will be used
  ↓
  • Personal Protective Equipment (PPE) - Where risk still remains, it will be reduced as far as reasonably practicable with use of PPE.