JSEA

• TASK:

• WORK ORDER No:

• JSEA No:

• Developed By:

• Conducted on

  Date

• Reviewed and Approved by Supervisor :

• Supervisor Phone No:

• Location
  Address

• Permits Required

  Select None Confined Space Excavation Hot Work Roof Access Isolation/Electrical High Voltage Permit to Work High Risk Licence Other

  • None
  • Confined Space
  • Excavation
  • Hot Work
  • Roof Access
  • Isolation/Electrical
  • High Voltage
  • Permit to Work
  • High Risk Licence
  • Other

• Please Specify

• JSEA Team Members

Name:

• NAME:

EMERGENCY RESPONSE INFORMATION:

• INTERNAL PHONE:

• EXTERNAL PHONE:

• EMERGENCY SERVICES: 000

• INTERNAL RADIO SYSTEM:

Hazards to Consider (Controls must be identified)

• Working at Height

  Select Ladders Lifting Equipment /EWP's Scaffolding Stairs / Platforms Working at height Working above others

  • Ladders
  • Lifting Equipment /EWP's
  • Scaffolding
  • Stairs / Platforms
  • Working at height
  • Working above others

• Electrical

  Select Static Electricity Sub-stations/Switch Rooms Underground Cables Contact with Electrical Equipment Electrical Cables High Voltage Equipment Overhead Cables

  • Static Electricity
  • Sub-stations/Switch Rooms
  • Underground Cables
  • Contact with Electrical Equipment
  • Electrical Cables
  • High Voltage Equipment
  • Overhead Cables

• Human Factors

  Select Rushing Complacency Fatigue Frustration

  • Rushing
  • Complacency
  • Fatigue
  • Frustration

• Mechanical

  Select Abrasive Blasting / Grinding Auto-Start Equipment Conveyors Entanglement Equipment Failure E-Stops beyond reach Hand and Power Tool Impact and Crushing Areas Pinch / Cutting Points Residual / Stored Energy Uncontrolled Movement Unguarded Moving Parts Welding or Cutting

  • Abrasive Blasting / Grinding
  • Auto-Start Equipment
  • Conveyors
  • Entanglement
  • Equipment Failure
  • E-Stops beyond reach
  • Hand and Power Tool
  • Impact and Crushing Areas
  • Pinch / Cutting Points
  • Residual / Stored Energy
  • Uncontrolled Movement
  • Unguarded Moving Parts
  • Welding or Cutting

• Pressure

  Select Competitive Pressures Compressed Gases / Air Fluid High Pressure Steam Hydraulic Water / Pulp

  • Competitive Pressures
  • Compressed Gases / Air
  • Fluid
  • High Pressure Steam
  • Hydraulic
  • Water / Pulp

• Thermal

  Select Cold - Ambient Heat, ie, Stress / Discomfort - Ambient Hot Materials / Fluids Hot Surfaces Steam / Condensate UV Exposure

  • Cold - Ambient
  • Heat, ie, Stress / Discomfort - Ambient
  • Hot Materials / Fluids
  • Hot Surfaces
  • Steam / Condensate
  • UV Exposure

• Mobile Plant

  Select Traffic / Pedestrian Interaction / Collision Uneven Terrain Unlicensed / Untrained Operators Vehicle Instability, eg Rollover

  • Traffic / Pedestrian Interaction / Collision
  • Uneven Terrain
  • Unlicensed / Untrained Operators
  • Vehicle Instability, eg Rollover

• Manual Handling (Ergonomic)

  Select Awkward / Unbalanced Load High / Low reach High Force / Heavy Loads Lighting Over Exertion / Fatigue Poor Design / Layout Repetitive Movements

  • Awkward / Unbalanced Load
  • High / Low reach
  • High Force / Heavy Loads
  • Lighting
  • Over Exertion / Fatigue
  • Poor Design / Layout
  • Repetitive Movements

• Chemical

  Select Chemicals / Reagents Dust / Fumes / Vapour / Mist Flammable Gases Handling Flammable Materials Hazardous Chemical Exposure Hazardous Substance Exposure Solid Chemical Splashes / Burns

  • Chemicals / Reagents
  • Dust / Fumes / Vapour / Mist
  • Flammable Gases
  • Handling Flammable Materials
  • Hazardous Chemical Exposure
  • Hazardous Substance Exposure
  • Solid Chemical
  • Splashes / Burns

• Workplace

  Select Asbestos Confined Space / Void Space Falling Objects General Access Housekeeping Illumination / Lighting Noise, ie, Exposure / Nuisance Poor Ventilation Protrusions / Holes/ Penetrations Restricted Visibility Restricted Work Area Slip & Trip Hazards Unauthorised Personnel Unlabelled Controls Vibration Wet / Slippery Wind / Storm Activity Working in Isolation

  • Asbestos
  • Confined Space / Void Space
  • Falling Objects
  • General Access
  • Housekeeping
  • Illumination / Lighting
  • Noise, ie, Exposure / Nuisance
  • Poor Ventilation
  • Protrusions / Holes/ Penetrations
  • Restricted Visibility
  • Restricted Work Area
  • Slip & Trip Hazards
  • Unauthorised Personnel
  • Unlabelled Controls
  • Vibration
  • Wet / Slippery
  • Wind / Storm Activity
  • Working in Isolation

• Environmental

  Select Air Contamination Contaminated Materials Contaminated Stormwater Drains Soil Contamination Solid Waste Stormwater Contamination Waste (effluent / hazardous)

  • Air Contamination
  • Contaminated Materials
  • Contaminated Stormwater Drains
  • Soil Contamination
  • Solid Waste
  • Stormwater Contamination
  • Waste (effluent / hazardous)

• Radiation

  Select Density Lvl Measure, ie, Radioactive Isotope / PH Probe / Conductivity Probes Infra-Red Microwaves Ultra-Violet Light, ie,Sun UPS System, ie, Acid Leak / Explosion X-Ray

  • Density Lvl Measure, ie, Radioactive Isotope / PH Probe / Conductivity Probes
  • Infra-Red
  • Microwaves
  • Ultra-Violet Light, ie,Sun
  • UPS System, ie, Acid Leak / Explosion
  • X-Ray

JOB STEPS - List the steps required to perform the task in the sequence they are carried out.

• Job step tasks

JOB STEP

• Is there any Hazards associated with this task?

  Yes

  No

  N/A

• Hazard Scenario - For each Job Step list the hazards that could cause injury when the task is performed.

• Raw Risk Score associated with Hazard.

• RISK CONTROL MEASURES - List the control measures required to eliminate or minimise the risk of injury arising from the identified hazard.

• 

• Risk Score after control

• Further controls are required.

• Risk Matrix

  

Job Safety and Environmental Analysis Work Team Sign-On

• The undersigned acknowledge that they have been consulted in respect to the hazards of the job and how the job is to be completed safely, that they have read, understood and will adhere to the requirements of this JSEA. Any changes to hazards, conditions, work environment or job steps requires modification of the JSEA and communication of changes.

• Work Team Sign-On

Name

• Add signature

  Sign