Title Page
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Document No.
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Job Reference
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Job Description
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Date
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Prepared by
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Location
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Personnel
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Emergency Plan
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Nominated First Aider and First Aid kit onsite. Location of First Aid Kit
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Documents on site. JA/ SWMS, MSDS sheets and other related documents onsite Documents Location
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Are all personnel inducted to site (BRS and Principle)
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Has all staff signed off on/onto SWMS/JSA and appropriate signage/isolation/barricading controls been implemented to work area?
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Traffic management plan required
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- F2.1 Footpath Divert
- F2.2 Footpath Divert into Berm
- F2.3 Footpath Divert into Road
- F2.5 Shoulder
- F2.6 Shoulder CLosed
- F2.11 Contra Flow not Cross Centre line
- F2.14 Stop-Go
- F2.16 Give Way
- F2.19 2 way Intersection
- F2.20 Contra Intersection
- J2.20a Contra 4 Way Intersection
- J2.20e 4 Way Intersection Centre Contra
Instruction 2 - Determine what Plant and Equipment is likely to be used
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List Plant and Equipment
- Truck
- Digger
- Drill
- Tool Wagon
- Hydro-Vac
- Ladder/ Harness
- Small Plant (Cutter/ Wacker/ Compactor
- Jinker Trailer
- Roller
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Close approach Consent Required
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Confirm working outside of MAD
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Safety Observer required
Instruction 3 – State and Review the Job Analysis or SWMS/s that are required for this task
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Name of JA/SWMS
- 0207 Directional Drilling
- 0208 Concrete Cutting
- 0210 Excavation and Trenching
- 0021 Confined Spaces
- 0029 Hauling Cables/ Testing Tubes
- 0031 Working at Heights
- 0037 Hauling Fibre Optics
- 0028 Working with Asbestos
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Hazards Identified by JA/ SWMS.
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Place a tick if the hazards are identified in the Job Analysis or SWMS selected in instruction 3.
- Electrical
- Chemical
- Tools
- Gasses
- First aid
- Vehicles
- Heights
- Depth
- Weight
- Lighting
- Pressure
- Access
- Vibration
- Noise
- Trenches
- Weather
- Bacteria
- Dust
- Slip / Trip
- Remote site
- Hot / Cold Objects
- Rotating Equipment
- Moving Equipment
- Lifting Equipment
- Underground Services
- Confined Space
- Dehydration
- Radiation (Sun)
- Manual Handling
- Exposed holes
- Overhead
- Sharps/needles
- Pedestrians
- Amenities
- Working Alone
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Personal Hazards
- Hit by moving objects
- Caught in / between
- Strain / repetitive
- Dropped objects
- Strike against
- Inhalation
- Burns
- Exposure to gas / heat / fumes
- Exposure to dust / chemicals
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Also Consider
- Pollution to the environment
- Soil erosion / contamination
- Runoff to drainage systems
- Simultaneous operations
- Security
- Damage to equipment
- Air / fumes and odours
- Public Liability
- Waste management
- Other Hazards
Instruction 4 – List Site Specific Hazards and Conduct Risk Assessment
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Hazard
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Initial Risk
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Controls
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Residual Risk
Instruction 5 – Determine what PPE is likely to be used
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What PPE is likely to be used? Tick Box if used
- Respiratory Protective Device
- Harness / Lifeline
- Eye Protection: Glasses/Goggles/Visor
- Hand Protection/Gloves
- Safety Boots / Gum Boots
- Overalls / Disposable Overalls
- Barricading and Signage
- Lock Out Tag Out Kit
- Hearing Protection
- Safety Helmet
- Communications Equipment
- Torch/Lighting
- Fire Fighting Equipment
- Mechanical Ventilation Device
- Sun Hat
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Other PPE not listed above
Instruction 6 –Toolbox this document with all personnel on site sign on I have read and understood the Job Analysis/Safe Work Method Statement and agree to perform the work according to the requirements of this Job Start Form and associated SDS, procedures, legislative requirements.
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Signature
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Signature
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Signature
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Signature
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Signature
