Step 1 - Initial Assessment

1. Stop, Step back and Think

Am I clear on what the task is?

Do I have the required skills, training and licenses?

Is there a JSEA or SWMS available for high risk tasks?

Is my equipment fit and correct for the task and in good working order?

Do I have the correct Personal Protective Equipment for the task?

Consider the following permits

Is a HOT WORK permit required?

Simply define task requiring permit:

Is a CONFINED SPACE permit required ?

Simply define task requiring permit:

Is Hazards in laboratories form PF 306 required?

Obtain form PF306 and have lab manager and UQ supervisor complete prior to undertaking works.

Is a FIRE SYSTEM IMPAIRMENT permit required ?

Simply define task requiring permit:

Is a SURFACE PENETRATION or EXCAVATION permit required ?

Simply define task requiring permit:

Tick the box if you have arranged the required permits.

Step 2 - Hazard / Issue Check

2. Identify the Hazards and Controls with the following JSEA

Are there any manual handling hazards?
(Lifting, awkward positions, impacts or over exertion)

What are the HAZARDS or RISKS ? List them here:

What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

Are there any hot surfaces?
( generator exhaust or radiators)

What are the HAZARDS or RISKS? List them here:

What CONTROLS are you putting in place to remove the risk to low? List them here.

Is the work at height >2 meters?

What are the HAZARDS or RISKS? List them here:

What CONTROLS are you putting in place to remove the risk to low? List them here.

Are you working near or around suspended loads?

What are the HAZARDS or RISKS? List them here:

What CONTROLS are you putting in place to remove the risk to low? List them here:

Add photo if possible?

Are there any Gravity hazards?
(Slips, trips and falls, or being struck by falling objects)

What are the HAZARDS or RISKS ? List them here:

What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

Add a photo if possible

Are there any Mechanical hazards?
(Caught in moving parts, struck by plant or flying objects)

What are the HAZARDS or RISKS ? List them here:

What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

Add a photo if possible?

Is there any mobile plant or traffic?

What are the HAZRDS or RISKS? List them here:

What CONTROLS are you putting in place to reduce the risk to low? List them here:

Add a photo if possible
Add media
Add media

Are there any Electrical hazards?
(Faulty tools or live power)

What are the HAZARDS or RISKS ? List them here:

What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

Add a photo if possible?

Are there any Chemical hazards?
(Inhalation, swallowing, acids, solvents or asbestos)

What are the HAZARDS or RISKS ? List them here:

What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

Add a photo if possible?

Are there any High Pressure hazards?
(Liquid, gas or air)

What are the HAZARDS or RISKS ? List them here:

What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

Add a photo if possible?

Are there any Noise hazards?
(Potential hearing damage, masking of emergency alarms)

What are the HAZARDS or RISKS ? List them here:

What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

Are there any ACM (asbestos) hazards?

What are the HAZARDS or RISKS ? List them here:

What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

Add a photo if possible?

Are there any Biological hazards?
(Potential disease contact, ,zoonoses, animals)

What are the HAZARDS or RISKS ? List them here:

What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

Add a photo if possible?

Are there any Radiation hazards?
(X-rays, sunlight, ultra violet)

What are the HAZARDS or RISKS ? List them here:

What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

Add a photo if possible
Add media

Are there any Environmental hazards?
(Dust, heat, cold, snow, ice)

What are the HAZARDS or RISKS ? List them here:

What CONTROLS are you putting in place to reduce risks to LOW ? List them here:

Add a photo if possible?

Step 3 - Final Assessment

3. Consultation with Supervisor or Manager.

Did you consult with your Supervisor or Customer Contact person for items in Section 2 where you answered YES and during the JSEA preparation

List your reason for not contacting your works Supervisor or UTAS Contact person.

4. Make the Hazards safe.

Are all hazards now removed or at LOW level?

Add reasons below for not reducing the hazard to a LOW risk rating:

Where needed, I have updated the JSEA or SWMS for this task?

Add the JSEA or SWMS title and reference number below: then forward a copy to your works Supervisor or UTAS Contact person.

5. Is the site now be SAFE so the task can be started ?

Tick the box if you have identified and assessed all hazards and made them safe. It is now SAFE to start the work.

6. Contractor / Worker Sign Off

Name of Person signing:

Enter name of person signing this audit in the space below then select "Sign"

Contractor / Worker Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.