Permit to Work - Cranes And Lifting Equipment

• Audit Category

  Select

• Audit Title

  Select

• Conducted On

  Date

• undefined

• Plant/Equipment Name

• Location of Work

• Description of Work

• Date of Work

  Date

• Expected duration of Work

• Forklift JIB

  Yes

  No

• Please Refer SOP or JSEA from Crane Provider

  Yes

  No

• Please Fill JSEA

  Yes

  No

• Job Details

• Location of Work

• JSEA Developed by

  Sign

• Date

  Date

• Personnel Involved in Activity

  Yes

  No

  N/A

• Name of Relevant Worker

• Qualification / Licenses / Ticket Held

• Signature

  Sign

• Personnel Involved in Activity

  Yes

  No

  N/A

• Name of Relevant Worker

• Qualification / Licenses / Ticket Held

• Signature

  Sign

• Common Hazards

  Yes

  No

• Work Environment/Site Layout

• Working from Height

• Ground Surface

• Stability

• Security

• Vibration

• Confined Spaces

• Site Access/Egress

• Underground Hazards

• Lighting

• Mobil Plant/Pedestrians

• House Keeping

• Asbestos

• Thermal Comfort

• Slips & Trips

• Overhead Hazards

• Site induction

• Chemical

• Biological

• Fire/Flammability

• Corrosive

• Compatibility

• Labelling

• MSDS Available

• Absorption

• Inhalation/Ingestion

• Signage

• Spill Control

• Storage

• PPE Available

• Manual Handling

• Repetitive Actions

• Cold/Hot

• Lifting/Carrying

• Bending/Reaching

• Excessive Distances

• Awkward Postures

• High Forces- Heavy Load

• Pushing/Pulling

• Restraining/Supporting

• Stability/Size of Load

• Plant

• Crushing

• Cutting/Stabbing

• Electrical

• Entanglement

• Falling

• High Pressure

• Hot Surfaces

• Isolation

• Maintenance

• Noise

• Pre-start Checks

• Striking

• Signage

• Safe Work Procedures

RISK MATRIX

• HSW RISK MATRIX

JOB SAFETY ANALYSIS

• Job Safety Analysis

  Yes

  No

  N/A

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Weather Conditions are suitable for work

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Barricades and Signage are Available and in Place

  Yes

  No

  N/A

• Work Complies with NSW overhead power line Code of practice

  Yes

  No

• Follow NSW overhead power line Code of Practice

• PPE has been checked and is Appropriate

  Yes

  No

• Lifting Gantry Crane

  Yes

  No

• Please Refer SOP or JSEA from Crane Provider

  Yes

  No

• Please Fill JSEA

  Yes

  No

• Job Details

• Location of Work

• JSEA Developed by

  Sign

• Date

  Date

• Personnel Involved in Activity

  Yes

  No

  N/A

• Name of Relevant Worker

• Qualification / Licenses / Ticket Held

• Signature

  Sign

• Personnel Involved in Activity

  Yes

  No

  N/A

• Name of Relevant Worker

• Qualification / Licenses / Ticket Held

• Signature

  Sign

• Common Hazards

  Yes

  No

• Work Environment/Site Layout

• Working from Height

• Ground Surface

• Stability

• Security

• Vibration

• Confined Spaces

• Site Access/Egress

• Underground Hazards

• Lighting

• Mobil Plant/Pedestrians

• House Keeping

• Asbestos

• Thermal Comfort

• Slips & Trips

• Overhead Hazards

• Site induction

• Chemical

• Biological

• Fire/Flammability

• Corrosive

• Compatibility

• Labelling

• MSDS Available

• Absorption

• Inhalation/Ingestion

• Signage

• Spill Control

• Storage

• PPE Available

• Manual Handling

• Repetitive Actions

• Cold/Hot

• Lifting/Carrying

• Bending/Reaching

• Excessive Distances

• Awkward Postures

• High Forces- Heavy Load

• Pushing/Pulling

• Restraining/Supporting

• Stability/Size of Load

• Plant

• Crushing

• Cutting/Stabbing

• Electrical

• Entanglement

• Falling

• High Pressure

• Hot Surfaces

• Isolation

• Maintenance

• Noise

• Pre-start Checks

• Striking

• Signage

• Safe Work Procedures

RISK MATRIX

• HSW RISK MATRIX

JOB SAFETY ANALYSIS

• Job Safety Analysis

  Yes

  No

  N/A

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Weather Conditions are suitable for work

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Barricades and Signage are Available and in Place

  Yes

  No

  N/A

• Work Complies with NSW overhead power line Code of practice

  Yes

  No

• Follow NSW overhead power line Code of Practice

• PPE has been checked and is Appropriate

  Yes

  No

• Stable Ground for Crane Setup

  Yes

  No

• Safe Work Load Tags Sighted and Certification made Available

  Yes

  No

  N/A

• Please See Manager

• Exclusion zone is sufficient to eliminate risk form falling objects

  Yes

  No

  N/A

• Suspend Permit, Please check with Permit Issuer/ Manager

• Crane operator holds license for the correct class or crane

  Yes

  No

  N/A

• Suspend Permit, Please check with Permit Issuer/ Manager

• Load will not Pass over workers in Internal Buildings or offices

  Yes

  No

  N/A

• Notify to Manager and Office Staff

• Operators have completed Cranes & Lifting Appliances training

  Yes

  No

• DO NOT OPERATE CRANE OR APPLIANCES

• Suspend Permit, Please check with Permit Issuer/ Manager

• Crane is Appropriate Size for the Loads and reaches of the Task

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Crane's Outrigger Legs Suitably Extended to Support the Crane

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• All External Doorway Access in Area is Roped off

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• All Personnel on site notified that the area is "NO-GO" Zone.

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Tag Lines are Available if required

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Mobile Lifting Crane

  Yes

  No

• Please Refer SOP or JSEA from Crane Provider

  Yes

  No

• Please Fill JSEA

  Yes

  No

• Job Details

• Location of Work

• JSEA Developed by

  Sign

• Date

  Date

• Personnel Involved in Activity

  Yes

  No

  N/A

• Name of Relevant Worker

• Qualification / Licenses / Ticket Held

• Signature

  Sign

• Personnel Involved in Activity

  Yes

  No

  N/A

• Name of Relevant Worker

• Qualification / Licenses / Ticket Held

• Signature

  Sign

• Common Hazards

  Yes

  No

• Work Environment/Site Layout

• Working from Height

• Ground Surface

• Stability

• Security

• Vibration

• Confined Spaces

• Site Access/Egress

• Underground Hazards

• Lighting

• Mobil Plant/Pedestrians

• House Keeping

• Asbestos

• Thermal Comfort

• Slips & Trips

• Overhead Hazards

• Site induction

• Chemical

• Biological

• Fire/Flammability

• Corrosive

• Compatibility

• Labelling

• MSDS Available

• Absorption

• Inhalation/Ingestion

• Signage

• Spill Control

• Storage

• PPE Available

• Manual Handling

• Repetitive Actions

• Cold/Hot

• Lifting/Carrying

• Bending/Reaching

• Excessive Distances

• Awkward Postures

• High Forces- Heavy Load

• Pushing/Pulling

• Restraining/Supporting

• Stability/Size of Load

• Plant

• Crushing

• Cutting/Stabbing

• Electrical

• Entanglement

• Falling

• High Pressure

• Hot Surfaces

• Isolation

• Maintenance

• Noise

• Pre-start Checks

• Striking

• Signage

• Safe Work Procedures

RISK MATRIX

• HSW RISK MATRIX

JOB SAFETY ANALYSIS

• Job Safety Analysis

  Yes

  No

  N/A

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Weather Conditions are suitable for work

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Barricades and Signage are Available and in Place

  Yes

  No

  N/A

• Work Complies with NSW overhead power line Code of practice

  Yes

  No

• Follow NSW overhead power line Code of Practice

• PPE has been checked and is Appropriate

  Yes

  No

• Stable Ground for Crane Setup

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Safe Work Load Tags Sighted and Certification made Available

  Yes

  No

  N/A

• Suspend Permit, Please check with Permit Issuer/ Manager

• Exclusion zone is sufficient to eliminate risk form falling objects

  Yes

  No

  N/A

• Suspend Permit, Please check with Permit Issuer/ Manager

• Crane operator holds license for the correct class or crane

  Yes

  No

  N/A

• DO NOT OPERATE CRANE

• Load will not Pass over workers in Internal Buildings or offices

  Yes

  No

  N/A

• Notify to Manager and Office Staff

• Operators have completed Cranes & Lifting Appliances training

  Yes

  No

• DO NOT OPERATE CRANE OR APPLIANCES

• Suspend Permit, Please check with Permit Issuer/ Manager

• Crane is Appropriate Size for the Loads and reaches of the Task

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Crane's Outrigger Legs Suitably Extended to Support the Crane

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• All External Doorway Access in Area is Roped off

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• All Personnel on site notified that the area is "NO-GO" Zone.

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Tag Lines are Available if required

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Long JIB

  Yes

  No

• Please Refer SOP or JSEA from Crane Provider

  Yes

  No

• Please Fill JSEA

  Yes

  No

• Job Details

• Location of Work

• JSEA Developed by

  Sign

• Date

  Date

• Personnel Involved in Activity

  Yes

  No

  N/A

• Name of Relevant Worker

• Qualification / Licenses / Ticket Held

• Signature

  Sign

• Personnel Involved in Activity

  Yes

  No

  N/A

• Name of Relevant Worker

• Qualification / Licenses / Ticket Held

• Signature

  Sign

• Common Hazards

  Yes

  No

• Work Environment/Site Layout

• Working from Height

• Ground Surface

• Stability

• Security

• Vibration

• Confined Spaces

• Site Access/Egress

• Underground Hazards

• Lighting

• Mobil Plant/Pedestrians

• House Keeping

• Asbestos

• Thermal Comfort

• Slips & Trips

• Overhead Hazards

• Site induction

• Chemical

• Biological

• Fire/Flammability

• Corrosive

• Compatibility

• Labelling

• MSDS Available

• Absorption

• Inhalation/Ingestion

• Signage

• Spill Control

• Storage

• PPE Available

• Manual Handling

• Repetitive Actions

• Cold/Hot

• Lifting/Carrying

• Bending/Reaching

• Excessive Distances

• Awkward Postures

• High Forces- Heavy Load

• Pushing/Pulling

• Restraining/Supporting

• Stability/Size of Load

• Plant

• Crushing

• Cutting/Stabbing

• Electrical

• Entanglement

• Falling

• High Pressure

• Hot Surfaces

• Isolation

• Maintenance

• Noise

• Pre-start Checks

• Striking

• Signage

• Safe Work Procedures

RISK MATRIX

• HSW RISK MATRIX

JOB SAFETY ANALYSIS

• Job Safety Analysis

  Yes

  No

  N/A

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Weather Conditions are suitable for work

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Barricades and Signage are Available and in Place

  Yes

  No

  N/A

• Work Complies with NSW overhead power line Code of practice

  Yes

  No

• Follow NSW overhead power line Code of Practice

• PPE has been checked and is Appropriate

  Yes

  No

• Stable Ground for Crane Setup

  Yes

  No

• Safe Work Load Tags Sighted and Certification made Available

  Yes

  No

  N/A

• Please See Manager

• Exclusion zone is sufficient to eliminate risk form falling objects

  Yes

  No

  N/A

• Suspend Permit, Please check with Permit Issuer/ Manager

• Crane operator holds license for the correct class or crane

  Yes

  No

  N/A

• DO NOT OPERATE CRANE

• Load will not Pass over workers in Internal Buildings or offices

  Yes

  No

  N/A

• Notify to Manager and Office Staff

• Operators have completed Cranes & Lifting Appliances training

  Yes

  No

• DO NOT OPERATE CRANE OR APPLIANCES

• Suspend Permit, Please check with Permit Issuer/ Manager

• Crane is Appropriate Size for the Loads and reaches of the Task

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Crane's Outrigger Legs Suitably Extended to Support the Crane

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• All External Doorway Access in Area is Roped off

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• All Personnel on site notified that the area is "NO-GO" Zone.

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Tag Lines are Available if required

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Small Lifting Crane

  Yes

  No

• Please Refer SOP or JSEA from Crane Provider

  Yes

  No

• Please Fill JSEA

  Yes

  No

• Job Details

• Location of Work

• JSEA Developed by

  Sign

• Date

  Date

• Personnel Involved in Activity

  Yes

  No

  N/A

• Name of Relevant Worker

• Qualification / Licenses / Ticket Held

• Signature

  Sign

• Personnel Involved in Activity

  Yes

  No

  N/A

• Name of Relevant Worker

• Qualification / Licenses / Ticket Held

• Signature

  Sign

• Common Hazards

  Yes

  No

• Work Environment/Site Layout

• Working from Height

• Ground Surface

• Stability

• Security

• Vibration

• Confined Spaces

• Site Access/Egress

• Underground Hazards

• Lighting

• Mobil Plant/Pedestrians

• House Keeping

• Asbestos

• Thermal Comfort

• Slips & Trips

• Overhead Hazards

• Site induction

• Chemical

• Biological

• Fire/Flammability

• Corrosive

• Compatibility

• Labelling

• MSDS Available

• Absorption

• Inhalation/Ingestion

• Signage

• Spill Control

• Storage

• PPE Available

• Manual Handling

• Repetitive Actions

• Cold/Hot

• Lifting/Carrying

• Bending/Reaching

• Excessive Distances

• Awkward Postures

• High Forces- Heavy Load

• Pushing/Pulling

• Restraining/Supporting

• Stability/Size of Load

• Plant

• Crushing

• Cutting/Stabbing

• Electrical

• Entanglement

• Falling

• High Pressure

• Hot Surfaces

• Isolation

• Maintenance

• Noise

• Pre-start Checks

• Striking

• Signage

• Safe Work Procedures

RISK MATRIX

• HSW RISK MATRIX

JOB SAFETY ANALYSIS

• Job Safety Analysis

  Yes

  No

  N/A

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Weather Conditions are suitable for work

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Barricades and Signage are Available and in Place

  Yes

  No

  N/A

• Work Complies with NSW overhead power line Code of practice

  Yes

  No

• Follow NSW overhead power line Code of Practice

• PPE has been checked and is Appropriate

  Yes

  No

• Stable Ground for Crane Setup

  Yes

  No

• Safe Work Load Tags Sighted and Certification made Available

  Yes

  No

  N/A

• Please See Manager

• Exclusion zone is sufficient to eliminate risk form falling objects

  Yes

  No

  N/A

• Suspend Permit, Please check with Permit Issuer/ Manager

• Crane operator holds license for the correct class or crane

  Yes

  No

  N/A

• DO NOT OPERATE CRANE

• Load will not Pass over workers in Internal Buildings or offices

  Yes

  No

  N/A

• Notify to Manager and Office Staff

• Operators have completed Cranes & Lifting Appliances training

  Yes

  No

• DO NOT OPERATE CRANE OR APPLIANCES

• Crane is Appropriate Size for the Loads and reaches of the Task

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Crane's Outrigger Legs Suitably Extended to Support the Crane

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• All External Doorway Access in Area is Roped off

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• All Personnel on site notified that the area is "NO-GO" Zone.

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Tag Lines are Available if required

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Lifting JIB

  Yes

  No

• Please Refer SOP or JSEA from Crane Provider

  Yes

  No

• Please Fill JSEA

  Yes

  No

• Job Details

• Location of Work

• JSEA Developed by

  Sign

• Date

  Date

• Personnel Involved in Activity

  Yes

  No

  N/A

• Name of Relevant Worker

• Qualification / Licenses / Ticket Held

• Signature

  Sign

• Personnel Involved in Activity

  Yes

  No

  N/A

• Name of Relevant Worker

• Qualification / Licenses / Ticket Held

• Signature

  Sign

• Common Hazards

  Yes

  No

• Work Environment/Site Layout

• Working from Height

• Ground Surface

• Stability

• Security

• Vibration

• Confined Spaces

• Site Access/Egress

• Underground Hazards

• Lighting

• Mobil Plant/Pedestrians

• House Keeping

• Asbestos

• Thermal Comfort

• Slips & Trips

• Overhead Hazards

• Site induction

• Chemical

• Biological

• Fire/Flammability

• Corrosive

• Compatibility

• Labelling

• MSDS Available

• Absorption

• Inhalation/Ingestion

• Signage

• Spill Control

• Storage

• PPE Available

• Manual Handling

• Repetitive Actions

• Cold/Hot

• Lifting/Carrying

• Bending/Reaching

• Excessive Distances

• Awkward Postures

• High Forces- Heavy Load

• Pushing/Pulling

• Restraining/Supporting

• Stability/Size of Load

• Plant

• Crushing

• Cutting/Stabbing

• Electrical

• Entanglement

• Falling

• High Pressure

• Hot Surfaces

• Isolation

• Maintenance

• Noise

• Pre-start Checks

• Striking

• Signage

• Safe Work Procedures

RISK MATRIX

• HSW RISK MATRIX

JOB SAFETY ANALYSIS

• Job Safety Analysis

  Yes

  No

  N/A

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Weather Conditions are suitable for work

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Barricades and Signage are Available and in Place

  Yes

  No

  N/A

• Work Complies with NSW overhead power line Code of practice

  Yes

  No

• Follow NSW overhead power line Code of Practice

• PPE has been checked and is Appropriate

  Yes

  No

• Stable Ground for Crane Setup

  Yes

  No

• Safe Work Load Tags Sighted and Certification made Available

  Yes

  No

  N/A

• Please See Manager

• Exclusion zone is sufficient to eliminate risk form falling objects

  Yes

  No

  N/A

• Suspend Permit, Please check with Permit Issuer/ Manager

• Crane operator holds license for the correct class or crane

  Yes

  No

  N/A

• DO NOT OPERATE CRANE

• Load will not Pass over workers in Internal Buildings or offices

  Yes

  No

  N/A

• Notify to Manager and Office Staff

• Operators have completed Cranes & Lifting Appliances training

  Yes

  No

• DO NOT OPERATE CRANE OR APPLIANCES

• Crane is Appropriate Size for the Loads and reaches of the Task

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Crane's Outrigger Legs Suitably Extended to Support the Crane

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• All External Doorway Access in Area is Roped off

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• All Personnel on site notified that the area is "NO-GO" Zone.

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Tag Lines are Available if required

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Dogmen/ Rigger

  Yes

  No

• Please Refer SOP or JSEA from Crane Provider

  Yes

  No

• Please Fill JSEA

  Yes

  No

• Job Details

• Location of Work

• JSEA Developed by

  Sign

• Date

  Date

• Personnel Involved in Activity

  Yes

  No

  N/A

• Name of Relevant Worker

• Qualification / Licenses / Ticket Held

• Signature

  Sign

• Personnel Involved in Activity

  Yes

  No

  N/A

• Name of Relevant Worker

• Qualification / Licenses / Ticket Held

• Signature

  Sign

• Common Hazards

  Yes

  No

• Work Environment/Site Layout

• Working from Height

• Ground Surface

• Stability

• Security

• Vibration

• Confined Spaces

• Site Access/Egress

• Underground Hazards

• Lighting

• Mobil Plant/Pedestrians

• House Keeping

• Asbestos

• Thermal Comfort

• Slips & Trips

• Overhead Hazards

• Site induction

• Chemical

• Biological

• Fire/Flammability

• Corrosive

• Compatibility

• Labelling

• MSDS Available

• Absorption

• Inhalation/Ingestion

• Signage

• Spill Control

• Storage

• PPE Available

• Manual Handling

• Repetitive Actions

• Cold/Hot

• Lifting/Carrying

• Bending/Reaching

• Excessive Distances

• Awkward Postures

• High Forces- Heavy Load

• Pushing/Pulling

• Restraining/Supporting

• Stability/Size of Load

• Plant

• Crushing

• Cutting/Stabbing

• Electrical

• Entanglement

• Falling

• High Pressure

• Hot Surfaces

• Isolation

• Maintenance

• Noise

• Pre-start Checks

• Striking

• Signage

• Safe Work Procedures

RISK MATRIX

• HSW RISK MATRIX

JOB SAFETY ANALYSIS

• Job Safety Analysis

  Yes

  No

  N/A

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Task

• Hazards

• Potential Risk Score

• Risk Control Measures

• Residual Risk Score

• Responsible Person

  Sign

• Weather Conditions are suitable for work

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Barricades and Signage are Available and in Place

  Yes

  No

  N/A

• Work Complies with NSW overhead power line Code of practice

  Yes

  No

• Follow NSW overhead power line Code of Practice

• PPE has been checked and is Appropriate

  Yes

  No

• Stable Ground for Crane Setup

  Yes

  No

• Safe Work Load Tags Sighted and Certification made Available

  Yes

  No

  N/A

• Please See Manager

• Exclusion zone is sufficient to eliminate risk form falling objects

  Yes

  No

  N/A

• Suspend Permit, Please check with Permit Issuer/ Manager

• Crane operator holds license for the correct class or crane

  Yes

  No

  N/A

• DO NOT OPERATE CRANE

• Load will not Pass over workers in Internal Buildings or offices

  Yes

  No

  N/A

• Notify to Manager and Office Staff

• Operators have completed Cranes & Lifting Appliances training

  Yes

  No

• DO NOT OPERATE CRANE OR APPLIANCES

• Crane is Appropriate Size for the Loads and reaches of the Task

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Crane's Outrigger Legs Suitably Extended to Support the Crane

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• All External Doorway Access in Area is Roped off

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• All Personnel on site notified that the area is "NO-GO" Zone.

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Tag Lines are Available if required

  Yes

  No

• Suspend Permit, Please check with Permit Issuer/ Manager

• Dogmen/ rigger Qualifications Documentation/ license

  Yes

  No

• DO NOT OPERATE DOGMEN/RIGGER

• Suspend Permit, Please check with Permit Issuer/ Manager

• Isolation Required

  Yes

  No

• Electrical

• Employee Name

• Plant/Equipment Name

• Time Locks were attached

  Date

• Time Locks were removed

  Date

• Signature

  Sign

• Pneumatic

• Employee Name

• Plant/Equipment Name

• Time Locks were attached

  Date

• Time Locks were removed

  Date

• Signature

  Sign

• Hydraulic

• Employee Name

• Plant/Equipment Name

• Time Locks were attached

  Date

• Time Locks were removed

  Date

• Signature

  Sign

• Stored Energy (Compressed Spring, Compressed Air, Hydraulic Pressure, Fluid Pressure)

• Employee Name

• Plant/Equipment Name

• Time Locks were attached

  Date

• Time Locks were removed

  Date

• Signature

  Sign

• Fluid (Chemical, CIP, Product, Hot Water, Cold Water)

• Employee Name

• Plant/Equipment Name

• Time Locks were attached

  Date

• Time Locks were removed

  Date

• Signature

  Sign

• Isolation Required

  Yes

  No

  N/A

• Employee Name

• Plant/Equipment Name

• Time Locks were attached

  Date

• Time Locks were removed

  Date

• Signature

  Sign

• Isolation Required

  Yes

  No

  N/A

• Employee Name

• Plant/Equipment Name

• Time Locks were attached

  Date

• Time Locks were removed

  Date

• Signature

  Sign

• Isolation Required

  Yes

  No

  N/A

• Employee Name

• Plant/Equipment Name

• Time Locks were attached

  Date

• Time Locks were removed

  Date

• Signature

  Sign

• Isolation Required

  Yes

  No

  N/A

• Employee Name

• Plant/Equipment Name

• Time Locks were attached

  Date

• Time Locks were removed

  Date

• Signature

  Sign

• I have reviewed the hazards and control measures documented in the relevant JSEA/SOP for this task. I believe that the work can be completed safely provided all the above-mentioned precautions and the relevant JSEA/SOP are complied with

• Permit Issuer

  Sign

• Permit User

  Sign

• Permit User

  Sign

• Safety Observer

  Yes

  No

  N/A

• Name and Signature

  Sign

• The permit has been suspended due to work not being completed. The following precautions have been completed in the work area

• Area access restricted

• Isolation retested

• Equipment Secured

• Signage in place

• Area Manager notified

• This Permit has been revalidated to allow suspended work to be recommenced. The following precautions have been completed

• Area Inspected

• Environmental conditions safe

• Pre-start checks completed

• Area Manager notified

• Permit Issuer

  Sign

• Permit User

  Sign

• I have inspected the work area and certify that all personnel, tools and equipment have been removed from the area, all guards and covers have been replaced, all LOTO devices have been removed and all barriers and notices removed. I confirm that the area is safe for normal operations to resumes.

• Permit Issuer

  Sign