SavCon 2016 Ltd Job START Form

• Document No.

• Job Reference

• Job Description

• Date

  Date

• Prepared by

• Location
  Address

• Personnel

• Emergency Plan

• Nominated First Aider and First Aid kit onsite. Location of First Aid Kit

• Documents on site. JA/ SWMS, MSDS sheets and other related documents onsite Documents Location

• Are all personnel inducted to site (BRS and Principle)

• Has all staff signed off on/onto SWMS/JSA and appropriate signage/isolation/barricading controls been implemented to work area?

• Traffic management plan required

• Traffic Management Diagram no.

Instruction 2 - Determine what Plant and Equipment is likely to be used

• List Plant and Equipment

  Select Truck Digger Drill Tool Wagon Hydro-Vac Ladder/ Harness Small Plant (Cutter/ Wacker/ Compactor Jinker Trailer Roller

  • Truck
  • Digger
  • Drill
  • Tool Wagon
  • Hydro-Vac
  • Ladder/ Harness
  • Small Plant (Cutter/ Wacker/ Compactor
  • Jinker Trailer
  • Roller

• Close approach Consent Required

• Confirm working outside of MAD

• Safety Observer required

Instruction 3 – State and Review the Job Analysis or SWMS/s that are required for this task

• Name of JA/SWMS

  Select 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

  • 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

• Hazards Identified by JA/ SWMS.

• Place a tick if the hazards are identified in the Job Analysis or SWMS selected in instruction 3.

  Select 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

  • 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

• Personal Hazards

  Select Hit by moving objects Caught in / between Strain / repetitive Dropped objects Strike against Inhalation Burns Exposure to gas / heat / fumes Exposure to dust / chemicals

  • Hit by moving objects
  • Caught in / between
  • Strain / repetitive
  • Dropped objects
  • Strike against
  • Inhalation
  • Burns
  • Exposure to gas / heat / fumes
  • Exposure to dust / chemicals

• Also Consider

  Select 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

  • 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

• Hazard

• Initial Risk

  Safe

  At Risk

  N/A

• Controls

• Residual Risk

  Safe

  At Risk

  N/A

Instruction 5 – Determine what PPE is likely to be used

• What PPE is likely to be used? Tick Box if used

  Select 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

  • 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

• 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.

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign