JSA

Where an unsafe work practice is observed and a SWMS is not required a JSA must be completed by the worker.
The Hierarchy of Control is a list of control measures, in priority order, that can be used to eliminate or minimise exposure to the hazard.

Reference - WHS Regulations Clause 36
https://www.legislation.nsw.gov.au/#/view/regulation/2011/674/chap3/part3.1/sec36

What are the work tasks?

What are the hazards/risk associated with the tasks?

Considering the Hierarchy of Control, what control measures will be implemented?

Who will be responsible to implement & monitor the control measures?

Signature of person responsible for implementing and monitoring the control measures.
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.