Information
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Document No.
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Task Description
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Job Number
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Site Address
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Conducted on
Assess the risk
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Is the activity a High Risk Construction Work task?
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A JSEA is required.
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Have you used the risk matrix to measure the level of risk of the task BEFORE putting any controls in place? Is the risk level high or extreme?
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A JSEA is required.
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Do you need to obtain a Permit for the task?
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A JSEA is required.
Identify the hazards
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(e) = also an environmental hazard/control
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Air Tools
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Risk
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Chemical/herbicide exposure (e)
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Risk
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Clearing of vegetation (e)
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Risk
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Contaminated Wastewater (e)
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Risk
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Driving
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Risk
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Engulfment/flooding (e)
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Risk
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Excavation under 1.5m (if deeper, JSEA must be used) (e)
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Risk
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Fatigue
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Risk
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Falls from heights under 2m (if higher, JSEA must be used )
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Risk
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Fuel/Oil/Chemical spill (e)
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Risk
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Fumes (e)
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Risk
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Harm to wildlife (e)
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Risk
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Hazardous manual tasks (please identify tasks)
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Risk
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Insects/aggressive animals
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Risk
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Lifting
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Risk
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Night work/poor lighting
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Risk
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Noise/odour/dust (e)
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Risk
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Overhead objects
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Risk
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Pinch/crush points
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Risk
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Power Tools
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Risk
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Public/customers/contractors
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Risk
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Service under pressure (if gas, JSEA must be used )
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Risk
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Severe weather (heat/rain)
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Risk
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Sharps/needles/cutting
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Risk
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Slip/trip obstacles
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Risk
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Waste disposal (e)
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Risk
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Wastewater contact/sewage discharge (e)
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Risk
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Water discharge/dewatering/soil erosion (e)
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Risk
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Working alone
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Risk
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Other
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Risk
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Other
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Risk
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Other
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Risk
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Other
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Risk
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Other
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Risk
Choose your controls
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Choose all appropriate controls for all identified hazards.
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Adequate breaks during tasks
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Air monitoring equipment
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Appropriate waste disposal (e)
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Barricading
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Bridging cables, rubber gloves
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Cable locator
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Communications
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Contact Supervisor or Environmental Advisor (e)
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Dewatering, divert water flow (e)
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Dial Before You Dig
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Dust/Face mask/SCBA (e)
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Edge protection
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Exclusion zone
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Eye protection
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First Aid kit and water
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Fuel, chemical spill kit (e)
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Gloves
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Hard hat
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Harness
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Heat Stress Assessment
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Hearing protection
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Identify slip/trip hazards, inform others
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Induction (Employee and Contractor) (e)
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Inform Western/Horizon Power
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Inspect for underground services
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Isolation, tagging, lock-out
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Job rotations
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Keep area tidy and remove trip hazards
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Lighting
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Lone worker - log on/off
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Machine guarding fitting
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Material Safety Data Sheet (MSDS) (e)
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Mechanical assistance
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Mechanical lifting aids
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Overalls (e)
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Personal Protective Equipment - standard issue
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Portable safety switch/RCD
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Relevant driver training (as required)
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Rescue/evacuation planned
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Safe hygiene practices
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Safe means of access/egress
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Safety grate and barriers
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Sand bags/Silt control/Blue Metal (e)
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Shoring/Benching
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Spotter
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Sunscreen/Insect repellent
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Tagged and inspected
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Team lifting
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Traffic management plan/signs/cones
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Vehicle checks
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Ventilation/Extraction/Purging
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Work day not exceeding 12 hours
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10 hour break before work day
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4Ps: Plan, pothole/prodder, protect, proceed
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Other
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Other
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Other
Team Sign On
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I have read the contents of and agree to work in accordance with this Step Back.
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Team Member
Person
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Name
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Role
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Signature
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Contractor Induction Card #
Responsible person/Supervisor/Line Manager Review
- Reviewer Details
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Reviewed by
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Date
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Signature
