Information
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Audit Title
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Document Number
JSA
Address
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Address
If working alone, monitoring control to be:
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Working Alone Controls
SWMS Applicable
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Select the SWMS Relevant to the task
- SWMS/001 Electrical Shock
- SWMS/002 NST Testing
- SWMS/003 HVI
- SWMS/004 Prescribed Insp
- SWMS/005 Working at Heights
- SWMS/006 Working on or Near LIVE Elect Equip
COES Sighted
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Has a COES been made available and sighted? (If Applicable)
General Hazard(s) Identified (Tick if applicable)
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Working with live equipment
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Trips, slips & falls
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Restricted (site) access
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Inclement weather
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Hard hat site or area
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Other 1 - General Hazards Identified (Tick is applicable)
- Lighting
- Traffic Hazard Assessment
- Public Area Clearances
- Confined Spaces
- Dangerous/Hazardous Materials
- Limits of Approach
- Manual Handling
- Non Restrained Animals
- Sharp Objects
- Falls From Holes
- Not Safe with Single Man
- Customer acting in threatening or dangerous manor
- Unsafe worksite or area
- Parking Congestion
General Hazard Control Measures
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Visual inspection
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Clear access obtained
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Full PPE in serviceable condition - Reflective Vest + LV Gloves + Eye Protection
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Safety helmet
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Other 1 - General Hazard Control Measures
- Spotlight or Torch
- Traffic Management - Signs, Cones
- Signs/Labels/Tags/Barriers
- Safety Harness or Belt
- Ladder and/or LV Sticks
- Housekeeping
- Fire Extinguisher
- Suringe Disposal Container
- Hearing Protection
- First Aid Kit
Environmental Hazard(s) Identified (tick if applicable)
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Are there Any Environmental Hazards Identified?
Environmental Hazard(s) Identified (tick if applicable)
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Asbestos
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Weeds, erosion, etc.
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Vehicle use - grass fires, emissions
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Oil and fluid spills
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Flora, water and minerals
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RF antenna
Environmental Hazard Control Measures
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Asbestos - isolate and report
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Wash car, take alternate route
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Maintain clearance
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Location of fire prevention equipment
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Site evacuation plan and emergency process
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Hazardous substance procedure
Live Works Hazard(s) Identified (tick if applicable)
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Working with and in the vicinity of live electrical apparatus
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Electrocution
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Damaged assets
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Reverse polarity
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Back feed
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Alternate generator supply
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Metal meter box
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Surge Arrestors (identified during Faults and HVI's)
Live Works Hazard Control Measures
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Isolate supply
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Appropriate clearance
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Full PPE in serviceable condition - Reflective Vest + LV Gloves + Eye Protection
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Insulated tools
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Visual inspection
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Surge Arrestors - Isolate and make safe prior to energisation
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Other - Live Works Hazard Control Measures
- LV Mats
- Tags, Labels and Barriers
- Control Physical Movements
Additional Hazard(s) identified
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Are there Additional Hazards to be Identified?
Additional Hazard (s) Identified
Additional Hazard Control Measures
Working From Heights
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Is Working at Heights involved with the Job?
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Fall from heights greater than 2 meters or over 2 meters near edge
Working from Heights Hazard Controls (Hierarchy)
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1st - Complete Task on Ground
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2nd - EWP or Guarding/Scaffold
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3rd - Restraint System
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4th - Lanyard/Harness/Belt
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5th - Ladder
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6th - Observer / Temporary Barrier (eg. Signs, witches hats, barricade tape)
Additional Comments / Notes
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Comments
Mandatory Section - Signature Required
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The risk assessment has been completed in accordance with the appropriate Safe Work Method Statement (SWMS), and all mandatory tests have been performed in accordance with TSA procedures
By signing this form you acknowledge that you understand the Work Instructions and are authorised to carry out this work -
Signature
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Signature
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Signature
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Signature
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Signature
