WHS_001F_JobSafetyAnalysis_VersionB

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CLIENT

JSA COMPLETED BY

LOCATION

This is physical location - 6 Cord Street, Dudley Park

DATE

Date

Time

Hour Minutes

AM/PM Option

WORK ACTIVITY /TASK DESCRIPTION

ARE THERE ANY OF THE FOLLOWING HAZARDS?

Any hazards ticked must be addressed below

Type a question

Probability (Likelihood it will happen)
Rare – Highly unlikely, minimal impact
Unlikely – Possible but uncommon
Possible – May occur occasionally
Likely – Expected to happen regularly
Almost Certain – Will happen frequently

Severity (Impact)
Low – No significant harm
Minor – Mild injury or damage
Moderate – Medical attention needed
Severe – Serious harm or disability
Major – Fatality or extreme loss

Type a question

Level 4 | Engineering

Level 5 | Administration

Level 6 | PPE

Level 4 | Engineering

Level 5 | Administration

Level 6 | PPE

Job Steps 1

In order of Activity

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating (Prior to Controls)

From Risk Matrix above, i.e. M9

Control Measures

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

If you have more Potential Hazards to add to the Job Step, please repeat the Job Step to continue adding Control Measures.

Job Steps 2

In order of Activity

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

If you have more Potential Hazards to add to the Job Step, please repeat the Job Step to continue adding Control Measures.

Job Steps 3

In order of Activity

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

If you have more Potential Hazards to add to the Job Step, please repeat the Job Step to continue adding Control Measures.

Job Steps 4

In order of Activity

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

If you have more Potential Hazards to add to the Job Step, please repeat the Job Step to continue adding Control Measures.

Job Steps 5

In order of Activity

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

If you have more Potential Hazards to add to the Job Step, please repeat the Job Step to continue adding Control Measures.

Job Steps 6

In order of Activity

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

Are there additional hazards for the same job step?

Potential Hazard

List 1 hazard at a time

Risk Matrix Rating

From Risk Matrix above, i.e. M9

Control Measures

Address all hazards selected above i.e. drowning

Residual Risk Matrix Rating

From Risk Matrix above, i.e. now M6 with controls

Team Member Responsible

Who is responsible for these controls?

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JOB SAFETY ANALYSIS (JSA)

ARE THERE ANY OF THE FOLLOWING HAZARDS?

RISK MATRIX

REQUIRED PPE

HIERARCHY OF CONTROL

WORKERS INVOLVED IN JOB TASK