WHS_001F_JobSafetyAnalysis_VersionB

JOB SAFETY ANALYSIS (JSA)

WHS_001F
Your Email*
So you receive a copy
CLIENT*
JSA COMPLETED BY*
LOCATION*
This is physical location - 6 Cord Street, Dudley Park
DATE*

DayMonthYear
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
AsbestosBeing struck by moving plantDrowningElectrocutionEnergy - Water, steam, electricityExposure to noise, heat, cold, vibrationFire or explosionHazardous substance(s)Layout and condition of the siteManual handlingObjects or structure fallingPlant or equipmentSlips, trips or fallsSystems of workThe physical working environmentViolence from the publicWorking at heightWorking in a confined spaceOther
RISK MATRIX
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
REQUIRED PPE
Steel cap boots (compulsory for all sites)Hi-Vis vest (compulsory for all sites)Sun protection for temperatures over 30 degrees celcius (compulsory for all sites)Safety glasses (compulsory for all sites)GlovesHard hatFace maskEar muffsRespiratorHarnessFace shield
HIERARCHY OF CONTROL
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
Yes - list more hazards to this stepNo - Start a New job stepsNo - Sign and Submit
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?
WORKERS INVOLVED IN JOB TASK
Name*
Company*
Signature*
Date*

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Signature
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Signature
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DayMonthYear
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Company
Signature
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DayMonthYear
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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