Job Safety Analysis (JSA)

Sample Co Ltd
Part 1: Project and Task Identification
Process Initiators of JSAs are responsible for consulting the Project Supervisor, Quality WHS Manager or other persons directly in charge of the work and other personnel involved in the execution of the task (as
appropriate) for input into the JSA. Other persons may be consulted for technical advice or review of the JSA to see that proposed measures are effective and workable. The task is to be broken up into steps. For
each step, the safety hazards are identified. For each of the hazards identified, corrective action, precautions, equipment are identified to reduce the hazard. All involved in the task must review and sign this JSA
form.

Client: TotalTrack Pty Ltd

Site: The Sample University, 99 Example Way Adelaide SA 5000 Job ID: A100
Contact Name Job Title Phone Mobile FAX Email
Scott LeBlanc Director 08 8351 1540 0408 831 550 08 8261 9977 [email protected]

JSA Initiated By
Date: JSA No. 2
Ben Workin

Work Locations/Areas:
Supervisor Review
Date: All
(Responsible for monitoring Ben Watchin
JSA compliance)

Management Review Date:

Sample Guy

Description of Work External Window Cleaning to 2 story building

to be Undertaken:

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 High Risk Construction Work covered in this SWMS
Risk of a person falling more than 2 metres Work on a telecommunication tower Demolition of load-bearing structure
Likely to involve disturbing asbestos Temporary load-bearing suport for structural alterations Work in or near a confined space
or repairs
Work in or near a shaft or trench deeper than Use of Explosives Work on or near pressurised gas mains or piping
1.5 m or a tunnel
Work on or near chemical, fuel or refrigerant Work on, in or adjacent to a road, railway, shipping lane or Work in any area that may have a contaminated or
lines other traffic corridor in use by traffic other than pedestrians flammable atmosphere
Tilt-up precast concrete elements Work on or near energised electrical installations or services Work in a area with movement of powered mobile plant
Work in areas with artificial extremes of Work in or near water or other liquid that involves a risk of Diving work
temperature drowning

Work Permits Not Required Hot Work Confined space Isolation Excavation Coring
Work permits for this activity: Demolition Work at Heights Plant Setup Road Closure Other:

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 First, identify and assess the risks, then decide the best way to control them by applying the Hierarchy of Control as follows:

LEVEL CONTROL DEFINITION

Level 1 Elimination Controlling the Hazard at source
Level 2 Substitution Replacing one substance or Activity with a less hazardous one
Isolation Separating the hazard from the person
Engineering Installing Guards on machinery
Level 3 Administration Implementing policies and procedures for safe work practices
Personal Protective Equipment Use of safety glasses, hardhats, protective clothing, etc.

Hierarchy of Controls

Effectiveness
Eliminate the hazard

Substitute the hazard

Isolate the hazard

Use engineering controls

Use administrative
controls

Use PPE

Part 2: Hazard Analysis, Control Worksheet Sample Co Ltd

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JSEAsy JSA - External Window Cleaning to 2 story building
 Part 2: Hazard Analysis, Control Worksheet Sample Co Ltd

Job Safety Analysis (JSA)

Process Steps Potential Hazard(s) / Risk Hazard Control Measures
Step List the steps needed to do the job Against each step list potential hazards that For each hazard, identify control measures
No. in the sequence to be done. could cause injury when the job is done. to eliminate or minimise the risk of injury.

1 Site Orientation/ Induction

1.1 Report to client’s reception Entering restricted areas Follow posted signs and go directly to reception

1.2 Undertake a site induction Unfamiliarity with emergency procedures Listen and ensure you obtain information and site emergency and
evacuation procedures
Unawareness of site specific hazards Listen and ensure you obtain information about any and all site hazards
Unawareness of restricted areas Listen and ensure you obtain information about any restricted areas
Unawareness of other operations or hazardous activities Listen and ensure you obtain information about any other activities being
being undertaken on site undertaken on site

2 Claim Work Area

2.1 Access the site Breaching minimum site PPE requirements HI visibility clothing must be worn at all times whilst on site
Steel toe safety boots must be worn at all times whilst on site
Safety glasses must either be worn or carried at all times whilst on site
Breaching site rules or requirements NO SMOKING on site-designated smoking area will be available and ALL
butts to be placed in bin
Progressive housekeeping clean as you go
2.2 Establish safe perimeter People entering work area Controlled by Site Manager
Ensure a 10m exclusion zone is set up
Bunt off the area to define work perimiter
Post signage

3 Working where there is movement of powered mobile plant

3.1 Enter the work area where powered Being hit or runover by powered mobile plant All team members must wear Hi-Visibility vests or clothing
mobile plant is or will be operating Ensure constant communication with all personnel in the immediate area
Never assume the plant operator has seen you or knows where you are
Establish eye contact with the operator
Communicate your intentions with the plant operator via radio or hand or
head signals and ensure an appropriate response
Crushing Never stand or traverse between the machine and a fixed structure at any
time
Never assume others have seen or are aware of any impeding obstacle
Tripping hazard Be aware of surroundings, risers and set downs

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 Job Safety Analysis (JSA)
Process Steps Potential Hazard(s) / Risk Hazard Control Measures
Step List the steps needed to do the job Against each step list potential hazards that For each hazard, identify control measures
No. in the sequence to be done. could cause injury when the job is done. to eliminate or minimise the risk of injury.

4 Safety Check And Use Of Boom Lift

4.1 Pre operation Check on Boom Lift – Faulty equipment machine failure Check for dents, cracks and faulty welds
visual checks need to be made for Check slew ring and basket
inclusion in logbook report and
maintained Check Outriggers or stabilisers, if fitted
Check all safety devices
Check all hydraulic rams and lines, controls for leaks
Pinch point injury Ensure hands are well clear
4.2 Board the Boom Lift Tripping or slipping off boom lift Board the Boom Lift through the correct access gate

4.3 Check for safe access and exit points Other trades obstructing the access and exit points Warning signs and traffic control if necessary
to enable positioning of the Boom Lift
EWP tipping over or sinking Check for firm ground support and be aware of Unstable ground surfaces i.e.
recently filled excavations and open trenches
4.4 Moving or driving the Boom Lift Loosing control of EWP Operator must be certified in accordance with national standards
Falling from Boom Lift Wear safety harnesses complying with AS1891.Ensure that the harness is
correctly fitted and attached to the anchor point.
Remain within the barriers of Boom lift
Mechanical failure whist at height/ elevated Keep in contact with personnel on the ground who can activate the manual
release and lower
Striking building and or persons Ensure the area of travel is clear of obstacles and personnel
Do not operate the machine if the hazard light is not working
Crushing Ensure no persons are standing or traversing between the machine and a
fixed structure at any time
Under no circumstance can you operate the controls from the ground and
walk with the boom lift
Tipping over Ensure gradient/slope within safe limits
Ground surfaces must be inspected to ensure sufficient compaction to
operate on, if in doubt seek advice from the Site Manager
The boom lift platform must be in the down position as low as practicable to
the ground before moving backward or forward on uneven ground
Never travel over penetrations covered over with ply, the ply wood may not
take the weight of the machine, or other non-trafficable or covers without an
adequate weight load rating
On slopes always travel facing directly up or down and do not attempt to turn
on a slope
4.5 Raising the boom lift Striking structure or overhead members Check for clear head room
Look before you move

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 Job Safety Analysis (JSA)
Process Steps Potential Hazard(s) / Risk Hazard Control Measures
Step List the steps needed to do the job Against each step list potential hazards that For each hazard, identify control measures
No. in the sequence to be done. could cause injury when the job is done. to eliminate or minimise the risk of injury.
Striking overhead Power Lines Maintain minimum distance for power lines as specified in AS2550
Crushing Work within confines of lifting platform
Ensure constant communication with all others in the machine
Never assume others have seen or are aware of any impeding obstacle
Before raising the scissor lift assess the area for overhead obstruction
4.6 Working at height from the boom lift Falling from Boom Lift Remain within the barriers of Boom lift
Wear safety harnesses complying with AS1891.Ensure that the harness is
correctly fitted and attached to the anchor point.
There is to be absolutely no standing on hand rails or mid rails to gain extra
height
Dropping materials Ensure EWP is directly under to act as catchment platform
If necessary, flag off exclusion zone below
Ensure constant communication with co-workers
Crushing Indicate clearly to partner before moving platform
Never assume others have seen or are aware of any impeding obstacle
Lower the boom lift before moving backward and forwards when working in
or around structural members, doorways or any other obstruction
4.7 Lower the boom lift Crushing Ensure persons and body parts are clear before lowering

5 Clean Windows with mop and squeegee

5.1 Wet mop in bucket of soapy water Chemical Burns Use only the correct strength of detergent
Read product SDS before use
Environmental - Inefficient resource use – wasting water Only fill bucket to the required amount

5.2 Apply soapy water to glass Muscle strain - musculoskeletal disorders Do not over reach
Slippping on floor Clean up all spills immediately
Dot not over wet the mop
5.3 Remove soap from glass with Muscle strain - musculoskeletal disorders Do not over reach
squeegee
6 Monitoring and Review of SWMS
6.1 Monitor the SWMS Ineffective SWMS Review the SWMS at a minimum of 3 monthly intervals
Monitor and complete an inspection of a minimum of 2 task observations
SWMS must be formally reviewed & updated whenever:
• a significant change to task or activity is identified
• an incident occurs relating to the task or activity

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 Job Safety Analysis (JSA)
Process Steps Potential Hazard(s) / Risk Hazard Control Measures
Step List the steps needed to do the job Against each step list potential hazards that For each hazard, identify control measures
No. in the sequence to be done. could cause injury when the job is done. to eliminate or minimise the risk of injury.
• a significant hazard is identified relating to the task or activity
SWMS Failure Stop Work
In conjunction with workers, review and formulate a new SWMS
Implement new controls
Conduct a toolbox meeting with all personnel involved with work activity

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 Sample Co Ltd
Part 3: Hazard Analysis, Control Worksheet - Site modifications, additions or alterations

Job Safety Analysis (JSA)

Process Steps Potential Hazard(s) / Risk Hazard Control Measures
Step List the steps needed to do the job Against each step list potential hazards that For each hazard, identify control measures
No. in the sequence to be done. could cause injury when the job is done. to eliminate or minimise the risk of injury.

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 Part 4: Worker Induction Record Sample Co Ltd

JSA Sign Off – Your signature below indicates that:

I understand the requirements of this JSA and they are clearly understood.
also clearly understand that the controls in this JSA must be applied as documented, otherwise work is to cease immediately.

No. Name Classification Employed By Signature Date

1 Ben Workin Window Cleaner Sample Co Ltd

2 Jean-Claude Van Man Driver Sample Co Ltd

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PPE Requirements for Task: Sample Co Ltd

Electrical Tool Tag Colours

Hi Visibility Vests or Clothing Red Dec-Feb Orange Jan-Jun
Green Mar-May White Jul-Dec
Blue Jun-Aug Black Annual
Safety Boots Yellow Sep-Nov

Safety Harness

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