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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT ACTIVITY OR TASK: General Cutting, welding and grinding JSA Preparation & task work team: Competence = Relevant Training/Qualifications + Experience Competence/ Qualific’n req’d to complete work safely JSA approved Name: Position / Competence/ Date: by person License: responsible i.e. Team Leader / Tradesman Location / Project: Job Number: JSA Number: G21 JSA Revision:

Codes of Practice & Legislation that are applicable:

2. HAZARD IDENTIFICATION Identify hazards that may be present by ticking items on the list below. 3. PRECAUTIONS: hard hat, safety glasses, safety boots compulsory WORK HAZARDOUS HIGH RISK HIGH RISK ADDITIONAL PERMITS LOCATION AREA PRECAUTIONS Difficult Hazardous Falling Suspended Gloves: type Hot Work Substances Entry/Exit Objects loads ……………… …. - attach MSDS to JSA Oxygen Poor Lighting Poor Goggles Excavation Deficiency Visibility Oxygen Working at Slippery Inhalable Full Face Confined Excess Heights Surfaces Dusts/Fibres Shield Space Engulfment Remote Area Multiple High Noise High Visibility Hazardous
Revision Date: March 2005 ………. of ………….. OHS-03-F01

of ………….HV Communicat Rescue e amongst workers Other? Ventilation Manual Handling Sharp Materials Ladders used in the task Working at Heights Working near Crane & Crane Runways Rail Movement Moving Machinery Tools & Equipment Heat/ Sunlight/ Radiation Traffic Movement Working near Operation Processing Lines Live Rails Lighting Erect Scaffolding to access Respirator or Dust mask Erect Warning signs Personal Locks or Tag system Group isolation Welding screen PERMIT NUMBER HAZARDOUS SUBSTANCES in work area / to be used -attach MSDS Revision Date: March 2005 ………. OHS-03-F01 .LV Work Extinguishers Access Platform Barricades Scaffolding Potential for Electrical Difficulty to Difficult Hazards .POWER (trench collapse) Poisonous Gas Present Temperature Extremes Defined Confined Space Explosive Gas Present JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT Electrical Levels Vest Work Feeds Clearance Motor Room Trip Hazards Use of Harness Access to Hazards Chemicals Area Toxic Electrical Elevated Fire High Voltage Substances Hazards ..

Likelihood: How likely is it to be that bad? Almost Certain Expected to Occur Consequences: how severe an injury? Death Serious Injuries Medical Treatment Req’d 1st Aid req’d 10 9 8 7 6 9 8 7 6 5 8 7 6 5 4 7 6 5 4 3 Likely – could happen sometime Moderate – could happen but not likely Unlikely – could happen but very rare Rare . of ………….POWER JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT Pressurised Pneumatics Fall Arrest Fluids systems Flamm. OHS-03-F01 . drains/waterw Flora /Fauna Medium: 5-6 or ays Low: 3-4 5. fumes) ground calculate whether the Noise (plant & Soil Erosion hazard you have identified equipment) is Extreme: 9-10 Spills to Hazard to High: 7-8.could happen but probably never will NAME OF TASK: General Cutting. The score is Equipment noted in the JSA risk score Safety / column on the next page – Emergency both before & after risk Equip’t control measures have been nominated. Welding Face Materials Shield Present 4. ENVIRONMENTAL HAZARDS – (IMPACTS) tick those identified RISK RATING TABLE Air Pollution Spills to Other: This table is used to (dust. EQUIPMENT REQUIRED: The objective of rating the Static Plant & risk is to lower the risk by Equipment initiating risk control Mobile Plant & measures. welding and grinding JSA Number: Rev: G21 Revision Date: March 2005 ………..

flashes. examine each to acceptable before work commences. of …………. Identify the hazards eliminate or minimise all hazards that could Use Logi (health and safety or lead to an accident. sparks and permit conditions observed. as a result of poor welding habitat setup Risk Ratin g Of the risk followi ng correc tive action Revision Date: March 2005 ………. ence Environmental Aspects step. correct Injury or equipment 1 Determine Location damage as a result of supervision unfamiliarity with worksite Injury or equipment All personnel working on permit must 2 Receive PTW damage as a result of understand permit to work system and if in unfamiliarity with job doubt ask supervisor scope and permit system Hot work procedure must be adhered to and Injury due to fire. injury. 3 Pre-work setup Explosion. The risk must be accomplish a major task on the sequ associated with each previo reduced or controlled to a level that is and be logical. OHS-03-F01 . Break down Job into steps..POWER JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT Potential Safety & Recommended Corrective Action or Risk Ste Sequence of Basic Job Environmental Procedure Ratin p Hazards/Impacts Determine what actions are necessary to Steps g No. illness or Each step should table cal environmental) environmental incident. us find all possible risk Indicate who is to perform the action where page factors applicable against each action to score risk Toolbox talks before job start.

use fire spotter flashes. as a result of failure to adhere to Ensure adequate fresh air is around weld area permit conditions. Revision Date: March 2005 ………. and that fumes are efficiently extracted away from the local work area.POWER JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT Maintain a visual check of conditions in 4 Welding. OHS-03-F01 . sparks and cover drains.. cutting Explosion. fire extinguisher. gas testing. welding habitat. grinding and oxy Injury due to fire. of ………….

7 to 15 inclusive. Use welding screens or blankets to shield arc from other personnel. 5 Clean up worksite Slips trips and falls due to poor housekeeping Remove tools equipment and rubbish from worksite and maintain a clean work environment. of …………. Wear AS1337 safety spectacles under welding shields. Welders assistants MUST WEAR anti weld flash eye protection to AS1337. Fit earth clamp securely to job. Wear gloves to protect hands and arms.POWER JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT Ensure job is set up as per safe welding procedures. then the sameprotection as welder is required. .. If assistant required to look at the arc. Wear welders shield with filter shade No. Welders must wear flame resistant work clothing and supplied leather PPE where applicable. OHS-03-F01 Revision Date: March 2005 ………. Only trained personnel to carry out welding.


POWER JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) CONSULTATION & SIGN-OFF RECORD I confirm by my signature below. have been reviewed. I confirm that copies of the relevant Permits. that I have attended a briefing on the requirements of the attached Job Safety & Environment Analysis and agree to perform the work in the manner detailed on it. Isolation Plans etc. MSDS's. JSA NAME NAME (Please print) JSA No: SIGNATURE Rev: DATE Revision Date: March 2005 OHS-03-F01 .

POWER JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) THIS SAFE WORK BRIEFING / TRAINING WAS CARRIED OUT BY (responsible person at that location) : Name: Signature: Date: Client sign off (where applicable) Site / Project Manager sign off (document reviewed) Revision Date: March 2005 OHS-03-F01 .

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