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Department: Training & Development Date Prepared: 20.12.2022 Prepared by: ko ko htike Approved: ye min latt
Note. C = Consequences P = Probability R = Risk Determine risk for each hazard (with no controls in place) using risk matrix at end of this form as a guide
Reside
Existing and Potential Hazards
No Basic Job Steps C P R Ways To Eliminate Or Control Hazards Risk
H/M/L
Exit from the confined space Miscommunication Inform standby man of exit from the area.
5 Fall from the ladder Fall protection device use when using ladder.
Material left behind Visual check to confirm no materials left behind.
With controls in place, are residual risks deemed to be Low and ALARP? ( State Yes or No)
NB - If any Residual Risk is determined as other than Low - higher level approval is required.
Manual PUWER
Permit Cold / Hot Isolation Temporary
MSDS Handling
Type(s) and confined Type(s) Yes Defeat(s) Area Specific Assessment
Required? Assessment
Required? space Required? Required? required
Required?
Performing The Job Associated Permit No(s).
Toolbox Talk
Has the JSA been reviewed by all persons performing the work to ensure that it is still relevant?
I have reviewed this JSA and understand the hazards and controls. Signatures of al l persons performing the task
Name Name Name Name Name Name Name Name Name
Indicate which of the following been discussed prior to commencing the job ( )
COSHH
Objectives of
Plan & Methods Responsibilities Manpower / Skills PPE / RPE Asbestos Weather
job
Radiation
Manual
Conflicting Local Site Isolations / Access & Hazardous Handling Previous
Activities Conditions Permits Evacuation Equipment Lessons Learnt
Lifting & rigging
Additional Precautions required?
Note: - JSA and Permit conditions to be reassessed with persons doing work following any significant changes to task conditions.
On completion of job – Competent person review JSA with other persons performing the work to determine any lessons learned.
Immediate areas of concern that have been resolved and require discussion at next safety meetings:
Areas of concern have been addressed and Lessons Learned added to The Lessons Learned Register - Name / sign Date:
Determine the Risk
Consequences Probability
Probability
A B C D E Risk
1 High
2 Medium
Cons
eque
4
3
Lower