WORKSAFE VICTORIA / SAFETY MANAGEMENT SYSTEMS GUIDE FOR LABOUR HIRE AGENCIES (2nd

JOB SAFETY ASSESSMENT

Who uses this form? Trained personnel from the labour-hire agency. (ie. suitably qualified in relation to OHS) Purpose? To assess risks of injury and illness at a proposed host employers workplace. Job Safety Assessments (JSAs) should be completed for each job that the worker will perform. Note: JSAs should be used to support compliance codes and regulations, but do not replace these statutory instruments. What should happen The labour-hire agency keeps the original in a file with the host employers name on it.

Organisation: Representative: Workers job title: Description of job: Completed by:

Organisation name Name Surname Workers job title Description of Job Name Surname Title: Agency Name Date of inspection: 01/01/05 Title: Location of the job: Agency Name Job Location

1. MANUAL HANDLING
Briefly describe any manual handling tasks: For example, lifting, carrying, assembling components, stacking materials, manually operating plant, equipment or tools. Description

IS IT LIKELY THAT THE WORKER COULD:

YES

NO

BRIEFLY DESCRIBE THOSE HOW CONSULTED AND WHEN THE INJURY COULD OCCUR?

BRIEFLY DESCRIBE ANY HAZARDOUS MANUAL HANDLING TASKS: For example, lifting, carrying,
assembling components, stacking materials, manually operating plant, equipment or tools.

PERSON RESPONSIBLE FOR ACTIONS

DATE COMPLET ED

1.1 1.2

Sustain a back injury from lifting or carrying? Sustain arm or shoulder muscle strains from having to lift, push, pull or hold a load or a piece of equipment? Suffer muscle fatigue from having to repeatedly move fingers, hands wrists or arms while using, tools, equipment or handling workpieces or materials? Injure feet or legs by dropping the load, material or equipment?

( ( ( (

( ( ( (

1.3

1.4

Page 1 of 8

WORKSAFE VICTORIA / SAFETY MANAGEMENT SYSTEMS GUIDE FOR LABOUR HIRE AGENCIES (2nd

JOB SAFETY ASSESSMENT

2. WORKING ENVIRONMENT
Briefly describe the working environment: For example, spray booth, foundry, assembly line, machine shop, dispatch, warehouse, fabrication shop. Description

IS IT LIKELY THAT THE WORKER COULD:

YES

NO

BRIEFLY DESCRIBE THOSE HOW CONSULTED AND WHEN THE INJURY COULD OCCUR?

BRIEFLY DESCRIBE ACTIONS TO PREVENT THE LIKELIHOOD OF INJURY (refer to p7 of JSA for guide)

PERSON RESPONSIBLE FOR ACTIONS

DATE COMPLET ED

2.1

Suffer the effects of extreme hot or cold? (For example, working in cold room or adjacent to furnace). Have difficulty seeing what they are doing or moving around because of poor lighting or glare? Suffer from poor ventilation or lack of fresh air? Be affected by airborne dust or strong unpleasant odours? Slip, trip or fall from a height, at ground level or below ground level? Be struck by a moving vehicle or mobile equipment? (For example, forklift, truck, motor vehicle). Be struck by a falling object which was being erected, positioned, moved, lifted, carried or transported? Strike or hit their head, hand, arm, hip or leg on equipment or machinery? Be bitten by an animal or insect? Be exposed to UV radiation? (For example, exposed to direct sunlight). Be injured or suffer an illness due to handling or coming in contact with biological materials or products? (For example, needle stick, human/animal waste). Suffer hearing damage due to excessive levels of background noise?

( ( ( ( ( ( ( ( ( ( (

( ( ( ( ( ( ( ( ( ( (

2.2

2.3 2.4 2.5 2.6

2.7

2.8 2.9

2.10

2.11

Page 2 of 8

WORKSAFE VICTORIA / SAFETY MANAGEMENT SYSTEMS GUIDE FOR LABOUR HIRE AGENCIES (2nd

JOB SAFETY ASSESSMENT

3. PLANT OR MACHINERY
Describe the plant or machinery being operated: For example, presses, guillotines, fork lifts, conveyors, jigs and fixtures, X-ray machines, hoists, cranes, robots. Description

IS IT LIKELY THAT THE WORKER COULD:

YES

NO

BRIEFLY DESCRIBE THOSE HOW CONSULTED AND WHEN THE INJURY COULD OCCUR?

BRIEFLY DESCRIBE ACTIONS TO PREVENT THE LIKELIHOOD OF INJURY (refer to p7 of JSA for guide).

PERSON RESPONSIBLE FOR ACTIONS

DATE COMPLET ED

3.1

Have their fingers hands or arms crushed or amputated by being caught in a moving part of the plant or machine? Be struck in the eye or face by a piece of the workpiece, plant or machine? Have their fingers or hands cut or amputated by rotating or moving blades or cutters? Have their hair or clothing caught by a moving or rotating part of the plant, machine or workpiece? Be burnt by coming in contact with exposed hot or cold parts of the workpiece plant or machine? Be burnt by hot or cold material escaping from the plant or machine? (For example steam, hot oil or molten material). Be exposed to radiation emitted by the plant or machine? (For example X- rays, lasers). Be electrocuted while operating, repairing, servicing or cleaning the machinery? Sustain hearing damage due to excessive levels of noise produced by the plant or machine? Be crushed as a consequence of the mobile plant they are operating rolling over? Sustain an injury because they were unable to identify, reach or operate the controls or emergency stop? (For example, if they were caught in the machine).

( ( ( ( ( ( ( ( ( ( (

( ( ( ( ( ( ( ( ( ( (

3.2 3.3

3.4

3.5

3.6

3.7 3.8 3.9

3.10 3.11

Page 3 of 8

WORKSAFE VICTORIA / SAFETY MANAGEMENT SYSTEMS GUIDE FOR LABOUR HIRE AGENCIES (2nd

JOB SAFETY ASSESSMENT

4. HAZARDOUS SUBSTANCES
Description of the hazardous substance(s): Obtained from Material Safety Data Sheet or label on container, drum or packaging. Description Is the hazardous substance: Please tick Corrosive/caustic?

A skin irritant?

(
NO

An eye or respiratory irritant?

Toxic or poisonous?

Flammable or explosive?

IS IT LIKELY THAT THE WORKER COULD:

YES

BRIEFLY DESCRIBE THOSE HOW CONSULTED AND WHEN THE INJURY COULD OCCUR?

BRIEFLY DESCRIBE ACTIONS TO PREVENT THE LIKELIHOOD OF INJURY (refer to p7 of JSA for guide).

PERSON RESPONSIBLE FOR ACTIONS

DATE COMPLET ED

4.1 4.2 4.3 4.4

Come in contact with the workers skin? Come in contact with the workers eyes? Be breathed in by the worker? Be unintentionally swallowed by the worker? Enter the workers body through any other means? (For example, open wound or injection). Cause a fire or explosion? Cause an injury because the container is not clearly labelled to alert workers to its contents or dangers?

( ( ( ( ( ( (

( ( ( ( ( ( (

4.5

4.6 4.7

Page 4 of 8

WORKSAFE VICTORIA / SAFETY MANAGEMENT SYSTEMS GUIDE FOR LABOUR HIRE AGENCIES (2nd

JOB SAFETY ASSESSMENT

5. TOOLS OR EQUIPMENT
Describe the tools or equipment being used: For example, electric drills, angle grinders, polishers, staple guns, chairs, computer screens. Description

IS IT LIKELY THAT THE WORKER COULD:

YES

NO

BRIEFLY DESCRIBE THOSE HOW CONSULTED AND WHEN THE INJURY COULD OCCUR?

BRIEFLY DESCRIBE ACTIONS TO PREVENT THE LIKELIHOOD OF INJURY (refer to p7 of JSA for guide).

PERSON RESPONSIBLE FOR ACTIONS

DATE COMPLET ED

5.1 5.2

Be struck in the eye or face by a piece of material? Have their fingers or hands pierced by a part of the equipment or material? (For example, nail or staple). Have their fingers or hands squashed or crushed by a part of the tool or equipment? Have their fingers or hands cut or amputated by rotating or moving blades or cutters? Be burnt by a part of the equipment or work piece? Be electrocuted while operating the equipment? Suffer hand, arm or shoulder injuries due to vibration generated by the piece of equipment? Suffer hearing damage due to excessive levels of noise produced by the equipment?

( ( ( ( ( ( ( (

( ( ( ( ( ( ( (

5.3 5.4 5.5 5.6 5.7

5.8

Page 5 of 8

WORKSAFE VICTORIA / SAFETY MANAGEMENT SYSTEMS GUIDE FOR LABOUR HIRE AGENCIES (2nd

JOB SAFETY ASSESSMENT

5. TOOLS OR EQUIPMENT
Describe the tools or equipment being used: For example, electric drills, angle grinders, polishers, staple guns, chairs, computer screens. Description

IS IT LIKELY THAT THE WORKER COULD:

YES

NO

BRIEFLY DESCRIBE THOSE HOW CONSULTED AND WHEN THE INJURY COULD OCCUR?

BRIEFLY DESCRIBE ACTIONS TO PREVENT THE LIKELIHOOD OF INJURY (refer to p7 of JSA for guide).

PERSON RESPONSIBLE FOR ACTIONS

DATE COMPLET ED

5.1 5.2

Be struck in the eye or face by a piece of material? Have their fingers or hands pierced by a part of the equipment or material? (For example, nail or staple). Have their fingers or hands squashed or crushed by a part of the tool or equipment? Have their fingers or hands cut or amputated by rotating or moving blades or cutters?

( ( ( (

( ( ( (

5.3 5.4

6. WORKING ARRANGEMENTS
Describe the working arrangements: For example, hours of work, length of shift, overtime arrangements remote or isolated work. Description

IS IT LIKELY THAT THE WORKER COULD:

YES

NO

BRIEFLY DESCRIBE THOSE HOW CONSULTED AND WHEN THE INJURY COULD OCCUR?

BRIEFLY DESCRIBE ACTIONS TO PREVENT THE LIKELIHOOD OF INJURY (refer to p7 of JSA for guide).

PERSON RESPONSIBLE FOR ACTIONS

DATE COMPLET ED

6.1

Suffer fatigue or lose concentration because they have to work irregular or extended hours of work? (For example, extended overtime). Suffer fatigue or lose concentration because they have to work at a pace which is too fast (difficult to maintain) or too slow?

( (

( (

6.2

Page 6 of 8

WORKSAFE VICTORIA / SAFETY MANAGEMENT SYSTEMS GUIDE FOR LABOUR HIRE AGENCIES (2nd

JOB SAFETY ASSESSMENT

IS IT LIKELY THAT THE WORKER COULD: YES NO BRIEFLY DESCRIBE THOSE HOW CONSULTED AND WHEN THE INJURY COULD OCCUR? BRIEFLY DESCRIBE ACTIONS TO PREVENT THE LIKELIHOOD OF INJURY (refer to p7 of JSA for guide). PERSON RESPONSIBLE FOR ACTIONS DATE COMPLET ED

6.3 6.4

Be subject to intimidation, verbal abuse, bullying or violence? Find it difficult to maintain necessary communication with colleagues? (For example, remote or isolated work).

( (

( (

Labour Hire Agency: Name Surname Name of person conducting assessment Host Employer: Name Surname Name of person conducting assessment

Signature:

Date:

01/01/05

Signature:

Date:

01/01/05

Page 7 of 8

WORKSAFE VICTORIA / SAFETY MANAGEMENT SYSTEMS GUIDE FOR LABOUR HIRE AGENCIES (2nd

JOB SAFETY ASSESSMENT

POSSIBLE SOLUTIONS TO PREVENT OR REDUCE THE LIKELIHOOD OF INJURIES (the lower numbered solutions in each Working Environment Manual Handling section are better).
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. Install ventilation extraction systems in hot work areas. Fit localised lighting on machines to enable operators to comfortably view work pieces. Suspend electrical power lines and air lines. Round-off edges and corners of benches, equipment or fittings. Install safety barriers to protect pedestrians from vehicles or mobile plant. Install mirrors and flashing lights to warn of approaching vehicles or mobile plant. Fit reverse warning beepers and lights to mobile plant for example, forklifts. Install hand rails on ramps and steps. Install non-slip floor surfaces. Install good lighting along walkways. Removing overhanging objects from work areas. Provide fixed plant and machinery with drip trays. Supply cool water for workers required to work in hot areas. Regularly sweep and clean floors. Keep walkways and work areas uncluttered. Identify walkways with painted yellow lines. Have available temporary signs to warn of slippery surfaces. Introduce job rotation and frequent rest breaks for jobs which could cause workers to suffer from the extremes of hot or cold. Provide workers with a variety of tasks. Introduce job rotation for jobs which may be fatiguing. Provide personal protective clothing and footwear to minimise the effects of cold. Enclose very noisy plant or machinery in sound-proof barriers or relocate in separate area from the majority of workers. Guard moving parts of the plant or machinery (fixed or adjustable guards, photo-electric, pressure sensing mats). Interlock guards with power supply (power supply is automatically switched off when guard is opened or removed). Make guards difficult to remove or machinery difficult to disable. Install two hand controls. Provide feeder tables or rollers. Use clamps, supports, guides or stops to position workpieces. Fit lock out switches to all plant and machinery to disconnect power supply while being cleaned, serviced or repaired. Guard or shield hot or cold machine components from accidental contact. Fit emergency stops to plant and machinery which is easy to see, operate and reach at all times. Make sure plant or machine controls are easy for the operator to understand and reach. Introduce lock-out procedures and provide locks and tags. Write safe operating procedures for all machinery operations. Clearly identify with warning signs and line marking areas where hot processes are carried out. Provide workers likely to be burnt by hot material with personal protective equipment such as gauntlets, aprons, face shields. Provide workers with good quality hearing protection. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Reduce the weight of the object to be lifted or carried; for example, smaller containers or less material per container. Make sure containers are easy to lift or carry; for example, they are provided with handles or grips, or are a comfortable shape and size. Change the height of workbenches or shelving to reduce the need to bend or overreach. Provide equipment to assist with the lifting carrying or moving; for example, hoists, trolleys, scissor lifts, conveyors. Make sure tools or equipment are comfortable and easy to lift, use or operate. Suspend heavy tools or equipment. Provide footrests, comfortable and adjustable seating and cushioned floor coverings. Reduce the distance to carry objects. Change the work process so that objects do not have to be lifted or moved as often by hand. Introduce job rotation with a mixture of repetitive and non repetitive tasks. Provide training in safe manual handling. Make sure there is a two person lift. Provide frequent short rest breaks for workers carrying out repetitive tasks. Make sure tools or equipment with rotating or moving blades or cutters are fitted with guards. Make sure electrically powered equipment is only used if protected by a safety switch (Residual Current Device). Provide industrially insulated power extension cords. Prevent mobile plant or vehicles driving over power cords. Regularly test and tag electrically powered equipment. Write safe operating procedures for all powered tools and equipment. Train workers on the safe use of tools and equipment. Introduce job rotation and frequent rest breaks for jobs which involve the risk of injury from mechanical vibration. Provide safety glasses or face shields. Provide workers with good quality hearing protection. Provide workers likely to be burnt by hot material with personal protective equipment such as gauntlets, aprons, face shields. Use less dangerous chemicals or substances. Use paste or pellets instead of powders. Apply paint by brush instead of spraying. Store chemicals in sealed containers. Install an extraction system to remove fumes vapours or dust. Obtain Material Safety Data Sheets for all chemicals or substances. Follow safety precautions contained in Material Safety Data Sheets. Make sure all containers are labelled. Write safe operating procedures for the handling or use of chemicals or substances. Train workers on the safe handling or use of chemicals or substances. Provide first aid, safety showers, eye wash. Provide proper personal protective equipment such as gloves, aprons, cartridge respirators, safety glasses and face shields. Page 8 of 8

Tools or Equipment

Plant or Machinery

Chemicals or Substances 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.