JHA Job Hazard Assessment

Complete this form for tasks that are: routine: moderate to high risk non-routine: low-risk
Date:

Task:

Job #:

STEP 1: HAZARDS t

(e) = also an environmental hazard/control

Identify Hazards

tick Identify Hazards

ti
ck Identify Hazards

Fatigue

High risk tools (incl. jet washer)

Driving
Harm to wildlife (e)

Public / customers / contractors

Asbestos

Hot work (e.g. welding) (e)

Slip / trip obstacles

Chemical exposure / spills (e)

Inclement weather (e.g. heat, wind)

Sharps

Clearing of vegetation (e)

Insects / aggressive animals

Traffic

Confined space entry (Complete JSA)

Manual handling / ergonomics

Underground services

Electricity / power / radiation

Mobile plant (e.g. excavator)

Waste disposal (e)

Electrified meter

Night work / poor lighting

Wastewater contact

Engulfment / flooding (e)

Noise (e), odour (e)

Water discharge/dewatering (e)

Excavation

Overhead objects

Wet / unstable surfaces

Falls from height

Overhead power

Working alone

Fuel spill / oil spill (e)

Pinch / crush points

Work on water

Fumes / dust / hazardous gases (e)

Power tools

Service under pressure

controls for fatigue tick controls for driving

tick controls for driving tick

Work day not exceeding 12 hours

Journey planned with supervisor

Water, first aid kit

10 hour break before work day

Lone worker

Vehicle checks

Adequate breaks during task

Relevant driver training (as required)

STEP 2: CONTROLS t

tick

Choose ALL appropriate controls for ALL hazards ticked.

If you are unable to apply appropriate OSH or environment controls you must check with your supervisor before commencing work.

choose controls tick

choose controls

Appropriate permits and approval (e)

Isolation and tagging

Rescue / evacuation planned

Appropriate waste disposal (e)

Keep area tidy

Safety grate and barriers

Bridging cables, rubber gloves

Lighting

Safe hygiene practices

Cable locator

Lone worker log on

Safe manual handling techniques

Communications (e.g. satellite phone)

Look for signs of underground services

Safe means of access / egress

Contact Supervisor or Environmental

Coordinator (e)

Machine guarding fitted

Shoring

Material safety data sheet (MSDS)

Signs

Correct asbestos disposal

Mechanical assistance

Site register

Dewatering, divert water flow

Mobile plant checks

Spotter

Dial Before You Dig

Personal flotation device (PFD)

Sunscreen/insect repellent

Exclusion zone

4Ps: plan, pothole/prodder, protect, proceed

Tagged and inspected

Fall arrest equipment

PPE Water Corporation standard

Traffic management diagrams

First aid kit and water

PPE additional (circle extra requirements)

Traffic signs and cones

Fuel, chemical spill kit (e)

Dust mask

Gas monitoring equipment

SCBA Gloves

Trained and competent

(employee & contractor)

Harness

Overalls

Ventilation/extraction

Identify slip / trip hazards, inform others

Hearing protection Other

Induction (employee & contractor) (e)

Portable safety switch / RCD

Inform Western / Horizon Power

Purging

STEP 3: SIGN OFF t

TICK choose controls tick

Face mask
Hard-hat

Other...

Team member sign off (Contractors must note induction card #)

name:

name:

name:

sign:

sign:

sign:

name:

name:

name:

sign:

sign:

sign:

Review this JHA if job conditions, equipment or personnel change at anytime.

AQUA Doc No: 2289407 Document Custodian: Manager Occupational Safety and Health Branch

Version Date: 15 February 2011

Next Review Date: 15 February 2013

JSA Job Safety Analysis

Complete this form for tasks that are: NON-routine: moderate to high risk
Date:

Task:

action / step

Job #:
POTENTIAL HAZARD

HAZARD CONTROL MEASURE(S)

Use additional sheets if required

Permits/Plans (circle if required)

1 Clearance to work (CTW)
2 Confined space entry (CSE)

3 Hot work
4 Isolation and tagging

5 Traffic Management
6 Other:

Team member sign off (Contractors must note induction card #)

I have read the hazards and controls for this task and reviewed appropriate safe work method statements or work instructions.
name:

name:

name:

sign:

sign:

sign:

name:

name:

name:

sign:

sign:

sign:

AQUA Doc No: 2289407 Document Custodian: Manager Occupational Safety and Health Branch

Version Date: 15 February 2011

Next Review Date: 15 February 2013