Safe Work Method Statement / JSA

Project: ELH Road & Bridge Construction Master Copy

Process: Initiators of SWMS/JSAs are responsible for consulting the Supervisor, Engineer or other persons in charge of the work and all personnel involved in performing the work for input into the SWMS/JSA. Other persons may be consulted for technical advice and review of the SWMS/JSA to see proposed measures are effective and workable. All involved in the task must review and sign this SWMS/JSA form.

Project No.:

ELH - 00000

Zone

SWMS/JSA No:

ELH-00000-A67

Rev. 01

Work locations / areas: Section 7 and 9 Initiated by: Rifaat Hanna / Management Review: Rahmy Hanna / OHS review: Jeff Boers / Date:
2/02/2010

Employer: ELH Road & Bridge Construction Job/ Task: Asphalt Works Zone 4 Supervisor: Section 9: Darryl Woodeson

Date: 2/02/2010 Date: 2/02/2010 Date: 2/02/2010

SWMS/JSA Sign off and acceptance of proposed work method and associated responsibilities
N
1 2 3 4 5 6 7 8 9 10 11 12 14

Surname

First Name

Classification

Employed by

Signature

Date

SWMS/JSA Sign off and acceptance of proposed work method and associated responsibilities
Reference Documentation
N777-SH-4010 Rev 2 SWMS/JSA Worksheet.doc

Document N, Rev

ELH-00000-A67 Rev. 01

Page 1 of 6

Safe Work Method Statement / JSA

Project: ELH Road & Bridge Construction Master Copy Project No.: ELH - 00000

N
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

Surname

First Name

Classification

Employed by

Signature

Date

Reference Documentation
N777-SH-4010 Rev 2 SWMS/JSA Worksheet.doc

Document N, Rev

ELH-00000-A67 Rev. 01

Page 2 of 6

Safe Work Method Statement / JSA

Project: ELH Road & Bridge Construction Master Copy Project No.: ELH - 00000

Brief description of work to be undertaken: General asphalting works in Section 9. Key safety issues to be managed and key safety controls to be implemented:
Working around plant, Traffic, Services, Overhead and Underground Services, Manual Handling, Working outside, Working near HOT asphalt (burns)

Key PPE issues: * Helmet * Safety footwear * High Vis Clothing * Safety glasses * Other forms of PPE to be worn when required LCPL Project Instructions Codes of Practice

Reference and detail applicable section/s of: Legislation OHS Act 2000 OHS Regs 2001

Project OHS&R Management Plant Australian Standard/s Nos

Manufacturer / Supplier recommendations / Specifications

(NSW Code of Practice:- Excavation, Moving Plant on Construction Sites, Noise Management and Protection of Hearing at Work)

List key individuals & qualifications:

John Walters (LCPL Foreman) Mick Kreutzer (LCPL Foreman) Boral Foreman/Supervisor T-way Permit to Excavate N ROL N TMP N

Key safety duties/responsibilities:

Overall Supervision for Zone 4 Job site Supervision - coordination Control of direct workforce enforce all rules

Detail training required to complete work:

Workforce must complete Project, Zone induction, First aider must be available per shift, Workforce must follow Manual Handling procedures

Detail any approvals required e.g. Permit to Excavate:

Hot Works Permit N Overhead Permit N

List Certificates or Licenses required to operate plant or perform tasks:

NSW RTA Drivers licences for vehicles Plant operator tickets,

List plant and equipment to be used for work:

Asphalt paver, various size/type rollers, tip trucks, bobcat Lifting equipment Variety of hand tool, small plant (wackers, quick cut saws) Portable electric hand tools,
Key contact Numbers:
Name: John Walters Number: 0404 812 237 Name: Mick Kreutzer

List plant, equipment and area safety inspections required:

Daily pre start completed and handed to LCPL Foreman Daily visual inspection plus 6 monthly cert. Inspection (register onsite) Daily visual inspection All tools monthly test-n-tagged, RCD units must be used (register onsite)
Name: Tim Rimer Number: 0434 070 314 Name: Jeff Bowers Number: 0433 692 811 Number: 0433 693 928

Reference Documentation

Document N, Rev

ELH-00000-A67

Page 3 of 6

Safe Work Method Statement / JSA

Project: ELH Road & Bridge Construction Master Copy Potential Hazard/s
Against each step list potential hazards that could cause injury when the jobs done.
Risk Leve l

Project No.:

ELH - 00000

Step N.

Process Steps
List the steps needed to do the job in the sequence to be done.

Hazard Control Measures

For each hazard identify control measures to eliminate or minimise the risk of injury.

Action by (Print name

of person)

1-4

Community

Community disputes

Dust generation 2 Environmental Pollute waterways 3

Unauthorised access/egress 3 Site establishment Unsafe conditions 1

Damage to under ground services. 4 Underground Services Trip and Fall into and in Excavation Unauthorised access to site 1

Working hour Mon to Fri 7am 6pm, and Sat 8am 1pm If approached by members of the public refer them to the T-Way info line: ph 1800 335 742 Areas where dust maybe generated, control methods are to be in place to reduce dust from leaving site. Water cart to be used where large areas of exposed material may cause dust Sediment controls to remain in place and if damaged they are to be repaired All personnel to be Project and Zone inducted All personnel to attend daily toolbox All personnel to wear mandatory PPE (Hard Hats, High Vis clothing, Safety Footwear, Safety Eyewear) should workforce undertake works in poor light or night works then reflective high vis clothing must be worn. Ensure safe access is provided for personnel. No excavation is allowed to proceed without a Permit to Excavate, (copy must be onsite with plant operators). If excavation is to proceed near a service, the service shall be pot holed and were possible protected. Access ladders are to be used and secured to enter and exit the excavation. Barricades and Handrails are to be in-place if excavation depth exceeds 1.5m meters. Follow Leighton T-way Project Instruction Working Near Overhead Powerline. If identified that works will be with in the Authority exclusion zone (<3m, <6m or <8m) then a Authority Permit is required (may require Outage). Adequate separation and or protection (barricade if necessary) from existing power poles/street light poles. Should it be difficult to achieve adequate separation or protection then a trained spotter shall be used.

Workforce (LCPL + Subcontractors)

Workforce (LCPL + Subcontractors)

Workforce (LCPL + Subcontractors)

Workforce (LCPL + Subcontractors)

Damage to overhead services. 5 Overhead Services Power poles/street light poles

Workforce (LCPL + Subcontractors)

Reference Documentation

Document N, Rev

ELH-00000-A67

Page 4 of 6

Safe Work Method Statement / JSA

Project: ELH Road & Bridge Construction Master Copy Process Steps
List the steps needed to do the job in the sequence to be done.

Project No.:

ELH - 00000

Step N.

Potential Hazard/s
Against each step list potential hazards that could cause injury when the jobs done.

Risk Leve l

Hazard Control Measures

For each hazard identify control measures to eliminate or minimise the risk of injury.

Action by (Print name

of person)

1-4

Persons hit by traffic 6 Traffic Damage to plant and or property 1

Do not work within 3m of live traffic unless, A Traffic Management Plan is in place. A Traffic Control system is in place under the direction of ticketed traffic controllers. There is a safety barrier in place (such as concrete new jersey kerbs), water filled Triton barriers and or a shadow vehicle. Work not to start until conditions are suitable (eg weather clears, traffic eases, etc) Revise as required to suit new conditions Safe access to be provided to working area

LCPL Engineer Workforce (LCPL + Subcontractors)

Review work conditions

Conditions not suitable for type of work, increasing the danger / risk of work hazards. Unsafe Access

All

Refer to Boral Asphalt Safe Work Method Statements/JSA

Reference material below is direct from Boral Safe Working Procedures Manual
Site induction rules Loading/unloading low loader float
8

Cleaning the hopper of a paver Hooking up trailers Locating, raising and Relocating light towers Raking Asphalt Refill Emulsion tank on spray truck Saw cutting asphalt Shovelling asphalt from paver hopper Sweeping site preparation/hot asphalt/around mobile plant

Towing paver from bog (AC) Working in auger discharge bay of paver machine Hand spraying emulsion Hand tamping Installing auger and extension boxes to paver Installing beams and sensors to paver Jackhammer edges Load crew truck at depot Feeding the paver with a bobcat Installing and removing lights to a paver

Loading truck from a profiler Parking plant on site with Diesel, oil and water Removing reflectors (Cats eyes) Spray work area with spray truck Taking temperature of AC in paver hopper Tipping asphalt into paver Unload crew truck on-site Using wacker plate for compaction Apply Stick N Stomps Marking out a job/paving run

Reference Documentation
N777-SH-4010 Rev 2 SWMS/JSA Worksheet.doc

Document N, Rev

ELH-00000-A67 Rev. 01

Page 5 of 6

Safe Work Method Statement / JSA

Project: ELH Road & Bridge Construction Master Copy Project No.: ELH - 00000

Risk Level Refer to Risk Matrix overleaf to determine risk level 1, 2, 3 or 4.

Consequence How severely could someone get hurt? Likelihood How likely is it that someone will get hurt?
Very Likely (could happen soon or l l ) Likely (could happen occasionally) Moderate (possible it might happen) Unlikely (could happen but rarely) Very Unlikely (could happen but probably never will)
Legend: Catastrophic Death, very serious environmental/ structural and/or plant damage Major Permanent disability, loss of production or major environmental/ structural and/or plant damage Moderate Temporary disability or moderate environmental/ structural and/or plant damage Minor Minor injury or minor environmental/ structural and/or plant damage

Environmental Checklist

Is the activity scheduled for approved hours of operation (7am-6pm M-F and 8am-1pm Sat)? If not please advise Environment Manager of proposed works and submit an Out of Hours Work Proposal. Have you considered potential for dust and associated controls? If so what are these (eg. water cart, spray grass, cover stockpile)? Is their potential for polluted water to leave the site or enter a drain? If so outline your control methods (eg. sediment fences, gravel socks, diversion drains, vegetated buffers). Are the works going to be very noisy? What possible controls or measures can you use to reduce noise? Do you need a specified waste dump area. Have you considered all other possible environmental risks?

1 1 2 2 3

1 2 2 3 3

1 2 2 3 4
3 Moderate Risk 4 Low Risk

3 3 3 4 4

1 Critical/ Extreme Risk 2 High Risk

Reference Documentation
N777-SH-4010 Rev 2 SWMS/JSA Worksheet.doc

Document N, Rev

ELH-00000-A67 Rev. 01

Page 6 of 6