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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT

ACTIVITY OR TASK: General Cutting, welding and grinding Location / Project:

JSA Job Number:
Preparation & JSA Number: G21 JSA Revision:
task work
team:
Competence = Relevant Training/Qualifications + Experience
Competence/ Codes of
Qualific’n req’d Practice &
to complete Legislation
work safely that are
JSA approved Name: Position / Competence/ Date: applicable:
by person License:
responsible i.e.
Team Leader /
Tradesman
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
Entry/Exit Substances Objects loads ………………
- attach MSDS ….
Oxygen to JSA 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

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

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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT
Pressurised Pneumatics Fall Arrest
Fluids systems
Flamm. Welding Face
Materials Shield
Present
4. ENVIRONMENTAL HAZARDS – (IMPACTS) tick those identified Likelihood: Consequences: how severe an injury?
Medical 1st Aid
Air Pollution Spills to Other: RISK RATING TABLE How likely is it to
be that bad?
Death Serious
Injuries Treatment req’d
Req’d
(dust, fumes) ground This table is used to Almost Certain - 10 9 8 7
Noise (plant & Soil Erosion calculate whether the Expected to Occur
Likely – could
equipment) hazard you have identified happen sometime
9 8 7 6

Spills to Hazard to is Extreme: 9-10 Moderate – could

happen but not likely
8 7 6 5
High: 7-8, Unlikely – could
drains/waterw Flora /Fauna happen but very rare
7 6 5 4

ays Medium: 5-6 or Rare - could happen

6 5 4 3
Low: 3-4 but probably never will

5. EQUIPMENT REQUIRED:
Static Plant & The objective of rating the
Equipment risk is to lower the risk by
Mobile Plant & initiating risk control
Equipment measures. The score is
noted in the JSA risk score
Safety /
column on the next page –
Emergency
both before & after risk
Equip’t
control measures have been
nominated.

NAME OF TASK: General Cutting, welding and grinding JSA Number: G21
Rev:

Revision Date: March 2005 ………. of ………….. OHS-03-F01

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

Revision Date: March 2005 ………. of ………….. OHS-03-F01

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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT
Ensure job is set up as per safe welding
procedures.
Only trained personnel to carry out welding.

Fit earth clamp securely to job.

Welders must wear flame resistant work

clothing
and supplied leather PPE where applicable.

Wear gloves to protect hands and arms.

Wear welders shield with filter shade No. 7 to

15 inclusive.
Wear AS1337 safety spectacles under welding
shields.
Use welding screens or blankets to shield arc
from other personnel.
Welders assistants MUST WEAR anti weld
flash eye
protection to AS1337.

If assistant required to look at the arc, then the

sameprotection as welder is required.

5 Clean up worksite Slips trips and falls due Remove tools equipment and rubbish from
to poor housekeeping worksite and maintain a clean work
environment.

Revision Date: March 2005 ………. of ………….. OHS-03-F01

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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT

Revision Date: March 2005 ………. of ………….. OHS-03-F01

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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA)

CONSULTATION & SIGN-OFF RECORD

I confirm by my signature below, 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.
I confirm that copies of the relevant Permits, MSDS's, Isolation Plans etc. have been
reviewed.

JSA JSA Rev:

NAME No:

NAME (Please print) SIGNATURE DATE

Revision Date: March 2005 OHS-03-F01

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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