JHA – Job Hazard AssessmentComplete this form for tasks that are: • routine: moderAte to HigH risk • non-routine: low-risk

STEP 1: HAZARDS tDate: / / Task: Job #:

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

IDEnTIfy HAzArDS TIck

Fatigue

driving

Asbestos

Chemical exposure / spills (e)

Clearing of vegetation (e)

Confined space entry (Complete JsA)

electricity / power / radiation

electrified meter

engulfment / flooding (e)

excavation

Falls from height

Fuel spill / oil spill (e)

Fumes / dust / hazardous gases (e)

IDEnTIfy HAzArDS TIck

High risk tools (incl. jet washer)

Harm to wildlife (e)

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

inclement weather (e.g. heat, wind)

insects / aggressive animals

manual handling / ergonomics

mobile plant (e.g. excavator)

night work / poor lighting

noise (e), odour (e)

overhead objects

overhead power

Pinch / crush points

Power tools

IDEnTIfy HAzArDS TIck

Public / customers / contractors

service under pressure

slip / trip obstacles

sharps

traffic

underground services

waste disposal (e)

wastewater contact

water discharge/dewatering (e)

wet / unstable surfaces

working alone

work on water

conTrolS for fATIguE TIckwork day not exceeding 12 hours

10 hour break before work day

Adequate breaks during task

conTrolS for DrIvIng TIckJourney planned with supervisor

lone worker

relevant driver training (as required)

conTrolS for DrIvIng TIckwater, first aid kit

Vehicle checks

Choose All appropriate controls for All hazards ticked.STEP 2: CONTROLS t

cHooSE conTrolS TIck cHooSE conTrolS TIck cHooSE conTrolS TIck

STEP 3: SIGN OFF tnAmE:

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Appropriate permits and approval (e)

Appropriate waste disposal (e)Bridging cables, rubber gloves

Cable locator

Communications (e.g. satellite phone)

Contact supervisor or environmental Coordinator (e)

Correct asbestos disposal

dewatering, divert water flow

dial Before You dig

exclusion zone

Fall arrest equipment

First aid kit and water

Fuel, chemical spill kit (e)

gas monitoring equipment

Harness

identify slip / trip hazards, inform others

induction (employee & contractor) (e)

inform western / Horizon Power

isolation and tagging

keep area tidy

lighting

lone worker – log on

look for signs of underground services

machine guarding fitted

material safety data sheet (msds)

mechanical assistance

mobile plant checks

Personal flotation device (PFd)

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

PPe water Corporation standard

PPE additional (circle extra requirements)

dust mask Face mask

sCBA gloves

overalls Hard-hat

Hearing protection other

Portable safety switch / rCd

Purging

rescue / evacuation planned

safety grate and barriers

safe hygiene practices

safe manual handling techniques

safe means of access / egress

shoring

signs

site register

spotter

sunscreen/insect repellent

tagged and inspected

traffic management diagrams

traffic signs and cones

trained and competent (employee & contractor)

Ventilation/extraction

other...

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

AQuA doc no: 2289407 document Custodian: manager occupational safety and Health Branch Version date: 15 February 2011 next review date: 15 February 2013

(e) = also an environmental hazard/control

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

JSA – Job safety AnalysisComplete this form for tasks that are: • non-routine: moderAte to HigH risk

AcTIon / STEP PoTEnTIAl HAzArD HAzArD conTrol mEASurE(S)

use additional sheets if required

Date: / / Task: Job #:

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.

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Permits/Plans (circle if required)1 Clearance to work (Ctw) 3 Hot work 5 traffic management

2 Confined space entry (Cse) 4 isolation and tagging 6 other:

AQuA doc no: 2289407 document Custodian: manager occupational safety and Health Branch Version date: 15 February 2011 next review date: 15 February 2013