Corporate Safety - Template

Job Safety & Environmental Analysis (JSEA) / Safe Work Method Statement (SWMS)
ABN: 75 450 239 876 Address: 117 Brisbane St, Ipswich 4305 Ph: (07) 3035 5500
Section 1 - Job details
Project name Work order or
JSEA/SWMS title
Principal contractor PID No.

Location / address Date/s of activity

Prepared by Date prepared Signature

Permits required Isolations required

☐ Confined space ☐ High risk work rescue plan ☐ High voltage access ☐ SCADA ☐ Mechanical ☐ Hydraulic

☐ Work at height ☐ Excavation & trenching ☐ Energised work ☐ Other (please specify) ☐ Electrical ☐ Pneumatic

☐ Penetration ☐ Grid mesh, flooring and guard rail removal ☐ Hot work Site access required ☐ Yes ☐ No

Section 2 - Common hazards (Each hazard identified below must be assessed in section 4)
Chemicals/hazardous substances High-risk activities
Name of chemicals or hazardous substance: ☐ Confined space ☐ Work at heights
☐ SDS available ☐ Hot work ☐ Excavation, trenching or penetrations
Energy sources ☐ Construction work ☐ Diving
☐ Electricity ☐ Pressure ☐ Demolition ☐ Structural alterations
☐ Gas / fuel ☐ Water Work location
Plant and equipment ☐ Sun ☐ Working over, in or near water
☐ Fixed plant ☐ Mobile plant ☐ Plants, animals or insects ☐ Contaminated / flammable atmosphere
☐ Vehicles/boats ☐ Hand tools ☐ Slips, trips and falls ☐ Work occurring in other areas
Manual tasks ☐ Biological hazards ☐ Fire
☐ Repetitive tasks ☐ Heavy lifting People
☐ Awkward posture ☐ Sustained posture ☐ Remote or isolated work ☐ Contractors
Facilities/built environment ☐ Fatigue ☐ Visitors/land owners/public
☐ Buildings and fixtures ☐ On, in or adjacent to roadways ☐ Competency or training required ☐ Licence required
☐ Open pits, trenches or tunnels ☐ Asbestos / lead Environment and water quality
☐ Overhead objects or services ☐ Underground objects or services ☐ Erosion & sediment control ☐ Waste / discharge
☐ Lighting ☐ Noise ☐ Emissions (or air pollution) ☐ Flora / fauna / weed management
☐ On or near pressurised gas distribution ☐ On or near chemical, fuel or refrigerant ☐ Release to drains/waterways ☐ Water quality
mains or piping lines
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 Corporate Safety - Template
Job Safety & Environmental Analysis (JSEA) / Safe Work Method Statement (SWMS)
Assessment / establishment of risk rating
Hazard Effect / Consequence
Seqwater Risk Matrix (Where an event has more than one ‘Loss Type’, choose the ‘Consequence’ with the highest rating)
Loss Type
(Additional ‘Loss Types’ may exist for an event; identify & Insignificant Minor Moderate Major Catastrophic
rate accordingly)
Symptoms requiring no Minor temporary injury or illness requiring
treatment or first aid medical treatment. Moderate injury or temporary impairment
Health and Safety Permanent injury or impairment. ≥1 Fatalities.
treatment only. Inability to complete rest of shift or One or more entire shift missed as a result.
Returned to full duties. modified duties.
Localised on/off site actual or
Localised on/off site actual or potential
potential serious harm/Impacts to the Actual or potential widespread
environmental harm/impact to the
Localised, on site, actual or Localised on/off site environmental ecosystem, flora, fauna (including environmental harm/Impacts to the
ecosystem, flora, fauna (excluding declared
Environment potential nuisance. Routine nuisance. Routine short term remediation
and rare threatened and vulnerable species)
declared and rare threatened and ecosystem, flora, fauna requiring
short term remediation. (<1 month). vulnerable species) requiring extensive resources to mitigate (>6
requiring limited resources to mitigate (>1 -
substantial resources to mitigate (>3 months).
<3 months).
- <6 months).
Low level legal matter Serious breach of law; investigation/report to Major breach of the law; Long term legal action, government
Minor legal issue, non-compliance and/or
Legal and Regulatory Regulatory reporting not
breach of a regulation.
regulatory body, prosecution and/or possible considerable prosecution and inquiry, significant penalties,
required. moderate penalty. penalties. prosecutions. Potential jail terms.

Slight impact - public International impact - international

awareness may exist but no Limited impact - localised public/media Considerable impact - regional public/media National impact - national
public/media attention
public concern concern concern. public/media attention
Highly offensive infringement of
Reputation / Social and Community Limited damage to heritage sites. Moderate damage to regional heritage sites, Significant damage to important QLD
cultural heritage.
Superficial infringement of Localised cultural heritage reputational regional cultural heritage reputational heritage site. Major infringement of
cultural heritage and no Total destruction of nationally
damage. damage. cultural heritage.
disturbance to heritage sites. significant heritage locations.
Reservoirs approaching agreed
Reservoir levels below communication
communication trigger levels. Treatment
Reservoirs lower than agreed trigger levels > 8 hours. Reduced operating Unplanned loss of water supply from Unplanned loss of water supply
plant at restricted output requiring supply
normal operating levels for <4 volumes due to treatment plant capability for any bulk water supply point to any from any bulk water supply point to
reconfiguration.
hours or restricted output a short duration resulting in retailer network non-network or connected any non-network or network
No loss of supply from any bulk water
from treatment plant. No loss configuration changes. customers supply zones for up to 24 connected supply zones for > 24
Water Quality and Supply of supply from any bulk water
supply point.
Widespread aesthetic impacts for SEQ hours. hours.
Localised aesthetic impacts for non-SEQ
supply point. Drinking Water Supply System plants.
Drinking Water Supply System plants.
Little or no disruption to Repeated breach of guideline value / Potential acute health impacts (no Potential acute health impacts,
Isolated sample reports above guideline
normal operations. specification in quarterly Water Quality declared outbreak expected). declared outbreak expected.
value / specification for chronic health
reports for chronic health parameters.
parameters.
Likelihood Risk Rating
Almost The event is expected to occur in
most circumstances
>90% Medium High High Extreme Extreme
Certain
The event will probably occur in
Likely most circumstances.
>50–90% Medium Medium High High Extreme
The event might occur, but not
Possible expected to occur under normal >10–50% Low Medium Medium High High
circumstances.
The event could occur at some
Unlikely time, but only in unusual >2–10% Low Low Medium Medium High
circumstances

The event could occur only in

Rare exceptional circumstances
<2% Low Low Low Medium Medium

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 Corporate Safety - Template
Job Safety & Environmental Analysis (JSEA) / Safe Work Method Statement (SWMS)
Section 3 - Hazard identification and risk control
Hierarchy of control
1. Elimination First option – most effective: can the hazard be removed 4. Engineering Change the design of equipment, the workplace or the process ……. do it
altogether by elimination of process or substance? differently.
2. Substitution Involves replacing the hazard with one that presents a lower risk. 5. Administrative Reduce or eliminate the exposure to a hazard by adherence to procedures,
instructions, signage or training. Administrative controls are dependent on human
behaviour for success.
3. Isolation Separate yourself from the hazard or separate the hazard from you. 6. PPE Last option – least effective: provides a barrier between a person and the
hazard. This is dependent on PPE being chosen correctly as well as fitted and
work at all times where required.
NOTE – To ensure all specific hazards for the job are identified and suitable controls put in place, the workplace WHS risk register must be reviewed.

Inherent risk rating Residual risk rating Person

Management risk controls responsible
Task / activity steps
Potential hazards C L Rate (risk controls to be in place in order to manage C L Rate (to ensure
(break job down into steps) implementation
potential hazards)
of risk controls)

Doc no. TEM-00013 Version date: 24/04/2015 Trim ID:

Doc owner: J. Paige Doc approver: Manager, WHS Rev no. 7 Page 3 of 6
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 Corporate Safety - Template
Job Safety & Environmental Analysis (JSEA) / Safe Work Method Statement (SWMS)
Inherent risk rating Residual risk rating Person
Management risk controls responsible
Task / activity steps
Potential hazards C L Rate (risk controls to be in place in order to manage C L Rate (to ensure
(break job down into steps) implementation
potential hazards)
of risk controls)

Doc no. TEM-00013 Version date: 24/04/2015 Trim ID:

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 Corporate Safety - Template
Job Safety & Environmental Analysis (JSEA) / Safe Work Method Statement (SWMS)

Section 4 - Amendments required to JSEA/SWMS due to changes in job or environment

Inherent risk rating Residual risk rating Person
Management risk controls responsible
Hazards resulting from
What has changed? C L Rate (risk controls to be in place in order to manage C L Rate (to ensure
change
potential hazards) implementation
of risk controls)

Section 5 - JSEA/SWMS supervision/approval

Detail person(s) responsible for ensuring implementation, monitoring and compliance with the JSEA/SWMS.
Name Position Company Contact Number

If this JSEA/SWMS has any hazards with a residual risk rating of medium or above approval is required.
Name Position Approval date Signature
Line supervisor approval
(required for any medium risks)
General manager approval
(required for any high risks)
Any hazards with a residual risk level of extreme must not be undertaken. The risk must be reported to the CEO and Board.

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Corporate Safety - Template
Job Safety & Environmental Analysis (JSEA) / Safe Work Method Statement (SWMS)

Section 6 - JSEA/SWMS consultation and sign on

By signing this JSEA/SWMS I confirm:
 I have been consulted and have been given reasonable opportunity to express my views and contribute to the development of this JSEA/SWMS
 I understand the documented hazards and risk controls associated with this activity and will comply with the control measures for those identified hazards
 I have implemented any risk controls I am responsible for.
I will inform the Project Manager / Works Coordinator if the hazards of the job change

Date Name Signature Company

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