(Council Details) / Job Pre-Start Safety Checklist – Health, Environment & Community Safety
File: 12.16.085 / Version No:
Issued:
Next Review:

Date …….………………………………. Officer …………………….……………………………………

Location and Contact Person(s) ……………………………………….………………….………………….………………….………………….

…………………………………………………………………………………………………………………………………….

Section 1: Awareness of SWMS/JSAs, hazards and SOPs

The task is:

□ Food premises inspections/audits (JSA # tba) □ Handling/capture of animals (JSA # tba)

□ Communicable disease inspections (JSA # tba) □ Block inspections (JSA # tba)

□ Domestic premises -squalor/pests (JSA # tba) □ Abandoned vehicles (JSA # tba)

□ Swimming pool inspections (JSA # tba) □ Site visitations - Community Safety (JSA # tba)

□ Syringe collection (JSA # tba) □ Parking enforcement (JSA # tba)

□ Plumbing/wastewater works inspections (JSA # tba) □ Other (task with no JSA/SWMS tba) ……………………..

…………………………………………………………….……..(Complete section 2 Assessment then report this to supervisor)

Does the JSA/SWMS cover all the hazards and steps in the job? □ Yes □ No (Complete Section 2 Assessment)

Is the full scope of work and steps understood? □ Yes □ No (Clarify with supervisor)

Do chemicals on site have SDS’s? □ Yes □ No (Obtain through supervisor)

Has everyone recently read / signed SWMS / JSAs & SOPs? □ Yes □ No (To be done before work starts)

Are you working alone in a remote or isolated area? □ Yes □ No (See WHS 22.1 Staff Safety Calls)

Are there contractors on site? □ Yes □ No (See Contractors Forms)

Will existing/changing weather conditions impact on the work

and/or hazards identified (eg Rain, High Winds, Hot Weather)? □ Yes □ No (specify conditions & controls)

Is appropriate PPE available and being utilised? □ Yes □ No (Obtain through supervisor)

………………………………………………………………………….………………………………………………………………………

Is there anything else to consider? (specify) ………………………………………………………………………………………

Section 2 Assessment for extra hazards not identified in the generic JSA /SWMS, and for jobs with no SWMS/JSA

Step of Task / Hazards / Controls / Level of Risk
……………………………….. / ……………………………….. / ……………………………………….……….. / …….………..
………………………………… / ………………………………. / ……………………………………………….. / ……………...
……………………………….. / ……………………………….. / ……………………………………….……….. / …….………..
……………………………….. / ……………………………….. / ……………………………………….……….. / …….………..
………………………………. / ………………………………. / ………………………………………………… / ………………

Section 3 – Pre-Start meeting for items attended by 2+ staff (ie situations where staff require back-up)

***Note: this section only needs to be completed by the leading officer involved in this task. Signatures are required by this Officer and each of the other participating staff members to illustrate their participation in the pre-start meeting

Is a pre-start meeting required (i.e. will the job involve 2+ staff?) / □ Yes □ No
Has a game plan been established in line with SOPs/JSAs/SWMS? / □ Yes □ No
Are all parties clear on their role and responsibilities in the carrying out of this task? / □ Yes □ No
Has relevant history (what is known) of the person/premises/animal been discussed? / □ Yes □ No
Are any additional controls required as a result of known history/circumstances? If so, what are they? ______
______/ □ Yes □ No

Pre-Start Meeting attendees - By signing below, I am confirming that I have attended the Pre-start meeting and am fit for duty and not adversely affected by fatigue, drugs or alcohol. I am clear about what is required of me in carrying out this task and am adequately trained to do so.

Name of attendee / Signature
Leading Officer:
Attendee:
Attendee:
Attendee:

Section 4 – Sign off on completed checklist

As the officer whose name appears at the top of this checklist, I am responsible for filling out this checklist in it’s entirety and I have ensured that all relevant items above are completed and I have followed all relevant procedures in undertaking these tasks:

Signature …………………………………………….………………….. Date …………………………………………..

Notes:

·  Completed Job Pre-Start Safety Checklist to be placed in Manager’s tray upon return to the office at the end of the work day

·  SWMS/JSAs to be updated with additional Steps of Job, Hazards, Risks,& Controls when they are frequently reoccurring

·  Job Pre-Start Safety Checklist & other completed forms to be registered to the relevant file in Synergy (12.16.085)

(document details) / The electronic version on Connect in the WHS area is the controlled version. Printed copies are considered uncontrolled.
Before using a printed copy, verify that it is the current version. / Page 1 of 2
(Council Details) / Job Safety Checklist / Version No:
Issued:
Next Review:

Hazard Identification

Code / A. Personal Injury/Illness or Death – Due to…
A1 / Access or egress from site / work area / A19 / Noise (eg machinery)
A2 / Asbestos / lead / A20 / Overhead hazards (power lines, scaffold, equipment, works)
A3 / Biological (Exposure to infection / infectious diseases) / A21 / Poor lighting
A4 / Burns (Exposure or contact with radiant heat, fire, hot objects, sparks) / A22 / Pressurized gas, fuel or refrigerant lines
A5 / Chemical exposure (use and handling, spill or leak) / A23 / Plant and equipment (entanglement, crush, cut, stab, puncture, shear, burn, strike, struck by moving machinery / mobile plant)
A6 / Confined Spaces / A24 / Remote or isolated work locations
A7 / Demolition work or alteration of a structure / A25 / Suffocation by gas, fumes, lack of oxygen (exposure to toxic chemical vapours, exposure to toxic combustion products, exposure to toxic chemical reaction gases)
A8 / Drowning / A26 / Slipping (eg on loose or wet or slippery surface
A9 / Dust / Particles / airborne contaminants / A27 / Traffic / Pedestrians (WZTM)
A10 / Electrocution/electric shock / A28 / Tripping (eg over an object)
A11 / Ergonomics (eg workstation, equipment controls) / A29 / Trenching / Excavations (Section C for specific hazard identification)
A12 / Falling from the same level (eg falling over on the same level) / A30 / Uneven surface (eg gradient / embankments)
A13 / Falling from height (eg falling from one level to another) / A31 / Vibration (eg machinery)
A14 / Falling objects (eg from same level or above) / B32 / Working over a pit / hole
A15 / Insect / animal bites and/or stings / A33 / Weather conditions (wind, rain, UV Radiation, visibility)
A16 / laceration from sharp or rough edges / objects / materials / A34 / Other hazards identified - specify
A17 / Manual handling (lifting, bending, twisting, repetitive, cramped, awkward, heavy)

Risk Assessment Matrix

Likelihood / Consequences
1 Insignificant
No injuries, insignificant damage, minimal financial loss, no impact on staff , no impact on service delivery / 2 Minor
Minor injury, first aid treatment or minor medical treatment by GP, AE or Out Patient, internal defusing or minimal external debriefing / 3 Moderate
Moderate injury, medical treatment required by AE, In Patient and/or specialist, external debriefing, moderate property / equipment damage, moderate financial loss, incident contained with outside assistance / 4 Major
Extensive injuries which may result in death, loss of production capability, incident contained with outside assistance, major financial loss, service delivery reduced or suspended / 5 Catastrophic
Death/s, incident with detrimental effect, service delivery stopped or closed permanently, large financial loss, possible abolition of the service
A Almost certain
Is expected to occur / H / H / E / E / E
B Likely
Will probably occur
“has happened” / M / H / H / E / E
C Possible
Might Occur “Ive heard of it happening” / L / M / H / E / E
D Unlikely
Could occur “Not likely” / L / L / M / H / E
E Rare
May Occur “Practically impossible” / L / L / M / H / H

Risk Rating

E - Extreme risk: Activity not to commence. Review of task and controls by relevant Works Supervisor, CWMS Coordinator, Recreational Services

Coordinator with workgroup to identify control measures to reduce the level of risk. If the risk remans Extreme then authorisation from

the General Manager is required before the activity can commence.

H - High risks: Authorised by relevant Works Supervisor, CWMS Coordinator, Recreational Services Coordinator. Should only be an acceptable level

of risk for ‘Major’ or ‘Catastrophic’ consequences.

M - Moderate risk: Authorised by Team Leader. An acceptable level of risk.

L - Low risk: Manage by routine procedures. An acceptable level of risk

Hazard Controls

Selecting control measures (WHS Regulations 2012, Regulation 36 – Hierarchy of control measures)

1.  Eliminate the risks so far as is reasonable practicable

2.  If this is not reasonably practicable, minimise them so far as reasonably practicable by applying the following hierarchy of control measures: Minimise the risk by doing one or more of the following:

o  substituting the hazard

o  isolating the hazard

o  implementing engineering controls

If the risk still remains, minimise the remaining risk by implementing administrative controls

If the risk still remains, minimise the remaining risk by ensuring the provision and use of suitable personal protective equipment (PPE).

(document details) / The electronic version on Connect in the WHS area is the controlled version. Printed copies are considered uncontrolled. Before using a printed copy, verify that it is the current version. / Page 2 of 2