JSA – Scaffolding – Andersons Scaffolding Services Pty Ltd

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This JSA is completed in conjunction with the Safe Work Method Statement (SWMS) for Erecting, Altering and Dismantling Scaffolding.

Minimum PPE consists of Hard Hat, High Vis clothing, Gloves and Steel capped boots. Who is not wearing correct PPE?*

Anyone without the correct PPE must contact management and arrange the appropriate PPE required before starting work on site.

What additional PPE (if any) is required for this site and task?*

Please select all that apply

No other PPE required

Hearing Protection

Safety glasses

Fall Arrest system/Safety Harness

Face Mask

Sun Protection

Personal Floatation Device (PFD)

Isolation locks

Activity - What is the task that you are doing?*

Erecting

Alteration

Dismantling

Is Edge Protection (Rail) being installed as well?*

Yes

Other than working at heights greater than 2 metres, working on or near traffic corridors, and using of mobile plant; are there any other high risk activities at this site?*

Please select all that apply

No other high risk activities

Work carried out near live power lines

Confined spaces

Demolition works

Asbestos

Using Explosives

Diving Work

Artificial extremes of temperatures

Tilt up or pre-cast concrete

Working at depths greater than 1.5m, including tunnels or mines

Pressurised gas distribution mains or piping chemical, fuel or refrigerant lines energised electrical installations/services

Work in an area that may have a contaminated or flammable atmosphere

In or near water or other liquid that involves risk of drowning

Client Name:*

Client Email (if they require a copy of this JSA)

Site Address*

Street Address

Date*

Day

Month

Year

Job Owner:*

A toolbox talk at the start of each day should be completed to discuss any site specific safety information. Please list items toolboxed:*

Please attach photos of the work area/scaffold location:*

Area may include driveways, walkways, exact scaffold location etc. PLEASE NOTE THAT IF YOU ARE NEEDING TO UPLOAD MORE THAN 1 OR 2 IMAGES, YOU WILL EITHER NEED TO REDUCE THE IMAGE SIZE OR SEND THEM TO THE JOB OWNER VIA SMS.

Drop files here or

Max. file size: 100 MB, Max. files: 99.

Are there any hazards or risks specific to this site?*

Using the hierarchy above, what control measures will be put in place to minimise the risk of injury?*

With these control measures put in place, what is the overall risk of an injury occurring?*

Low (Proceed with work and monitor)

Moderate (Proceed with work and monitor)

High (Review and introduce more controls before starting work)

Major (Do not start work, further control measures are needed)

Control measures must be continuously monitored throughout the day to ensure they remain adequate. If an incident or injury occurrs, you must follow incident response procedures first, then control measures MUST be reviewed and amended accordingly to reduce the likelihood of the same or similar injury happening again.

Acknowledgement*

All employees/contractors have participated in the pre-start JSA and acknowledge and agree to abide by these control measures.

This risk assessment process has been developed in consultation and cooperation with employee/workers and relevant Employer/PCBU. I/we have participated in the above risk assessment and understand its contents. I/we confirm that I/we have the skills and training, including relevant certification to conduct the task as described. I/we agree to comply with safety requirements within this risk assessment including risk control measures, safe work instructions and Personal Protective Equipment described.

Person conducting this Prestart meeting:*

Signature

All other workers participating in this JSA:

By signing I am confirming my participation in this pre-start meeting:

Name	Signature	Do you have the correct PPE to start the task? i.e. Gloves, Hard hat, Hi-vis etc.	Actions

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Job Safety Analysis

This JSA is completed in conjunction with the Safe Work Method Statement (SWMS) for Erecting, Altering and Dismantling Scaffolding.

All other workers participating in this JSA:

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