SAFE WORK METHOD STATEMENT/JSA WORKSHEET

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1 Employer: Nelson Agricultural and Landscaping Services Zone: SWMS/JSA No: Job/Task: Landscaping Services Work Locations/ areas: Supervisor/ leading hand: Initiated by Date: OHS review Date:30/6/2017 Management Review Date:30/06/2018 SWMS/JSA Sign off and acceptance of proposed work method and associated responsibilities No Surname First Name Classification Employed by Signature date 1 Dean Fomiatti Operator/Owner Nelson Ag

2 Brief description of work to be undertaken: Reference and detail applicable sections of: Manufacturer / Supplier recommendations / specifications Australian Standards Nos Codes of Practice List key individuals and qualifications: Key safety duties/responsibilities: Detail training required to complete work: As signed in on page 1 Wear correct ppe & and obey all site regulations Statement Of Attainment or VOC Ticket Detail any approvals required e.g. Permit to Excavate: N/A List Certificates or Licenses required to operate plant or perform tasks: Drivers licenses / OH&S Whitecard List plant and equipment to be used for work Tractor and implements List plant, equipment and area safety inspections required: See Attached Nelson Ag Daily Plant Checklist Key contact number Name Dean Fomiatti Key contact number Name Key contact number Name

3 Project No. Key safety issues to be managed and key safety controls to be implemented: Key PPE issues: Helmet Safety footwear High Vis Clothing Safety glasses All unloading equipment (eg Chains/Slings) for lifting purposes only must be tagged for usage Other forms of PPE to be worn when required Safety Legislation: Legislation OHS ACT 2000 OHS Regulation 2001 Moving Plant on Construction Site Code of Practice 2004 Control of Workplace Hazardous Substances 2006 (eg Lime MSDA will be attached as separate addendum) Interim Guide to Operating Plant in Proximity for Overhead Power Lines RTA G22 Truck and Plant Requirements Excavation Code of Practice 2000 Project OHS&R Management Plan Safe Work Guidelines

4 Step No Process steps List the steps needed to do the job in the sequence to be done 1 Pre start Truck /Tractor safety Entering and exiting truck Assess site traffic conditions and controls Complete daily prestart checklist Potential Hazards Against each step list potential hazards that could cause injury when the jobs done Risk level 1-4 Hazard Control Measures Slip, fall, trip causing injury 3 Walk around the truck before starting housekeeping Collision with plant, equipment or people 3 Attend daily toolbox talk Determine traffic expectations flow for day Take care at all times and be on the look-out for pedestrians workers and other plant Dirty/broken windscreen, mirrors 4 Fix clean windscreens mirror prior to starting Action By (print name of person) 2 General option Driving on a construction site Reversing the truck Transport of materials 3 Arrival on site Site Traffic and working plant Accident causing damage to equip or persons 2 Drive defensively obey road signs and traffic control plans Collision with other plant equipment or 1 Check reversing alarm persons Use a spotter Injury to people other vehicles and 2 Cover loads at all times whilst in transit occupants Use appropriate tie down straps as necessary Over load truck 3 Only load truck to within safe working load Collision with or obstruction to traffic 2 Follow site rules and direction of traffic controllers

5 Chisel Plough/ Ripping/ Dripline 5 Rotary Hoeing/ Slashing/ Broadcasting 6 Levelling/ Direct drill seeding 7 Lime/ Gypsum Spreading/ Spraying herbicide Dust, Rollover on slopes 3 Wear mandatory site PPE required, Visually check site, Avoid steep slopes and banks, Ensure amber safety beacon operational Dust, Power Take Off (PTO) shaft 3 Wear mandatory site PPE required, Visually check site, Avoid steep slopes and banks, Daily Inspection, Ensure adequately greased, Ensure amber safety beacon operational Dust, Rollover on slopes 3 Wear mandatory site PPE required, Visually check site, Avoid steep slopes and banks, Ensure amber safety beacon operational Dust, Lift Injury 3 Wear mandatory site PPE required, Visually check site, Avoid steep slopes and banks, Ensure amber safety beacon operational, Ensure correct lifting practices (ie multiple personnel). Refer to attached MSDA sheet for AG Lime application. Risk level refer to Risk Matrix overleaf to determine risk level 1, 2, 3 or 4

6 Likelihood How Likely is it that someone will get hurt? Very Likely (Could Happen soon) Likely (could happen occasionally) Moderate (possible it might happen) Unlikely (could happen but rarely) Very Unlikely (could happen but probably never will) Consequence How severely could someone get hurt? Catastrophic Death very serious environmental/struc tural and or plant damage Major Permanent disability loss of production or major environmental structural and or plant damage Legend: 1 Critical /Extreme Risk 3.- Moderate Risk 2 High Risk 4.- Low Risk Moderate Temporary disability or moderate environmental structural and or plant damage Minor Minor injury or minor environmental structural and or plant damage Environmental Checklist Is the activity scheduled for approved hours of operation (7am-6pm M-F and 8am-1pm Sat) if not please advise Environment Manager or proposed works and submit an Out of Hours Work Proposal. Have you considered potential for dust and associated controls? If so what are these (eg water cart, spray grass, cover stockpile)? Is their potential for polluted water to leave the site or enter a drain? If so outline your control methods(eg sediment fences, gravel socks, diversion drains, vegetated buffers) Are the works going to be very noisy? What possible controls or measures can you use to reduce noise? Do you need a specified concrete washout area? Have you considered all other possible environmental risks?