Job Safety Analysis

JSA




This JSA is only for personnel who have successfully
completed ALGN Driver Induction and have
commenced the ALGN Training Program

HAZARD

Potential to Cause
Injury/Death

Y/N
HOW OFTEN

Frequent 10 times + hour
Occasionally 6-9 time hour
Infrequent 3-5 times hour
Unlikely <2 times/hour
ACTIVITY

Describe the activity being
carried out that involved
exposure to the hazard
RISK RATING

Refer Risk
Assessment
Table
Manual Handling
Could you be injured by:
MH01
Bending down with hands
below mid-thigh height?

MH02
Working in a cramped
position?

MH03
Extending arms above the
shoulders?

MH05
Moving the object, load or
equipment?

MH06
Using force to hold or restrain
the object, load or equipment?

MH07
What is the approximate
weight of the object, load or
equipment? .............kg

Plant and Equipment
Could you:


PE01
Be caught on a part of the
object, load or equipment?

PE02
Be struck by a part of the
object, load or equipment?

PE03
Come in contact with
electricity, radiation, vibration,
compressed gas or fluid?

PE04
Find it difficult to reach or
operate the controls?

Hazardous Substances
Could the task involve:

HS01
Coming in contact with liquids,
gases, powders or creams?

HS02
Producing dust, smells or
odours, mists, liquids or
vapours?

HS03

Handling or coming in contact
with biological materials or
products?

Working Environment
Will you have to work in an
environment which is:


WE01


Dusty or smelly (strong
odours)?

WE02
Noisy?


Name: __________________________________

Date/Time: ______________________________

Location: _______________________________

Description of Task: ______________________

________________________________________

_____________________________________________

_____________________________________________

_____________________________________________
This procedure must be followed every-time
you are required to work by yourself on site.
HAZARD


(Potential to cause
injury/illness)


Y
N
HOW OFTEN


Frequent 10 times + hour
Occasionally 6-9 time hour
Infrequent 3-5 times hour
Unlikely <2 times/hour
ACTIVITY



Describe the activity being
carried out that involved
exposure to the hazard
RISK
RATING


Refer Risk
Assessment
Table Manual Handling
Could you be injured by:

MH01
Bending down with
hands below mid-thigh
height?

MH02
Working in a cramped
position?

MH03
Extending arms above
the shoulders?

MH05

Push, pull or turn the
object, load
or equipment?


MH06
Use force to hold or
restrain the
object, load or
equipment?

MH07

What is the
approximate weight
of the object, load or
equipment?
.............kg

Plant and Equipment
Could you:


PE01
Be caught by a part of
the object, load or
equipment?


PE02


Struck by a part of the
object, load or
equipment?

PE03


Come in contact with
electricity, radiation,
vibration, compressed
gas or fluid?

PE04



Could it be difficult to
reach or operate the
controls?







Document ID: ALGN005
Version: 1.0
HAZARD


Potential to Cause
Injury/Death


Y/N
HOW OFTEN

Frequent 10 times + hour
Occasionally 6-9 time hour
Infrequent 3-5 times hour
Unlikely <2 times/hour
ACTIVITY

Describe the activity being
carried out that involved
exposure to the hazard
RISK RATING

Refer Risk
Assessment
Table
Do you believe or feel that the work
environment is:


WE03 Bright (too much light)?



WE04 Stuffy (no air flow)?



WE05 Dark (not enough light)?



Is the person(s) at risk of:



WE06 Tripping or slipping?



WE07 Falling from height?



WE08 Being electrocuted?



WE09 Being struck by an object



Working Arrangements
Does the person:



WA01
Have to work irregular or
extended hours of work
(overtime)?





WA02
Have to work at a pace which
is too fast (difficult to maintain)
or too slow?





WA03
Believe or feel that they may
be subject to intimidation,
violence or verbal abuse?



WA04
Find it difficult to maintain
necessary communication with
their colleague(s) (working in
confined space)?


Has the person carrying out the
task suffered any:


WA05
Physical pain or mental
discomfort while carrying out
the task?







If yes, describe what part of the body
suffered the pain or discomfort and under
what circumstances: