Page 1 of 6 How to use the Assessment Charts 1. Determine the Likelihood on the Qualitative Assessment Process Chart (pick a letter applicable to the task). 2. Determine the Consequence on the Qualitative Assessment Process Chart (pick a number applicable to the task). 3. Take Likelihood score and the Consequence score to the Analysis Matrix and line up both letter and number scores by using the matrix to determine the Rating. 4. Write the scores in the Rating (eg. Likelihood = C - Possible, Consequence = 3 - Moderate, Rating = High). 5. Determine whether a JSA is required. If the is rated above Low then a JSA must be completed. A B C D E Freo Group Limited Qualitative Assessment Process Step 1 Determine the Likelihood Almost Certain Expected to happen Likely May easily happen Possible May happen Unlikely May happen sometime Rare May happen in extreme circumstances 1 2 3 4 5 Step 2 Determine the Consequence Low No injuries or low financial cost Minor First aid treatment or medium financial loss Moderate Medical treatment required or high financial cost Major Lost time injury or major financial loss Critical Death or extreme financial loss Likelihood A (Almost Certain) B (Likely) C (Possible) D (Unlikely) E (Rare) 1 (Low) Legend: Low - 1-5 Moderate - 6-9 High - 10-17 Extreme - 18-25 Freo Group Limited Analysis Matrix Step 3 - Calculate the 2 (Minor) Consequences 3 (Moderate) 4 (Major) 5 (Critical) 11 16 20 23 25 7 12 17 21 24 4 8 13 18 22 2 5 9 14 19 1 3 6 10 15 A JSA MUST be undertaken for any risk greater than a 'Low' rating 1
Page 2 of 6 JSA Task Description: Job Location: Date: JSA #: Revision: Plant, Equipment and Tools Work Group List: Permits, Isolations, Barricades, Signs JSA Participants: # of: Classification: 1 Sign: Supervisor 2 Sign: Crane Operator 3 Sign: Rigger 4 Sign: Dogman 5 Sign: Transport 6 Sign: Other 7 Sign: SUPERVISOR APPROVAL Name: Company: Date: Sign: Personal Protective Equipment (PPE) required (Check box of required PPE): Protective clothing Hi vis clothing Hard hat Safety boots Gloves Safety glasses Mono goggles Face shield Welding mask Harness Hearing protection Dust mask Half face mask Respirator Breathing apparatus Hair protection 2
Page 3 of 6 Step No. Job Step What is performed at this step? Potential Hazards & Consequences 1 Appropriate personnel for the task Incompetent Personnel Unfamiliar work areas Inherent Control Measure 1. Operator to have appropriate licences and verified competent. 2. All personnel to be site inducted Residual 2 Mobilise equipment to work area Equipment not inspected for site Traffic and machinery 1. All equipment inspected/approved for site 2. Obey road/ site rules & signage 3 Unload equipment and tools Manual handling Slips, Trips and Falls Sprains and Strains 1. Correct lifting techniques, assistance from others, 2. Correct PPE 3. Housekeeping 4 Site possession Interference by others, Unauthorised personnel in work area 1. Install hard barricading 2. Correct Flagging 3. Information Tags 5 Concrete placing Manual handling Slips, Trips and Falls Sprains and Strains Cuts scratches Electric shock Noise Concrete spatter/ burn Collision/ struck by concrete truck 1. Correct lifting techniques, assistance from others, 2. Correct and appropriate PPE (Check MSDS) 3. Housekeeping 4. Generator to have RCD and current tag. 5. All power tools and leads to be tagged. 6. Use of lead stands to keep leads above ground. 7.MSDS available at all times 8. Spotter for concrete truck at all times 9. Barrier Cream, 3
Page 4 of 6 Step Inherent Job Step Potential Hazards & Consequences No. What is performed at this step? 6 Control Measure Residual 7 8 9 4
Page 5 of 6 Date Step Description of the Change Including New Hazards and Controls JSA Management of Change Change Made By Change Approved By Team Review By New Rating 5
Page 6 of 6 JSA Worksheet Daily Review - All personnel must read, understand and sign the JSA Date Name Signature Date Name Signature 6