To save as PDF: use your browser's Print → Save as PDF or Print to PDF. This form prints as 2 pages (A4).
High-risk construction work — complete before work begins.
PAGE 1 OF 2
Work Steps & Hazard Analysis
List each step of the task. Identify hazards, rate the risk (L = Likelihood × C = Consequence), document controls, then re-rate the residual risk.
| # | Work Step | Hazards | Risk (L×C) |
Control Measures | Residual Risk |
Responsible |
|---|---|---|---|---|---|---|
| 1 | Site setup & access | Unauthorised entry, traffic | 3×3=H | Fencing, signage, traffic management plan | 2×3=M | Site supervisor |
| 2 | Excavation / trenching | Cave-in, underground services | 4×4=E | Locate services (Dial Before You Dig), shore/bench, exclusion zone | 2×4=H | Excavation supervisor |
| 3 | Working at heights | Falls from height | 4×5=E | Edge protection, scaffolding, harness/lanyard, exclusion zones below | 2×5=H | Heights supervisor |
| 4 | Mobile plant operation | Struck by, crush injuries | 3×5=E | Exclusion zones, spotters, communication, plant inspection | 2×4=H | Plant operator |
| 5 | Material handling | Manual handling injuries, falling objects | 3×3=H | Mechanical aids, team lifts, hard hats, drop zones | 2×3=M | Leading hand |
| 6 | Hot work (welding/cutting) | Fire, burns, fumes | 3×4=H | Hot work permit, fire watch, ventilation, PPE | 2×3=M | Supervisor |
PPE Requirements
| PPE Item | Required (Y/N) |
|---|---|
| Hard hat | |
| Safety glasses | |
| Hi-vis vest | |
| Steel cap boots | |
| Hearing protection | |
| Gloves | |
| Harness / lanyard | |
| Respiratory protection |
Additional Hazards Record any site-specific hazards not covered above
| Hazard | Risk (L×C) | Control Measures | Responsible |
|---|---|---|---|
Worker Sign-on Register All workers must read and understand this JSA/SWMS before commencing work
| # | Name (print) | Company | Signed | Date |
|---|---|---|---|---|
| 1 | ||||
| 2 | ||||
| 3 | ||||
| 4 | ||||
| 5 | ||||
| 6 | ||||
| 7 | ||||
| 8 | ||||
| 9 | ||||
| 10 |
Declaration
I confirm that this JSA/SWMS has been prepared for the task described, all identified hazards have been assessed, and control measures are in place. All workers listed above have been briefed on the content of this document and understand the hazards and controls.