(Council
Details)
Job Pre-Start Safety Checklist – Health, Environment & Community Safety
Version No:
File: 12.16.085
Date …….……………………………….
Issued:
Next Review:
Officer …………………….……………………………………
Location and Contact Person(s)
……………………………………….………………….………………….………………….………………….
Section 3 – Pre-Start meeting for items attended by 2+ staff (ie situations where staff require back-up)
…………………………………………………………………………………………………………………………………….
***Note: this section only needs to be completed by the leading officer involved in this task. Signatures are required
by this Officer and each of the other participating staff members to illustrate their participation in the pre-start meeting
Section 1: Awareness of SWMS/JSAs, hazards and SOPs
Is a pre-start meeting required (i.e. will the job involve 2+ staff?)
□ Yes
□ No
The task is:
Has a game plan been established in line with SOPs/JSAs/SWMS?
□ Yes
□ No
Are all parties clear on their role and responsibilities in the carrying out of this
task?
Has relevant history (what is known) of the person/premises/animal been
discussed?
Are any additional controls required as a result of known history/circumstances? If
so, what are they? __________________________________________________
__________________________________________________________________
□ Yes
□ No
□ Yes
□ No
□ Yes
□ No
□ Food premises inspections/audits (JSA # tba)
□ Handling/capture of animals (JSA # tba)
□ Communicable disease inspections (JSA # tba)
□ Block inspections (JSA # tba)
□ Domestic premises -squalor/pests (JSA # tba)
□ Abandoned vehicles (JSA # tba)
□ Swimming pool inspections (JSA # tba)
□ Site visitations - Community Safety (JSA # tba)
□ Syringe collection (JSA # tba)
□ Parking enforcement (JSA # tba)
□ Plumbing/wastewater works inspections (JSA # tba) □ Other (task with no JSA/SWMS tba) ……………………..
…………………………………………………………….……..(Complete section 2 Assessment then report this to supervisor)
Does the JSA/SWMS cover all the hazards and steps in the job?
Is the full scope of work and steps understood?
Do chemicals on site have SDS’s?
Has everyone recently read / signed SWMS / JSAs & SOPs?
Are you working alone in a remote or isolated area?
Are there contractors on site?
Will existing/changing weather conditions impact on the work
and/or hazards identified (eg Rain, High Winds, Hot Weather)?
Is appropriate PPE available and being utilised?
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ No (Complete Section 2 Assessment)
□ No (Clarify with supervisor)
□ No (Obtain through supervisor)
□ No (To be done before work starts)
□ No (See WHS 22.1 Staff Safety Calls)
□ No (See Contractors Forms)
□ Yes
□ Yes
□ No (specify conditions & controls)
□ No (Obtain through supervisor)
………………………………………………………………………….………………………………………………………………………
Is there anything else to consider? (specify) ………………………………………………………………………………………
Section 2 Assessment for extra hazards not identified in the generic JSA /SWMS, and for jobs with no SWMS/JSA
Step of Task
Hazards
Controls
Level of Risk
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(document details)
Pre-Start Meeting attendees - By signing below, I am confirming that I have attended the Pre-start meeting
and am fit for duty and not adversely affected by fatigue, drugs or alcohol. I am clear about what is required
of me in carrying out this task and am adequately trained to do so.
Name of attendee
Signature
Leading Officer:
Attendee:
Attendee:
Attendee:
Section 4 – Sign off on completed checklist
As the officer whose name appears at the top of this checklist, I am responsible for filling out this checklist in it’s entirety and I have
ensured that all relevant items above are completed and I have followed all relevant procedures in undertaking these tasks:
Signature …………………………………………….…………………..
Date …………………………………………..
Notes:



Completed Job Pre-Start Safety Checklist to be placed in Manager’s tray upon return to the office at the end of the work day
SWMS/JSAs to be updated with additional Steps of Job, Hazards, Risks,& Controls when they are frequently reoccurring
Job Pre-Start Safety Checklist & other completed forms to be registered to the relevant file in Synergy (12.16.085)
The electronic version on Connect in the WHS area is the controlled version. Printed copies are considered uncontrolled.
Before using a printed copy, verify that it is the current version.
Page 1 of 2
(Council
Details)
Version No:
Job Safety Checklist
Issued:
Next Review:
Hazard Identification
Code
A1
A2
A3
A4
A5
A. Personal Injury/Illness or Death – Due to…
Access or egress from site / work area
Asbestos / lead
Biological (Exposure to infection / infectious diseases)
Burns (Exposure or contact with radiant heat, fire, hot objects, sparks)
Chemical exposure (use and handling, spill or leak)
A19
A20
A21
A22
A23
A6
A7
Confined Spaces
Demolition work or alteration of a structure
A24
A25
A8
A9
A10
A11
Drowning
Dust / Particles / airborne contaminants
Electrocution/electric shock
Ergonomics (eg workstation, equipment controls)
A26
A27
A28
A29
A12
A13
A14
A15
A16
A17
Falling from the same level (eg falling over on the same level)
Falling from height (eg falling from one level to another)
Falling objects (eg from same level or above)
Insect / animal bites and/or stings
laceration from sharp or rough edges / objects / materials
Manual handling (lifting, bending, twisting, repetitive, cramped, awkward,
heavy)
A30
A31
B32
A33
A34
Noise (eg machinery)
Overhead hazards (power lines, scaffold, equipment, works)
Poor lighting
Pressurized gas, fuel or refrigerant lines
Plant and equipment (entanglement, crush, cut, stab, puncture,
shear, burn, strike, struck by moving machinery / mobile plant)
Remote or isolated work locations
Suffocation by gas, fumes, lack of oxygen (exposure to toxic
chemical vapours, exposure to toxic combustion products,
exposure to toxic chemical reaction gases)
Slipping (eg on loose or wet or slippery surface
Traffic / Pedestrians (WZTM)
Tripping (eg over an object)
Trenching / Excavations (Section C for specific hazard
identification)
Uneven surface (eg gradient / embankments)
Vibration (eg machinery)
Working over a pit / hole
Weather conditions (wind, rain, UV Radiation, visibility)
Other hazards identified - specify
Risk Assessment Matrix
Likelihood
A Almost certain
Is expected to occur
B Likely
Will probably occur
“has happened”
C Possible
Might Occur “Ive heard of it
happening”
D Unlikely
Could occur “Not likely”
E Rare
May Occur “Practically
impossible”
Risk Rating
E - Extreme risk:
H - High risks:
M - Moderate risk:
L - Low risk:
1 Insignificant
No injuries,
insignificant damage,
minimal financial loss,
no impact on staff , no
impact on service
delivery
2 Minor
Minor injury, first aid
treatment or minor
medical treatment by
GP, AE or Out Patient,
internal defusing or
minimal external
debriefing
H
H
M
H
L
M
Consequences
3 Moderate
Moderate injury, medical treatment
required by AE, In Patient and/or
specialist, external debriefing, moderate
property / equipment damage,
moderate financial loss, incident
contained with outside assistance
5 Catastrophic
Death/s, incident with
detrimental effect,
service delivery
stopped or closed
permanently, large
financial loss, possible
abolition of the service
E
4 Major
Extensive injuries
which may result in
death, loss of
production capability,
incident contained with
outside assistance,
major financial loss,
service delivery
reduced or suspended
E
H
E
E
H
E
E
E
L
L
M
H
E
L
L
M
H
H
Activity not to commence. Review of task and controls by relevant Works Supervisor, CWMS Coordinator, Recreational Services
Coordinator with workgroup to identify control measures to reduce the level of risk. If the risk remans Extreme then authorisation from
the General Manager is required before the activity can commence.
Authorised by relevant Works Supervisor, CWMS Coordinator, Recreational Services Coordinator. Should only be an acceptable level
of risk for ‘Major’ or ‘Catastrophic’ consequences.
Authorised by Team Leader. An acceptable level of risk.
Manage by routine procedures. An acceptable level of risk
Hazard Controls
Selecting control measures (WHS Regulations 2012, Regulation 36 – Hierarchy of control measures)
1.
2.
Eliminate the risks so far as is reasonable practicable
If this is not reasonably practicable, minimise them so far as reasonably practicable by applying the following hierarchy of control measures: Minimise the risk by
doing one or more of the following:
o substituting the hazard
o isolating the hazard
o implementing engineering controls
If the risk still remains, minimise the remaining risk by implementing administrative controls
If the risk still remains, minimise the remaining risk by ensuring the provision and use of suitable personal protective equipment (PPE).
(document details)
The electronic version on Connect in the WHS area is the controlled version. Printed copies
are considered uncontrolled. Before using a printed copy, verify that it is the current version.
Page 2 of 2