F101 JOB SAFETY ANALYSIS
Date
/
Day
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Month
Year
Date
Job Number
Client Name
Please Select
RIDLEY CLIFTON
RIDLEY TMBA
ADBRI
AHERN
BACK A
BEBBINGTON I
BECKER R
BERNIER B & L
BETTS P
BITWISE P/L
BREDHAUER P
BROWN DP & BI
BULL & BARLEY INN
C & C REFRIGERATION
CAMBOOYA STORE & NEWS
CAMBOOYA UNITING CHURCH
CARLTHROP C
CENTRAL GARAGE
CLEAR MT FAIRVIEW STUD
CLIFTON HOSPITAL
COONAN INVESTMENTS
COURTNEY M
DANEILS D
ERBACHER C
ERGON ENERGY
EUGVIC SUPER FUND
FENTON D
FENTON-ANDERSON P
FERGUSON J
FIECHTNER G
FLOR R & A
FLYNN K
GIBB FARMING CO.
GOOLEY D
GRASSICK J
GRIFFIN J
HAMILTON-SMITH J
HARROW FARMING CO.
HENRY M & G
HINZE W
HOGARTH W
HOLCOMBE & PLATTEL
HOLLIS-NEATH N
HOUSE P
HUGHES C
HUNT B
JAMES P
KEATS G
KOALA FARMS
KORGO M
KROG PLUMBING
KRONK D & L
LANCEY S
LORENZ P
MACKAY A & T
MARINYA FARMING CO.
Mc DERMOTT K
Mc GINLEY P & B
MITCHELL M
MITCHELL R & M
MOLLER G
NIELSEN R & B
NOLLER JI & LC
PARSONS AD & GL
PIONEER HI-BRED AUST P/L
PORTER M & A
QFES
QUADE & ROBERTS
RHULE DEVELOPMENTS.
RICHARDS T & M
ROBERTS PAUL
ROBERTS PETER
ROCKSHORE P/L
RURAL AFFINITY INSURANCE
SHEPHERD A
SHIPTON L
SLACKSMITH A
SOUTH EAST ENGINEERING
STEHN R
STENZEL A
STENZEL G
STRICKS PUMP REPAIRS
TAYLOR A
TRC
VIEVERS R
WATTS J & C
WELLS M
WESTVIEW SEEDLINGS
WRIGHT G & K
YATES S
ZELLER E
Other
Client Email
example@example.com
Address
Street Address
Street Address Line 2
City
State
Post Code
Address 1
Street Address
Street Address Line 2
City
State
Post Code
Address 2
Street Address
Street Address Line 2
City
State
Post Code
Address 3
Street Address
Street Address Line 2
City
State
Post Code
Address 4
Street Address
Street Address Line 2
City
State
Post Code
Address 5
Street Address
Street Address Line 2
City
State
Post Code
Address 6
Street Address
Street Address Line 2
City
State
Post Code
Address 7
Street Address
Street Address Line 2
City
State
Post Code
Address 8
Street Address
Street Address Line 2
City
State
Post Code
Address 9
Street Address
Street Address Line 2
City
State
Post Code
Address 10
Street Address
Street Address Line 2
City
State
Post Code
Address 11
Street Address
Street Address Line 2
City
State
Post Code
Address 12
Street Address
Street Address Line 2
City
State
Post Code
Address 13
Street Address
Street Address Line 2
City
State
Post Code
Address 14
Street Address
Street Address Line 2
City
State
Post Code
Address 15
Street Address
Street Address Line 2
City
State
Post Code
Address 16
Street Address
Street Address Line 2
City
State
Post Code
Address 17
Street Address
Street Address Line 2
City
State
Post Code
Address 18
Street Address
Street Address Line 2
City
State
Post Code
Address 19
Street Address
Street Address Line 2
City
State
Post Code
Address 20
Street Address
Street Address Line 2
City
State
Post Code
Address 21
Street Address
Street Address Line 2
City
State
Post Code
Address 22
Street Address
Street Address Line 2
City
State
Post Code
Address 23
Street Address
Street Address Line 2
City
State
Post Code
Address 24
Street Address
Street Address Line 2
City
State
Post Code
Address 25
Street Address
Street Address Line 2
City
State
Post Code
Address 26
Street Address
Street Address Line 2
City
State
Post Code
Address 27
Street Address
Street Address Line 2
City
State
Post Code
Address 28
Street Address
Street Address Line 2
City
State
Post Code
Address 29
Street Address
Street Address Line 2
City
State
Post Code
Client Name & Address
*
Client / Work Site Name
Street Address
City
State
Post Code
Job Description
*
Back
Risk Management
SAFE WORK SWMS used for this activity
SWMS 100 Manual Handling
SWMS 101 Working on Construction Sites
SWMS 102 Working with Power Drills
SWMS 103 Working with Angle Grinders
SWMS 104 Working on or near a Roadway
SWMS 105 Working with Cranes
SWMS 106 Operate Mini Digger Excavator
SWMS 107 Confined Spaces
SWMS 108 Hot Works
SWMS 109 Work in Ceiling Spaces
SWMS 110 Fatigue Management
SWMS 111 Work near Hydro Vac Plant
SWMS 112 Excavate near Underground Services
SWMS 113 Heat Stress
SWMS 114 Trenching & Excavation
SWMS 116 CORONA VIRUS CONTROL
WORK AT HEIGHT SWMS used for this activity
SWMS 200 Work at Heights
SWMS 201 Working with Ladders
SWMS 202 Working with Scissor Lifts
SWMS 203 Work with Elevated Work Platform (Less than 11 meters)
SWMS 204 Work with EWP (11 meters & above)
ELECTRICAL SWMS used for this activity
SWMS 300 Live Testing & Fault Finding
SWMS 301 Isolate Isolate & Work on Electrical Equipment
SWMS 302 Service or Repair Electrical Equipment
SWMS 303 Service or Repair Electrical Appliance
SWMS 304 Electrical Installation Work
SWMS 305 Surface Installation of Conduit or Duct
SWMS 306 Installation of Cables and Supports
SWMS 307 Installation of Electrical fittings
SWMS 308 Isolate and Work with PV Systems
SWMS 309 Installation of Underground Mains
SWMS 310 New Building Rough In
SWMS 311 New Building Cut Out
SWMS 312 New Building Fit Off
SWMS 315 Install Solar (PV) Systems
SWMS 316 Install Underground Cables & Conduits
REFRIGERATION SWMS used for this activity
SWMS 400 HVAC Refrigeration Plant Installation & Repairs
SWMS 401 HVAC Duct Work Installation & Repairs
SWMS 402 HVAC Refrigeration Plant Routine Maintenance
SWMS 403 HVAC Filter Exchange
SWMS 404 HVAC Refrigeration Coil Cleaning
SWMS 405 HVAC Refrigerant Handling
SWMS 406 HVAC Installation & Replacement of Split System AC Units
SWMS 407 HVAC Service or Repair Split System A.C. Unit
DATA & COMMS SWMS used for this activity
SWMS 500 Terminating & Splicing Fibre Optics
SWMS 501 Data Installation
FIRE PROTECTION SWMS used for this activity
SWMS 700 Fire Protection Systems
SWMS 701 Test Fire Protection
ELEVATORS & ESCALATORS SWMS used for this activity
SWMS 800 Isolate Lift from Service
SWMS 801 Elevator Electrical Repair
SWMS 802 Access & Work on Top of Lift
SWMS 803 Access & Work in the Pit
SWMS 804 Machine Room Maintenance
AUTOMATIC DOORS & GATES SWMS used for this activity
SWMS 900 Automatic Door Installation
SWMS 901 Automatic Gate Installation
SWMS 902 Automatic Gate & Roller Door Service & Repair
HAZARDOUS MATERIALS SWMS used for this activity
SWMS 1100 Working with Asbestos
SWMS 1101 Working with Conduit Glue
SWMS 1102 Working with Silicone Products
SWMS 1103 Working with Inox Penetrating Oil
SWMS 1104 Working with CRC ZINC IT
SWMS 1105 Working with Unleaded Petrol
SWMS 1106 Diesel Fuel
SWMS 1107 Crystalline Silica (RCS)
PLANT & EQUIPMENT SWMS used for this activity
SWMS 1200 Mobile Plant
SWMS 1201 Operate Cable Locator
SWMS 1202 Operate Chainsaw
Are there additional Safety or Environmental Hazards not covered by the SWMS?
*
Please Select
No
Yes
Additional Safety & Environmental Hazard (1)
Task
Hazard 1
Hazard
Risk 1
Risk
Risk Level 1
Risk Level
Controls 1
Controls
Residual Risk 1
Residual Risk
Additional Safety & Environmental Hazard (2)
Task
Hazard 2
Hazard
Risk 2
Risk
Risk Level 2
Risk Level
Controls 2
Controls
Residual Risk 2
Residual Risk
Additional Safety & Environmental Hazard (3)
Task
Hazard 3
Hazard
Risk 3
Risk
Risk Level 3
Risk Level
Controls 3
Controls
Residual Risk 3
Residual Risk
Additional Safety & Environmental Hazard (4)
Task
Hazard 4
Hazard
Risk 4
Risk
Risk Level 4
Risk Level
Controls 4
Controls
Residual Risk 4
Residual Risk
Do the above hazards require new or updated SWMS ?
Please select
No
Yes
Back
Permits Required
Hot Work Permit Required?
*
Please Select
No
Yes
Use Client Hot Work Permit
Confined Space Permit Required?
*
Please Select
No
Yes
HOT WORK PERMIT
Ignition Controls Employed
Fire Extinguishers adjacent to the work area (Not Permanent Extinguishers)
Combustable Materials Removed (Includes from above & below the work area)
Ignition Sources Removed (Includes from above & below the work area)
Catch Mats or Boards positioned over flooring & grates
Fire & Heat Sensitive Equipment (Electric Cables) in or near the work area covered
Water/Hose primed & ready at the work area (When clear of electrical equipment)
Safety Observer available to monitor fire risk during the work
Safety Observer available to monitor fire risk after the work
Confined Space Controls Employed
Locate equipment outside the confined space
Extraction fan inlet located close to the contamination source
Contaminates expelled where they cannot recirculate or harm other workers
Arc welding suspended and equipment secured against accidental arc or contact
Gas welding/cutting suspended and equipment removed from the confined space
Name of Person in Direct Control
Chris Henry
Daniel Knecht
Max O'Leary
Other
Name
E-mail
Date
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Day
-
Month
Year
Date Picker Icon
Permit valid until:
1
2
3
4
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7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Signature of Person in Direct Control
CONFINED SPACE PERMIT
ISOLATION REQUIRED
*
NO
YES
CHECK
Electrical
Mechanical
Pneumatic
Gas
Water/Steam
Hydraulic
Radiation
Fire Control
Other
Isolation checked by:
Chris Henry
Daniel Knecht
Max O'Leary
Other
Name
Signature
ATMOSPHERIC TESTS
*
TEST RESULT
Oxygen (between 19.5 & 23.5%)
Explosive gas (less than 5%LEL)
Carbon Monoxide (less than 30 ppm)
Hydrogen Sulphide (less than 10 ppm)
Other
Tests Conducted by:
Chris Henry
Daniel Knecht
Max O'Leary
Other
Signature
VENTILATION
*
NATURAL
FORCED
SPRAY
TYPE
PPE
*
REQUIRED
Supplied Air Respirator
Harness and lifeline
Hand Protection
Protective Clothing
Personal Atmospheric Monitoring Equipment
Communication Equipment
Self-Rescue Respirator
Eye Protection
Protective Footwear
Hearing Protection
Safety Helmet
Other
ENTRY PARTY
*
CSE TICKET
ENTER
LEAVE
Chris Henry
Daniel Knecht
Max O'Leary
Other
SURFACE PARTY
*
CSE TICKET
ENTER
LEAVE
Chris Henry
Daniel Knecht
Max O'Leary
Other
AUTHORITY TO ENTER
Chris Henry
Daniel Knecht
Max O'Leary
Other
Name
E-mail
Date
-
Day
-
Month
Year
Date Picker Icon
Permit Valid Until
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Signature of Authorised Person in Direct Control
Back
Acceptance
I/We certify that the above SWMS and control measures have been implimented and the Safety Risk has been reduced to an acceptable level
*
Chris Henry
Daniel Knecht
Max O'Leary
Other
Name
Name of other person
E-mail
*
Email of other person
Signature of Person in Control of the work
*
Submit Report
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