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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT
ACTIVITY OR TASK: LIFT PERSONNEL IN SCISSOR LIFT
JSA Preparation & task work team:
Competence = Relevant Training/Qualifications + Experience

Location / Project: Job Number: JSA Number: G02 Codes of Practice & Legislation that are applicable: JSA Revision:

Competence/ Qualificn reqd to complete work safely JSA approved by person responsible i.e.
Team Leader / Tradesman

Name:

Position / Competence/ License:

Date:

2. HAZARD IDENTIFICATION
compulsory

Identify hazards that may be present by ticking items on the list below.

3. PRECAUTIONS: hard hat, safety glasses, safety boots

ADDITIONAL PRECAUTIONS
Gloves: type . Goggles Full Face Shield High Visibility Vest Harness Fire Extinguishers Barricades Ventilation Lighting Erect Scaffolding to access Respirator or Dust mask Erect Warning signs Personal Locks or Tag system Group isolation Welding screen Fall Arrest systems Welding Face Shield

WORK LOCATION
Difficult Entry/Exit Oxygen Deficiency Oxygen Excess Engulfment (trench collapse) Poisonous Gas Present Temperature Extremes Defined Confined Space Explosive Gas Present

HAZARDOUS AREA
Hazardous Substances - attach MSDS to JSA Working at Heights Remote Area Motor Room Hazards Toxic Substances Potential for Difficult Rescue

HIGH RISK
Falling Objects Poor Lighting Slippery Surfaces Multiple Electrical Feeds Trip Hazards Electrical Hazards - LV Electrical Hazards - HV Manual Handling Sharp Materials Ladders used in the task Working at Heights Working near Crane & Crane Runways Rail Movement Pressurised Fluids Flamm. Materials Present

HIGH RISK
Suspended loads Poor Visibility Inhalable Dusts/Fibres High Noise Levels Use of Chemicals Elevated Work Platform Difficulty to Communicate amongst workers Moving Machinery Tools & Equipment Heat/ Sunlight/ Radiation Traffic Movement Working near Operation Processing Lines Live Rails Pneumatics

PERMITS
Hot Work Excavation Confined Space Hazardous Work Clearance Access to Area High Voltage Access Scaffolding Other?

HAZARDOUS SUBSTANCES in work area / to be used

-attach MSDS

PERMIT NUMBER

4. ENVIRONMENTAL HAZARDS (IMPACTS) tick those identified

Air Pollution (dust, fumes) Noise (plant & equipment) Spills to drains/waterways Spills to ground Soil Erosion Hazard to Flora /Fauna

Other:

RISK RATING TABLE

This table is used to calculate whether the hazard you have identified is Extreme: 9-10 High: 7-8, Medium: 5-6 or Low: 3-4
The objective of rating the risk is to lower the risk by initiating risk control measures. The score is

Consequences: how severe an Likelihood: How likely is it to injury? 1st Aid be that bad? Death Serious Medical
Injuries Treatment Reqd reqd

Almost Certain Expected to Occur

10 9 8 7 6

9 8 7 6

8 7 6 5

7 6 5 4 3

5. EQUIPMENT REQUIRED: Static Plant & Equipment

Mobile Plant & Equipment

Likely could
happen sometime

Moderate could
happen but not likely

Unlikely could
happen but very rare

Revision Date: March 2005

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Rare - could happen

but probably never will

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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT
Safety / Emergency Equipt
noted in the JSA risk score column on the next page both before & after risk control measures have been nominated.

NAME OF TASK: LIFT PERSONNEL IN SCISSOR LIFT

JSA Number: Risk Rating

G02

Rev: Risk Rating

Of the risk following corrective action

Step No.
Logical sequence

Identify the hazards (health and safety or Use table on Break down Job into steps. Each step should accomplish a major task and environmental) associated with each step, the previous page to examine each to find all possible risk factors be logical. score risk Environmental Aspects

Sequence of Basic Job Steps

Potential Safety & Environmental Hazards/Impacts

Recommended Corrective Action or Procedure

Determine what actions are necessary to eliminate or minimise all hazards that could lead to an accident, injury, illness or environmental incident. The risk must be reduced or controlled to a level that is acceptable before work commences. Indicate who is to perform the action where applicable against each action

1 2

Obtain PTW Identify work area

Injury / damage as a result of incorrect information Risk of injury due to low awareness of work environment, Unauthorised operator, Mechanical failure, Falling from heights, Scissors lift topples, Coming into contact with Instruments, Valves or other items.

Obtain correct PTW. Training in PTW system. Operators for this task will be trained and competent in the use of SCISSOR LIFTS no other person is to operate the SCISSOR LIFT for this task, First task is to complete your daily checks to assess that the SCISSOR LIFT is in a safe working condition and complete the attached logbook for future reference. Check all oil and fuel levels where applicable or the charge level of the Electric type units. Prior to SCISSOR LIFT set up assess area for obstructions, drains, uneven or unstable ground and any other item that may raise a concern for the work crew. At all times while driving the SCISSOR LIFT along road ways etc the occupants of the work platform of the scissor lift must keep inside the platforms safety rails If the area that requires the use of a scissor lift is congested, then it is advisable to gain the services of an observer to assist the operator to gain access into the area with out the risk of damage to live plant, equipment or personnel

Revision Date: March 2005

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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT
3

Set up scissor lift

Fire / explosion

Gain a clearance and permit prior to setting scissor lift up on Roadway. The small electric scissor lift is best to be transported to the relevant work sites with the use of a Franna crane to maintain a high battery level. Scissor lift to be directed to set up area by competent person. Scissor lift to operated (driven) and be set up on firm and level foundation as per manufacturers specifications. While setting up scissor lift and equipment if anything is assessed as a physical risk ask for assistance. If the scissor lift is fitted with an attachment point for a safety harness then all occupants of the scissor lift must wear an approved harness. Visually monitor all scissor lift movements and ask for assistance if vision is obscured. Conduct take 5 and Job Start meeting with the entire work crew to discus tasks at hand any potential hazard that may impact on the safety of Personnel. Gain all relevant road closures to eliminate uncontrolled traffic movement in work area. If the scissor lift is working or parked on the Refinery road system then we must protect our work area, personnel and scissor lift by placing high visibility barricading around this area to eliminate any access from unauthorised vehicles, pedestrians or bicycles from entering the danger zone. While working near the edge of Roadways keep Scissor lift a minimum of 1 metre from the edge of the roadway and operate under the guidance of a spotter. If during the scissor lifts operation the supporting surface subsides or shows signs of the scissor lift wheels penetrating and sinking into the ground or if the work area has altered and is deemed to be unsafe, stop work and contact the work group Supervisor. Make the area safe and then once the concerns are discussed if there is an alternative location the scissor lift can be positioned then conduct a new job start meeting and continue on or if the area cannot be deemed safe to continue, stop the work until it is deemed safe to do so.

Prepare to carry out tasks from scissor Scissor lift topples lift platform Fire, explosion Collision with plant, equipment, Vehicles or personnel. FALLING FROM HEIGHTS Edge of road way collapses

Revision Date: March 2005

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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT
5

Install and remove equipment as required

Falling tools people below Fall from Scissor lift High winds Hand or eye injury

Barricade work area at ground level to prevent people entering in the danger zone for falling objects Position the scissor lift so that personnel working from the work platform do not have to lean out or over reach past the railing to complete the task. If this is a requirement then stop work and conduct another take 5 and job start to discus the risks and an alternate method for completion of the task at hand. Access the risk from high winds and Electrical storms on a regular basis. halt the job if necessary, assess the conditions and if cleared up conduct take 5 and job start. Gloves and safety glasses must be worn When placing scissor lift into lay down or parking area maintain minimum of 1 metre clearance between the scissor lift wheels and the edge of the roadway. As a suggestion with the small electric scissor it is efficient to transport this unit with a franna crane. Please note this is a guide only for firm and stable ground and each area must be assessed on an individual basis prior to this motion-taking place. The electric scissor lift requires that it is placed on charge at the end of each night, gain all relevant permits and clearances and plug in the tested electrical lead to the end of the unit where the battery L.E.D lights a positioned. electric scissor it is efficient to transport this unit with a franna crane. Please note this is a guide only for firm and stable ground and each area must be assessed on an individual basis prior to this motion-taking place. The electric scissor lift requires that it is placed on charge at the end of each night, gain all relevant permits and clearances and plug in the tested electrical lead to the end of the unit where the battery L.E.D lights a positioned.

Placing scissor lift into lay down or parking area

Scissor lift topples Falling from heights

Revision Date: March 2005

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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT

Revision Date: March 2005

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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) CONSULTATION & SIGN-OFF RECORD
I confirm by my signature below, that I have attended a briefing on the requirements of the attached Job Safety & Environment Analysis and agree to perform the work in the manner detailed on it. I confirm that copies of the relevant Permits, MSDS's, Isolation Plans etc. have been reviewed.
JSA NAME JSA No:

Rev: DATE

NAME

(Please print)

SIGNATURE

THIS SAFE WORK BRIEFING / TRAINING WAS CARRIED OUT BY (responsible person at that location) : Name: Signature: Date: Client sign off (where applicable) Site / Project Manager sign off (document reviewed)

Revision Date: March 2005

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