JSA Template 5 - Plumbing and Wastewater System Inspections

Council Job Safety Analysis (JSA) Version No:
Issued:
Logo) For construction and other work Next Review:
Legislative Requirements Steps for filling out the JSA template
The Job Safety Analysis (JSA) should be completed in consultation with the worker(s) or others who will undertake the work. All those involved in
Regulation 34Duty to identify hazards. A duty holder, in managing risks to health and safety, must the work are to be advised of any requirements which are identified during the analysis.
identify reasonably foreseeable hazards that could give rise to risks to health and safety.
Steps
Regulation 289: Construction work is defined as any work carried out in connection with the construction,
alteration, conversion, fitting-out, commissioning, renovation, repair, maintenance, refurbishment, demolition, 1. Complete Part A JSA Summary with the job details
decommissioning or dismantling of a structure. Construction work includes the following: 2. Use Part B Hazard Identification to Identify the hazards associated with the task/job
o any installation or testing carried out in connection with an activity referred to in the above definition
3. Enter the Hazard Identification Codes from Part B Hazard Identification on Part C Hazard and Risk Identification, Assessment and
o the removal from the workplace of any product or waste resulting from demolition Control Risk Rating in the Hazard Code column.
o the prefabrication or testing of elements, at a place specifically established for the construction work, for
4. In the Hazard Description column describe what the hazard is the Hazard Description column on Part C Hazard and Risk Identification,
use in construction work
Assessment and Control Risk Rating.
o the assembly of prefabricated elements to form a structure, or the disassembly
of prefabricated elements forming part of a structure 5. In the Current Hazard Controls column list the current hazard control measures that are currently in pace Part C Hazard and Risk
o the installation, testing or maintenance of an essential service in relation to a structure Identification, Assessment and Control Risk Rating.
o any work connected with an excavation 6. Use Part E - WHS Risk Assessment Table to identify the Initial Level of Risk for each hazard.
o any work connected with any preparatory work or site preparation (including landscaping as part of site 7. Complete the Initial Risk Rating to identify how effective the control measures are at eliminating or reducing the level of risk. If the risk rating
preparation) carried out in connection with an activity referred to in the above definition is High or Extreme, review the Current Hazard Controls, develop and document additional controls on the Additional Controls column.
o an activity referred to in the above definition that is carried out on, under or near water, including work on Complete the Residual Risk Rating with the additional control measures in place to assess if the level of risk has been reduced to a lower /
buoys and obstructions to navigation acceptable level.
Regulation 35 Managing Risks to Health and Safety. A duty holder in managing risks to health and safety 8. In the Who Is Responsible column, identify who is responsible to implement the identified control measures.
must-
9. Completed Part D Other Safety Considerations
o Eliminate risks to health and safety so far as is reasonably practicable
10. After completion the JSA, meet with all those who will be working on the job and go through the completed form to ensure they are familiar
o if it is not reasonably practicable to eliminate risks to health and safety minimise those risks so far with the process and their safety requirements. They should then sign off on the JSA.
as is reasonably practicable
Section 18 Reasonably Practicable. What is reasonably practicable in ensuring health and safety taking Selecting control measures (WHS Regulations 2012, Regulation 36 Hierarchy of control measures)
into account. 1. Eliminate the risks so far as is reasonable practicable
(a) the likelihood of the hazard or the risk concerned occurring; and 2. If this is not reasonably practicable, minimise them so far as reasonably practicable by applying the following hierarchy of control measures:
(b) the degree of harm that might result from the hazard or the risk; and Minimise the risk by doing one or more of the following:
o substituting the hazard
(c) what the person concerned knows, or ought reasonably to know, about;
o isolating the hazard
(i) the hazard or the risk; and o implementing engineering controls
(ii) ways of eliminating or minimising the risk; and If the risk still remains, minimise the remaining risk by implementing administrative controls
(d) the availability and suitability of ways to eliminate or minimise the risk; and If the risk still remains, minimise the remaining risk by ensuring the provision and use of suitable personal protective equipment (PPE).
(e) after assessing the extent of the risk and the available ways of eliminating or minimising the risk, the cost
JSA compliance (information, monitoring and review)
associated with available ways of eliminating or minimising the risk, including whether the cost is grossly
1. Brief each team member on the JSA before commencing work. Ensure each team member knows work is to stop if the JSA is not followed.
disproportionate to the risk.
2. Observe the work being carried out and monitor compliance with the JSA. Review risk controls regularly, including:
How to Manage Work Health & Safety Risks Code Of Practice before a change occurs to the work itself, the system of work or the work location
How to manage and control asbestos in the workplace if a new hazard associated with the work is identified
when new or additional information about the hazard becomes available
Managing the risk of falls at workplaces when a notifiable incident occurs in relation to the work
These Codes applys to all types of work and all workplaces covered by the WHS Act. when risk controls are inadequate or the JSA is not being followed.
In all of the above situations stop the work, review the JSA, adjust as required and re-brief the team.
PSSI Element 8 - Hazard identification, evaluation and control Keep the JSA in a readily available location for the duration of the high risk construction work.
The organisation must ensure a hazard management process that includes identification, evaluation and Following the completion of the work, completed forms and CWMS are to be filed to relevant file on synergy.
control is in place.
WHS 048.4 - JSA FORM The electronic version on Connect in the WHS area is the controlled version. Printed copies are considered uncontrolled. Page 1 of 13
Updated Dec 2013 by WHS Officer Before using a printed copy, verify that it is the current version.
FORM WHS
Issued:
3
Dec 2013
Logo) For construction and other work Next Review: Dec 2015
PART A JSA Summary
Enter Council Details JSA Number
Workgroup: Environmental Health Work Location: Private premises / worksites

Work Activity: Plumbing and wastewater system inspections
Work/s Supervisor: To enter
Contact Phone: To enter

Names of Workers To enter Names of Workers To enter
who were involved in who were also
developing this JSA consulted in
developing this
JSA.
Person Responsible for To enter Last JSA Review

ensuring compliance with JSA Date:
Person(s) Responsible for To enter Signature:
reviewing the JSA
This is a predefined JSA. Should there be identified risks or hazards once onsite then this JSA will need to be updated with those risks/hazards and
controls implemented and the additions signed off.
This JSA will need to be authorised and re-communicated.
(Doc version details) The electronic version on Connect in the WHS area is the controlled version. Printed copies are considered uncontrolled. Page 2 of 13
Before using a printed copy, verify that it is the current version.
Issued:
3
Oct 2013
Logo) For construction and other work Next Review: Oct 2015
PART B Hazard Identification

Use the following prompts to identify the hazards associated with the activity as indicated in Part B Hazard and Risk Identification, Assessment and Control
If the prompt is applicable tick Yes then continue with the risk assessment in Part B. If the prompt is not applicable tick No. If the prompt does not apply tick N/A.
Code A. Personal Injury/Illness or Death Due to Yes No N/A Code B. Fire or Explosion Resulting from the activity Yes No N/A
A1 Access or egress from site / work area B1 Ignition source in hazardous area (Naked flame, sparks, welding)
A2 Asbestos / lead B2 Generation of static discharge
A3 Biological (Exposure to infection / infectious diseases) B3 Ignition of flammable or explosive vapours
A4 Burns (Exposure or contact with radiant heat, fire, hot objects, sparks) B4 Decomposition reaction
A5 Chemical exposure (use and handling, spill or leak) B5 Chemical reaction
A6 Confined Spaces B6 Reaction of incompatible materials
A7 Demolition work or alteration of a structure B7 Detonation of explosive materials
A8 Drowning B8 Dust explosion
A9 Dust / Particles / airborne contaminants B9 Overpressure of vessel or tank
A10 Electrocution/electric shock B10 Other specify:
A11 Ergonomics (eg workstation, equipment controls) Code A. Excavation & Trenching Due to. Yes No N/A
A12 Falling from the same level (eg falling over on the same level) (See Note 1 for C1 Underground essential services
criteria) C2 Fall or dislodgement of earth or rock
A13 Falling from height (eg falling from one level to another) (See Note 1 for criteria) C3 Fall from one level to another
A14 Falling objects (eg from same level or above) C4 Inappropriate placement of excavated materials, plant or other
A15 Insect / animal bites and/or stings loads
A16 laceration from sharp or rough edges / objects / materials C5 The instability of any adjoining structure caused by the excavation
A17 Manual handling (lifting, bending, twisting, repetitive, cramped, awkward, heavy) C6 Any previous disturbance of the ground including previous
A19 Noise (eg machinery) excavation
A20 Overhead hazards (power lines, scaffold, equipment, works) C7 The instability of the excavation due to persons or plant working
A21 Poor lighting adjacent to the excavation
A22 Pressurized gas, fuel or refrigerant lines C8 The presence of or possible inrush of water or other liquid
A23 Plant and equipment (entanglement, crush, cut, stab, puncture, shear, burn, C9 Hazardous manual tasks
strike, struck by moving machinery / mobile plant) C10 Hazardous chemicals (e.g. these may be present in the soil where
A24 Remote or isolated work locations excavation work is to be carried out)
A25 Suffocation by gas, fumes, lack of oxygen (exposure to toxic chemical vapours, C11 Hazardous atmosphere in an excavation (e.g. using Methyl Ethyl
exposure to toxic combustion products, exposure to toxic chemical reaction Ketone (MEK) solvent for PVC pipes in poorly ventilated trenches)
gases) C12 Vibration and hazardous noise
A26 Slipping (eg on loose or wet or slippery surface C13 Overhead essential services (powerlines) and ground mounted
A27 Traffic / Pedestrians (WZTM) essential services (transformers, gas and water meters).
A28 Tripping (eg over an object)
A29 Trenching / Excavations
A30 Uneven surface (eg gradient / embankments)
A31 Vibration (eg machinery)
A32 Working over a pit / hole
A33 Weather conditions (wind, rain, UV Radiation, visibility)
A34 Other hazards identified Physical threat from violent persons
Issued:
3
Oct 2013
PART C Hazard and Risk Identification, Assessment and Control

Hazard Hazard Description Current Hazard Controls Risk Additional Controls Residual Who is Responsible?
Rating (to reduce the Level of Risk) Write the name of the person responsible
Code Risk
With Using the Hierarchy of Controls, (1. Eliminated, 2. (supervisor or above) to implement the
(From What is the problem? Describe the hazards Rating
current Substitution, 3. Engineering Controls, 4. Administrative control measures identified.
Part B) and the risks and how they could cause
controls Controls, 5 Personal Protective Equipment) list the Review
harm to workers or the public.
in place control measures required to eliminate or reduce the risk
Review of injury and detail how the control measures will be put
in place.
A1 Inspect wastewater works Inspect site prior to entry for visible hazards Nil hazard controls have been in place prior to
Access or egress from 3 points of contact development of JSA
site/work area Barricading, barrier tape and signage
Housekeeping
o Site is worksite Look before moving L L
and could cause PPE
sprains, strains,
cuts, abrasions,
concussion
A2 Inspect wastewater works Where complaint is about asbestos, remain in Nil hazard controls have been in place prior to
Asbestos/lead car and do visual risk assessment about development of JSA
o Old pipework suitability for further exploration. Internal training
will also be provided about asbestos risks and
may contain how to manage them and understanding where it
asbestos. Risk is and is not suitable to attend on-site. Where
of mesothelioma visual assessment deems it is not safe for officer H H
if unmanaged to attend and inspect closer, organize for
asbestos specific contractor to attend and assess
risk or utilise the precautionary principle in the
South Australian Public Health Act and have the
person illustrate to you that there is no risk to
public health from the asbestos.
A8 Inspect wastewater works Assess presence of swimming pool, dams, open Nil hazard controls have been in place prior to
Drowning septic tanks or other bodies of water prior to development of JSA
o Workspace may entering inspection site. Remain a safe distance
from them when undertaking activities to avoid
be near falling in. Walk slowly around these water bodies
swimming pools, in case of slipping into water. Keep a safe H H
dams or open distance to inspect tank with both feet on the
septic tanks and ground.
falling in could PPE non slip shoes
result in death
Issued:
3
Oct 2013
Code Risk
in place.
A9 Inspect wastewater works Remain in vehicle if dust is too prevalent and Nil hazard controls have been in place prior to
Dust/particles wait until dust subsides. Cease inspection if dust development of JSA
o Inhalation of will not subside. Ask excavator to cease
excavation whilst you are inspecting if it is
dust may impact causing excessive dust..
on breathing or L L
dust in eyes may
cause
irritation/sight
issues
A11 Contact premise user/owner and organise Nil hazard controls have been in place prior to
Record Findings working space prior to attending development of JSA
Ergonomics M M
Record notes upon return to a comfortable
o Lack of desk and position in the vehicle. Or if more appropriate for
seat onsite may the site, record information upon return to the
cause injury office.
from moving
body into difficult
positions to
record notes.
Ergonomics
o If done back in L If workspace is inadequate and cannot be made L
Ensure that workspace is adequate with Council
office, usual RSI standard chair, desk and computer screen. suitable thought is to be given as to how to
and office based Replace any broken or substandard equipment. remedy
risks Advise staff about adequate assessment of
workstation. If aids are required to assist with
posture or comfort, ensure that these are
available and utilised by staff.
Issued:
3
Oct 2013
Code Risk
in place.
A12 Inspect wastewater works Awareness of surroundings, visual Nil hazard controls have been in place prior to

inspection before moving to a new location development of JSA
within a site.
Housekeeping
Wear stable, nonslip sensible shoes which
Falling from the are those without excessive or thin/pointy
heel and with a base that provides some
same level (eg falling over grip
on the same level) due to L L
Ensure that access and egress is safe to
o slippery surface use
o Uneven surface Ensure that floor coverings are not worn or
o Cluttered torn or wet
worksite Workplace inspections
o Sprains, strains, Signage advising of altered ground /
cuts, abrasions, surface conditions
concussion
A13 Inspect wastewater works Have awareness of trenches and other Nil hazard controls have been in place prior to
Falling from height (eg excavated areas on a building site. Cease development of JSA
falling from one level to inspection if the ground is not stable or if
another) you cannot safely conduct inspection
without risk of falling into trench/hole. L L
o Sprains, strains,
cuts, abrasions,
concussion
A15 Inspect wastewater works Check Councils property database for dog Nil hazard controls have been in place prior to
Insect / animal bites and/or registration development of JSA
stings Inspect the site for animals/insects prior to
o Dogs or other entry.
animals/insects Where a site has high dry grass be aware
M M
on site may bite of the possible presence of reptiles.
or sting First aid kits available in all Council
vehicles. Mobile phone available and
charged in case of snake bite. Knowledge
of snake bite first aid.
Issued:
3
Oct 2013
Code Risk
in place.
Laceration from sharp or inspection before moving to a new location development of JSA
rough edges / objects / within a site. First Aid kits are to be
materials available in all Council vehicles in case of
o Metal work and laceration injury Apply first aid.
pipe cutting Housekeeping L L
implements or Worksite Inspection
pipes PPE
themselves may
cause cuts or
abrasions
A17 Inspect wastewater works In accordance with the Alexandrina Council Nil hazard controls have been in place prior to
Manual Hazardous Tasks- Manual Handling policy, no specific development of JSA
Musculoskeletal Disorders direction available.
(sprains, strains, back Bend from the knees
injuries, joint / bone injuries, Refrain from high or sudden use of force
nerve injuries,) Dont maintain sustained or awkward L L
o Sprain or strain posture
injury from Undertake Manual Handling risk
bending down to assessment
inspect pipework Use 2 people where there is a requirement
to move an item that is heavier than 4kg
Poor lighting inspection before moving to a new location development of JSA
o Plumbing within a site. If lighting insufficient, cease
additions inside inspection until adequate light is available.
premises where Take a torch L L
areas may be
poorly lit could
lead to
trips/injury
Issued:
3
Oct 2013
Code Risk
in place.
A23 Inspect wastewater works Approach site in view of excavation and Nil hazard controls have been in place prior to
Plant and equipment other heavy machinery. development of JSA
(entanglement, crush, cut, Wear steel cap shoes and high visibility
stab, puncture, shear, burn, vest.
strike, struck by moving Get the attention of the excavator operator
machinery/mobile plant) before entering the site. H H
o Injury from being Wear PPE-Hi Vis
hit by excavation Cease inspection if unable to safely get the
vehicle onsite attention of machinery operator without
entering site first.
A24 Inspect wastewater works Charged Mobile telephone Nil hazard controls have been in place prior to
Remote or isolated work Use of Whos In to keep other staff development of JSA
locations informed of whereabouts.
o Hostage or Use of remote and isolated workers policy
and Answering Adelaide service for M M
Injury without
medical attention monitoring the safe return of staff.
Take a backup staff member where unsure.
Slipping (eg on loose or wet inspection before moving to a new location development of JSA
or slippery surface) within a site.
o Sprains, strains, Wear steel cap boots.
Use 3 points of contact where available L L
cuts, abrasions,
concussion
A27 Inspect wastewater works Vehicle is to be safely pulled over to the Nil hazard controls have been in place prior to
Traffic/pedestrians side of the road so as to reduce risk of development of JSA
o Injury from being danger to other vehicles/pedestrians or risk
hit by vehicle to officer/vehicle from inappropriate location
of parked vehicle. M M
onsite
Issued:
3
Oct 2013
Code Risk
in place.
Tripping (eg over an object) inspection before moving to a new location development of JSA
o Sprains, strains, within a site.
cuts, abrasions, Wear steel cap boots.
Housekeeping L L
concussion
Trenching/excavations inspection before moving to a new location development of JSA
o Sprains, strains, within a site. Ensure that when moving over
cuts, abrasions, site, care is taken to avoid moving close to
from falling in open trenches. L L
Trenches should be secured from
unathorised access (if greater than 1.5ms)
First aid kit in car
Uneven surface (eg inspection before moving to a new location development of JSA
gradient/embankments) within a site.
o Sprains, strains, Use 3 points of contact on stairs
L L
cuts, abrasions
A32 Inspect wastewater works Remain a safe distance from an open Nil hazard controls have been in place prior to
Working over a pit/hole septic tank or open soakage pit or development of JSA
o Sprains, strains, excavations.
cuts, abrasions Keep both feet on the ground whilst
inspecting. L L
from falling in
Issued:
3
Oct 2013
Code Risk
in place.
A33 Drive to site Refer to Inclement weather and UV Nil hazard controls have been in place prior to
Weather conditions protection procedure. Ensure that staff are development of JSA
o Vehicle accident aware of the policy and its application is E
E
resulting in injury utilised within the team.
to driver Vehicle licensed and insured
Driver licensed
Inspect wastewater works

Weather conditions L
L
o Slip injury from Follow council procedure for working
wet or UV outdoors. Use appropriate PPE
exposure/burn (sunglasses, sunscreen, long clothing etc).
Be aware of the surrounding areas and
conditions
A34 Speak to plumber Do not enter a property alone if there is any Nil hazard controls have been in place prior to
Physical/psychological expectation of a physical threat arising. development of JSA
threat from Walk away if the site is unsafe and report
violent/aggressive persons this to Manager.
Ensure your mobile is charged and M M
o Injury from
violence available
Issued:
3
Oct 2013
Part D Other Safety Considerations

Type of Permit / Licence Required: (please indicate by ticking yes/no box)
Yes No Yes No Yes No Yes No Yes No
Gov Authority Lock Out Scaffolding / Scafftag EWP Disp or Trans Solid /
(eg, TSA) Liquid Waste
Hot Work Traffic Control Radiation Explosives Asbestos
Confined Shoring / Battering / Boxing / Gas Test Air /Water Personnel Cage
Space Benching / Sheet Piling Emissions
Other
(specify)
PPE Requirements: (please indicate by ticking yes/no box)

Yes No Yes No Yes No Yes No Yes No
Goggles/ Dust Mask Signage Safety Harness Long Pants
Glasses
Face Shield Gloves Fire Blanket Static Line Chemical resistant
Gloves
Hearing Safety Boots Fire Extinguisher PPE for Clothing for Welding
Protection Asbestos
Respirator Helmet Hi-Vis Clothing Long Sleeves Chemical resistant
Clothing
Wet weather
clothing
Other Note: long pants and sleeves required in line with Council policy and may not be required in all instances.
(specify)
Key safety equipment / plant / facilities Key Safety Checks Experience Training / Qualifications required to
complete the work
Footwear Assess surroundings Manual handling
Utilise Answering Adelaide Behaviour assessment & conflict resolution
By signing below, I am confirming that I understand the contents and will comply with the safety requirements identified in this JSA.
Name Signature Date Name Signature Date Name Signature Date
Cassie Tuck
Angela Sorger
Michelle Foster
Karen Rokicinski
Issued:
3
Oct 2013
Part E - WHS Risk Assessment Table

Risk is analysed by determining the consequences and their likelihood of an event occurring to provide a Level of Risk. Existing controls and their
effectiveness and efficiency should be also taken into account when identifying a Consequence Rating and a Likelihood Rating.
Where no reliable or relevant past data is available, subjective estimates may be made which reflect an individuals or groups degree of belief that
a particular event or outcome will occur. Assumptions made in the analysis should be clearly stated.
Consequences
1 2 Minor 3 Moderate 4 Major 5 Catastrophic
Likelihood Insignificant Minor injury, first aid Moderate injury, Extensive injuries Death/s, incident
No injuries, treatment or minor medical treatment which may result in with detrimental
insignificant medical treatment required by AE, In death, loss of effect, service
damage, minimal by GP, AE or Out Patient and/or production delivery stopped or
financial loss, no Patient, internal specialist, external capability, incident closed permanently,
impact on staff , defusing or minimal debriefing, moderate contained with large financial loss,
no impact on external debriefing property / equipment outside assistance, possible abolition of
service delivery damage, moderate major financial loss, the service
financial loss, incident service delivery
contained with outside reduced or
assistance suspended
A Almost certain H H E E E
Is expected to
occur
B Likely M H H E E
Will probably occur
has happened
C Possible L M H E E
Might Occur Ive
heard of it
happening
D Unlikely L L M H E
Could occur Not
likely
E Rare L L M H H
May Occur
Practically
impossible
Risk Rating
E - Extreme risk: Activity not to commence. Review of task and controls by relevant Manager / Coordinator, with workgroup to identify
control measures to lower the level of risk. If the risk remains Extreme then authorisation from the General Manager is
required before the activity can commence.
H - High risks: Authorised by relevant Manager / Coordinator. Should only be an acceptable level of risk for Major or Catastrophic
consequences.
M - Moderate risk: Authorised by Supervisor / Team Leader. An acceptable level of risk.
L - Low 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. Eliminate the risks so far as is reasonable practicable
2. 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).
Issued:
3
Oct 2013

JSA Template 5 - Plumbing and Wastewater System Inspections

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Council Job Safety Analysis (JSA) Version No:

PART A JSA Summary

Enter Council Details JSA Number

Workgroup: Environmental Health Work Location: Private premises / worksites

Contact Phone: To enter

Person Responsible for To enter Last JSA Review

PART B Hazard Identification

PART C Hazard and Risk Identification, Assessment and Control

Inspect wastewater works

Part D Other Safety Considerations

PPE Requirements: (please indicate by ticking yes/no box)

Part E - WHS Risk Assessment Table

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