JOB SAFETY ANALYSIS WORKSHEET (JSA)
Activity: Window Cleaning
Workplace:
(Name of building, location within the building and address)
Client Contact:
(Name and phone number)
Client Purchase Order Number:
(If applicable)
Date JSA Prepared:
Date work is to be performed:
JSA No:
Names of all proposed employees:
Authorized by:
JSA prepared by:
Company Name:
Address:
ABN:
Tasks
List the tasks performed during
this assessment
Hazards
Risk Control Measures
Against each task list the hazards
that could cause injury when the
task is performed.
RB
List the control measures required to
eliminate or minimise the risk of injury
arising from the identified hazard.
RA
Responsible
Officer
NOTE: RB = Risk Rating before controls implemented - RA = Risk Rating after controls are implemented
Possible electrocution
2E
Operator to check machinery prior to
use for any possible damage. Check
that the test and tag is current
5E
Operator to ensure this is
done
Tasks
List the tasks performed during
this assessment
Hazards
Risk Control Measures
Against each task list the hazards
that could cause injury when the
task is performed.
RB
List the control measures required to
eliminate or minimise the risk of injury
arising from the identified hazard.
RA
Responsible
Officer
NOTE: RB = Risk Rating before controls implemented - RA = Risk Rating after controls are implemented
Damage to environment
3D
Slip and fall
3C
Trips caused by exposed
hoses/cords
3C
Exposure to chemicals
3C
Damage to self and or client
property
3C
Manual handling injuries
3C
Operator to dispose of waste
appropriately off-site.
Operators to ensure
signage/barricades are used and that
all areas are safe when the job is
finished.
Operators to ensure
signage/barricades are used and extra
care is taken including how the
hoses/cords are laid out.
Always use non-hazardous chemicals
if possible. If hazardous products have
to be used, then the operator is use as
outlined in the MSDS plus ensure
current MSDS including risk
assessments for hazardous chemicals
and a hazardous substance register is
also available on site at all times. PPE
is to be available and used on site.
Operator to ensure work is organised
through client to ensure furniture is
moved. Otherwise all furniture is to be
moved as per the manual handling
procedure dictates.
Operator to ensure machinery and or
property is handled according to the
relevant manual handling procedures.
5D
Operator to ensure this is
done
5C
Operator to ensure this is
done
5C
Operator to ensure this is
done
5C
Operator to ensure this is
done
5C
Operator to ensure this is
done
5C
Operator to ensure this is
done
Tasks
List the tasks performed during
this assessment
Hazards
Risk Control Measures
Against each task list the hazards
that could cause injury when the
task is performed.
RB
List the control measures required to
eliminate or minimise the risk of injury
arising from the identified hazard.
RA
Responsible
Officer
NOTE: RB = Risk Rating before controls implemented - RA = Risk Rating after controls are implemented
Regular breaks may be necessary of
longer jobs.
Checked by: Operator
Method of classify risk
Reference: Workplace Health and Safety - Risk assessment Risk Management Code of Practice
Step 1 Determine Likelihood – What is the possibility of the event happening?
Criteria
Description
Almost certain
Over Straining
On Jobs over 2,000 Meters
Likely
Tripping over hoses
Have offsider pull hoses out of way
Possible
Operating too close to People
working
Place out of area from work way
Unlikely
Could occur at some time
Event is not likely to occur at the site or I
have not heard of it happening
Rare
May occur only in exceptional
circumstances
Event is practically impossible.
Step 2 Determine Consequence - What will be the result if it happens?
Classification
Example detail description
Insignificant
Bruise
Minor
Small Cut
Moderate
Have First Aid Officer Treat
Major
Have worker Go home
Catastrophic
Need Ambulance
Step 3 Determine the risk score
CONSEQUENCE
LIKELIHOOD
Insignificant (A)
Minor (B)
Moderate (C)
Major (D)
Catastrophic (E)
Almost certain
(1)
1A
1B
1C
1D
1E
Likely
(2)
2A
2B
2C
2D
2E
Possible
(3)
3A
3B
3C
3D
3E
Unlikely
(4)
4A
4B
4C
4D
4E
Rare
(5)
5A
5B
5C
5D
5E
Step 4 Record risk score on worksheet (Note – Risk scores have no absolute value and should only be used
for comparison and to engender discussion
RATING
ACTION
ACT NOW – Urgent - do something about the risks immediately.
Significant
Requires immediate attention.
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Medium
Significant
Highest management decision is required urgently.
Insignificant
Follow management instructions.
Acceptable
OK for now. Record and review if any equipment/ people/
materials/ work processes or procedures change.
Hazard Elimination and Risk Control
To properly manage exposure to risks, control measures must be considered for their appropriateness. It is
worth remembering that change may itself introduce new risks that need to be identified, assessed, treated and
monitored.
Example – if one procedure is substituted for another, do employees know of the change, do they accept the
change and is it actually implemented?
Control measures should be considered and implemented in the following order (Hierarchy of Controls):
1. ELIMINATION
4. ENGINEERING CONTROLS
2. SUBSTITUTION
5. ADMINISTRATIVE MEASURES
3. ISOLATION
6. PERSONAL PROTECTIVE EQUIPMENT
1. ELIMINATION of the hazard or preventing the risk.
Examples:
a. Repairing or replacing faulty equipment
b. Eliminating dangerous work processes
2. SUBSTITUTION of the hazard with another that has a lesser risk.
Examples:
a. Use a different, less dangerous piece of equipment
b. Use safer materials or chemicals.
3. ISOLATION of the hazard that is creating risk to employees and others.
Examples:
Electrical cords taped down, Safety switches.
The use of fume cupboards is a good way of isolating dangerous chemicals from workers using them.
4. ENGINEERING CONTROLS - minimising the risk by engineering means.
Examples:
a. Adding machine guards or lock-out devices.
b. changing lighting to reduce glare
c. installing exhaust fans, etc
5. ADMINISTRATIVE MEASURES – Implementing safe work practices.
Examples:
a. Establish written safe work procedures
b. Change daily routines, e.g. so that keyboard operators get breaks from keyboarding to do other
duties.
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6. PERSONAL PROTECTIVE EQUIPMENT – Least effective way of controlling hazards.
Note:
a. PPE is only useful when it is in good condition and always worn correctly.
b. People need to know when to wear their PPE and how to fit and look after it.
c. Employers must ensure that the equipment provided is appropriate for the person and controls the
risk for the person.
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Training Register for JSA
I acknowledge that I have read the attached JSA and the controls are clearly understood. My training and qualifications are current
and allow me to perform my duties whilst complying with this JSA. I have been consulted and have had the opportunity to provide
input.
DATE:
NAME:
Training facilitator:
Page 7 of 7
SIGNATURE: