Land Surveyors Licensing Board

Job Safety Analysis Worksheet Page 1

Project Name: Curtin University Baseline & Exam SIte Client: Land Surveyors Licensing Board
Project Location Address: Kent Street Bentley Project: Practical examinations – Curtin University Site
JSA Approved by: Land Surveyors Licensing Board : (date) Work permit required? yes: no: X
JSA reviewed by: Examiners Review: (date) Date of JSA: 2008
List of names and mobile phone numbers of party members to be handed to
Certificates & Training Required: CSA card: No Site induction: Yes Other:
examiner JSA No:
Gear on site: vehicle: Survey Instruments Other: Sufficient water for 8 hours and appropriate first aid kit. Job No:
TASK HAZARDS RISK SAFE WORK METHOD STATEMENT RISK
elimination most desirable
record the potential injury causing hazard for prevention
list the tasks to be analysed pre post
each task reduction
mitigation least desirable - acts to reduce consequences
Outdoor survey work in examination Heat Stress ext Carry drinking water in the vehicle and drink about one litre per hour under sustained physical acyivity. Generally if ext
conditions someone is thirsty then water must be drunk immediately. If the person is thirsty and has a severe headache then
sig sig
they must stop work and re-hydrate. If the headache persists then medical attention may be required. Schedule
mod regular breakes where conditions dictate. Contact examiner if stress develops mod
low low
Outdoor survey work in examination Skin cancer/Eye Damage ext Skin cancer detection is the individual worker’s responsibility, so have regular checks and find out what skin cancer ext
conditions looks like. Ultra violet (UV) rays from the sun cause cancer so that protection is needed. As UV rays are reflected
sig sig
protection is required even in shade. For UV protection on exposed skin areas, use 30+ sun screen every 2 hours, or
mod more often, where it is rubbed or sweated off. Where lightweight broad rim hat with neck protection, use 30+ UV sun mod
low protection, wear UV protective sunglasses and wear lightweight safety clothing and equipment. low
Outdoor survey work in examination Traffic safety ext Particular care is to be taken when entering or leaving public road ext
conditions Lookout to be kept for Curtin University vehicles (including mowers) moving across site
sig sig
Every survey vehicle is to have a first-aid kit handy and a mobile phone.
mod Record examiner's phone number mod
low low

click text form field to type an entry, click boxes – or print & hand write. KEEP THIS JSA IN THE JOB BOX
 Land Surveyors Licensing Board

Job Safety Analysis Worksheet page 2

TASK HAZARDS RISK SAFE WORK METHOD STATEMENT RISK

elimination most desirable
record the potential injury causing hazard for prevention
list the tasks to be analysed pre post
each task reduction
mitigation least desirable - acts to reduce consequences
ext ext
sig sig
mod mod
low low
ext ext
sig sig
mod mod
low low
ext ext
sig sig
mod mod
low low
ext ext
sig sig
mod mod
low low
ext ext
sig sig
mod mod
low low

click text form field to type an entry, click boxes – or print & hand write. KEEP THIS JSA IN THE JOB BOX
 Land Surveyors Licensing Board
Consequences: page 3
People: Equipment, Project output, Environment:
1 Fatality, permanent disability: extreme damage, extreme project reorganization, major environmental damage
2 Serious injury: high level damage, significant project reorganisation, serious environmental damage
3 Disability: medium level damage, serious project disruption, reversible environmental damage
4 Medical treatment required: low level damage, slight disruption to project, light environmental damage
5 First aid or no injury: negligible damage, minimal project disruption, no environmental damage

Probability – indicate most likely:

A Daily: common or frequent occurrence
B Weekly: has happened or miss has happened
C Monthly: could occur or I have heard of it happening
D Annually: not likely to happen
E Once in 5 years: almost impossible

Risk:
A B C D E
1 EXTREME EXTREME SIGNIFICANT SIGNIFICANT SIGNIFICANT
NOTE:
2 EXTREME SIGNIFICANT SIGNIFICANT SIGNIFICANT MODERATE If ranked extreme or significant
3 SIGNIFICANT SIGNIFICANT SIGNIFICANT MODERATE LOW control measures are required
4 SIGNIFICANT SIGNIFICANT MODERATE LOW LOW

5 SIGNIFICANT MODERATE LOW LOW LOW

Land Surveyors Licensing Board examination candidates are to sign this JSA on their first time at site

I understand & agree to comply with this JSA

PRINT NAME SIGN DATE

Original or copy of completed form to Land Surveyors Licensing Board Examiner