11 JSEA and SWMS Kitchen Exhaust Canopy

Project:
Job No: Client:

Project Manager:
ABN 69 105 083 341
JSEA form for site specific WMS inductions High Risk Construction Activity JSEA No.: 11
Lake Air Systems Pty Ltd, Trading as: Air Systems Duct Cleaning Unit 3/32 Beach Street Kippa-Ring QLD 4021 Ph: 07 3284 0088 Fax: 07 3284 0044. Email: sales@airsystems.com.au
JOB SAFETY ENVIRONMENT ANALYSIS/SAFE WORK METHOD STATEMENT (PART 1)

Workplace / Area: Kitchen Scope of works: Clean Kitchen Exhaust system
JSEA/WP Development Reviewed By: Date:

Alex Moretti Who is responsible for (Client if applicable)
Consultation Team
the monitor & review of
this JSEA: Site supervisor
Reviewed By:(Team Leader/Project Manager) Date:
Suzanne Moiso Wayne Stevens 24/05/2021
TYPE OF PERMIT REQUIRED: (please indicate by ticking the appropriate box)

Yes No Yes No Yes No Yes No Yes No
Electrical Isolation Y Scaffolding N Gas Test N Solid/Liquid Waste Y
___________ Permit
Roof Access Y High Voltage N Lifting N Scissor Ticket N
Hot Work N Excavation N Radiation N Explosives N Forklift Ticket. N
Isolated location N Personnel Cage N Confined Space N High Pressure Water N
PPE AND/OR CONTROL MEASURES REQUIRED: (please indicate by ticking the appropriate box)
Yes No Yes No Yes No Yes No Yes No
Safety N Dust Mask Y Height Safety Y Electrical Safety N Barricading/Signs Y
Glasses
Face Shield N Safety Harness N Fire Blanket/Spark N Specific Training / Y Emergency Plan N
containment Induction
Respirator Y Gloves Y Extinguisher N SDS.’s Y Manual Handling Y
Details of Extra PPE Requirements: The above are additional to the standard site PPE requirements.
SAFETY REFERENCE MATRIX Table 1. Table 2.
Page 1 of 10
Document No.: AS-SAFEWMS-011 Prepared by: Wayne Stevens Revision: 24/05/2021

Project:
Job No: Client:
Project Manager:
ABN 69 105 083 341
AS Probability Risk Level Consequences
/ A – almost certain People
B – likely 1 – incident report only
C – possible 2 – first aid treatment
D – unlikely 3 – medical treatment
E – rare 4 – lost time injury or illness
5 – fatality or permanent disability
Table 3. Table 4. Environment
Risk Level 1 -- no environmental impact
Yellow - almost certain 2 – on site release immediately contained
Red - likely 3 – off site release contained with outside assistance
Green - possible 4 – off site release with no detrimental effect
Blue - unlikely / rare 5 – toxic release off site with detrimental effect
P1– Potential Death, Permanent Disability or Major Structural
Damage or Potential incident resulting in permanent or
significant detrimental impact on environmental elements (natural
NZS ISO 31000 : 2009 Risk Management-Principals and
VH = Very High Do not proceed or built).
Guidelines H = High Supervision
Hierarchy of Control M = Medium Check hourly P2 – Potential Temporary Disability or Minor Structural Damage
1 = Elimination L = Low Check weekly or Potential incident impacting on environmental elements (natural
Modify the process method or material to eliminate the hazard completely. or built) that can be contained and remediated to acceptable
2 = Substitution conditions with no long-term effect. Any Infringement of statutory
Replace the material, substance or process with a less hazardous one. conditions.
3 = Separate
Isolate the hazard from the person by safeguarding or by space or time. P3 – Potential incident, which has the potential to cause minor,
damage to the environment or persons that would require first aid.
4 = Redesign / Engineering Controls
Residual risk rating– Use Table 1.
Redesign or modify the part or process to reduce or eliminate the risk. Likelihood multiplied by the impact the risk happening after
5 = Administration controls are in place. This rating cannot be calculated unless
Adjust the exposure time of conditions or process by training, procedures / there are controls of in place that have been inherently assessed.
signs etc.
6 = PPE
Use appropriately designed and properly fitted equipment where other
controls are not practicable or are accessed.
Page 2 of 10

Project:
Job No: Client:
Project Manager:
ABN 69 105 083 341
Potential Environmental Hazards (please indicate by ticking the appropriate box) Safety Data Sheets (SDS) Relevant To Fire / Emergency Equipment Reqd
This item requires continual review to include the specific area or activity Works Being Undertaken (consider.fire extinguishers, rescue gear, etc.
Nil Nil Principal contractors Emergency

Evacuation Plan

NOTE: EVERY MEMBER OF THE WORK CREW/TEAM MUST SIGN OFF ON THE JSEA/WMS FORM TO ACKNOWLEDGE AWARENESS & PARTICIPATION
Team Member to print name Team Member to Sign Date Team Member to print name Team Member to Sign Date
Page 3 of 10

Project:
Job No: Client:
Project Manager:
ABN 69 105 083 341
STEP JOB STEP POTENTIAL HAZARD Risk REQUIRED HAZARD CONTROL
Environmental
Consequence
Residual Risk
Consequence
NO. List the steps required to Against each step list the potential / Rank For each hazard identified list the control
Responsible
Probability
Probability
perform risk hazards that could cause injury / L measures required to eliminate or
Person
RISK
the task in the sequence damage when the task step is M minimise the risk of injury.
they are performed. H
Carried out. VH
1 Unfamiliarity with site Site Hazards C 2 M 1 Complete walk-through, site-specific E 1 L ASDC

People movement induction
2 Review JSEA at pre-start Housekeeping C 2 M 1 Read and understand the JSEA, if you 2 L ASDC
meeting / toolbox Unknown job site hazards are unsure of anything or wish to make a D
consultation comment make sure it is noted and
signed on the toolbox documents.
3 Review work location and Manual Handling equipment, B 2 M 1 Move equipment to site. C 2 M ASDC
discuss hazards, access Housekeeping trips and falls Ensure access and egress ways are
and egress. Slips and falls. clear of debris.
Damage to roof sheeting. Stand only on designated walkway on
roof.
Safety harness or roof edge protection
may be site requirement, check with site.
4 Check fan unit Remove access panel, lifting, slips B 2 M 1 Ensure no work below fan unit, ensure C 1 L ASDC
and falls work not carried out in wet or windy
weather
5 Access ductwork and clean Grease, cuts from edges C 2 M 2 Completed if required, grease is D 2 L ASDC
internal transferred and bagged before exit from
ductwork
Page 4 of 10

Project:
Job No: Client:
Project Manager:
ABN 69 105 083 341
Environmental
Consequence
Residual Risk
Consequence
Responsible
Probability
Probability
Person
RISK
Carried out. VH
Environmental
Consequence
Residual Risk
Consequence
Responsible
Probability
Probability
Person
RISK
Carried out. VH
6 Access Fan unit Grease, cuts from edges, slips falls C 2 M 2 Gloves to be worn during cleaning D 2 L ASDC
from grease. works.
Grease to be bagged and removed from
site
7 Clean roof sheeting Slips and falls c 2 M 1 Wear appropriate non-slip footwear D 2 L ASDC
8 Pack up site Access doors left out, filters not C 2 M 2 Two people to observe and check all D 2 L ASDC
replaced, unit not de-isolated air access panels are in place and filters are
flow problems. returned to canopy clean.
9 Clean floor and benches Client dissatisfaction, loss of C 2 M 1 Remove cardboard from floor and check D 1 L ASDC
potentially more work. all areas for cleanliness, clean as
required
12 Return all equipment back Lost tools and misplaced equipment C 1 L 1 Site supervisor to do walk through and D 1 L ASDC
to vehicle costs confirm all tools and equipment removed
from site.
10 Test Restart exhaust unit Unit not de-isolated and won’t be C 3 M 1 Test start and run till fully operational D 1 L ASDC
Page 5 of 10

Project:
Job No: Client:
Project Manager:
ABN 69 105 083 341
Environmental
Consequence
Residual Risk
Consequence
Responsible
Probability
Probability
Person
RISK
Carried out. VH
operational next day then shut down as per client procedures.

Personal Qualifications and Experience: Personnel, Duties and Responsibilities: Training Required to Complete Work
Supervisor trained and conversant with JSEA / WMS Site Supervisor to ensure that JSEA / WMS are adhered General induction & training course (White Card).
and MSDS to by all workers. Monitor and Review JSEA
Level 1 trained duct cleaners and labourers All workers are to work in accordance with the JSEA / Site Specific Induction, general induction & training
WMS and MSDS course (White card) JSEA Training
Daily inspection of work areas
Plant and Equipment to be used Engineering Details/Certificates Approvals:
1, Vacuum cleaners, extraction fans, various manual tools and sockets, extension
Test and tag in date, tools clean and in good condition, ladders clean and in good
Page 6 of 10

Project:
Job No: Client:
Project Manager:
ABN 69 105 083 341
leads, ladders
condition
2. Hot water gerni
Maintenance Checks:
1, visual inspection for damaged containers
Codes of Practice, Legislation and Regulation, And Australian

Standards. Check the reference sources to verify that they are correct
and current.
Work Health and Safety Act 2011
Work Health and Safety Regulations 2011
Managing the risk of falls at workplaces Code of Practice 2011
Hazardous Manual Tasks Code of Practice 2011
AS/NZS 2865-2001 Safe working in a confined space
How to manage WHS Risks in the workplace Code of Practice 2011
Page 7 of 10

Project:
Job No: Client:
Project Manager:
ABN 69 105 083 341
AS/NZS 1715-1992 Selection, use and maintenance of respiratory protective devices

code of practice No. 20 confined spaces 1997
(PART 4)
Part 3.1, regulation 38, sub regulation 1, 2 & 3 of the Workplace Health & Safety Regulations 2011. Chapter3. General Risk and Workplace Management.
Review of control measures
Monitoring methods such as the Air Systems Duct Cleaning, Task Observation Checklist (AS-SAFEWMS-002)) shall be used to monitor this JSEA for any
Failures in the steps or controls. If any failures in the steps or controls are found, all works shall cease, a specific Toolbox Consultation shall be called and a
review of the JSEA shall take place. Any amendments to the JSEA shall be documented on the JSEA Document Control Register (AS-SAFEWMS-003), and
reissued for approval before reinstatement of works.
“A” Monitor “C” Corrective Action for identified failure

 Have the control measures been implemented as intended? * Toolbox Consultation
 Are the control measures adequate? * Re- Induct
 Did the implementation of control measures create other hazards or risks? * Stop work for potential serious event
“B” Review
 Has anything changed over time since the risk process was implemented?
 Is the control of risks still adequate?
 Was the risk management process conducted effectively?
Page 8 of 10

Project:
Job No: Client:
Project Manager:
ABN 69 105 083 341
1. All Training and Consultation of this JSEA and Reviews of this JSEA shall be done during a Toolbox Consultation or a Prestart Work Meeting
Monitor:
Review Date:
Time:
Reviewed by:
Attendees: Signature:
Review:
Monitor:
Review Date:
Time:
Reviewed by:
Attendees: Signature:
Review:
Page 9 of 10

Project:
Job No: Client:
Project Manager:
ABN 69 105 083 341
Page 10 of 10

11 JSEA and SWMS Kitchen Exhaust Canopy

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Project:

Job No: Client:

JOB SAFETY ENVIRONMENT ANALYSIS/SAFE WORK METHOD STATEMENT (PART 1)

JSEA/WP Development Reviewed By: Date:

TYPE OF PERMIT REQUIRED: (please indicate by ticking the appropriate box)

Document No.: AS-SAFEWMS-011 Prepared by: Wayne Stevens Revision: 24/05/2021

Document No.: AS-SAFEWMS-011 Prepared by: Wayne Stevens Revision: 24/05/2021

Nil Nil Principal contractors Emergency

JOB SAFETY ENVIRONMENT ANALYSIS/SAFE WORK METHOD STATEMENT (PART 2)

Document No.: AS-SAFEWMS-011 Prepared by: Wayne Stevens Revision: 24/05/2021

STEP JOB STEP POTENTIAL HAZARD Risk REQUIRED HAZARD CONTROL

1 Unfamiliarity with site Site Hazards C 2 M 1 Complete walk-through, site-specific E 1 L ASDC

Document No.: AS-SAFEWMS-011 Prepared by: Wayne Stevens Revision: 24/05/2021

STEP JOB STEP POTENTIAL HAZARD Risk REQUIRED HAZARD CONTROL

STEP JOB STEP POTENTIAL HAZARD Risk REQUIRED HAZARD CONTROL

Document No.: AS-SAFEWMS-011 Prepared by: Wayne Stevens Revision: 24/05/2021

STEP JOB STEP POTENTIAL HAZARD Risk REQUIRED HAZARD CONTROL

operational next day then shut down as per client procedures.

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

Document No.: AS-SAFEWMS-011 Prepared by: Wayne Stevens Revision: 24/05/2021

1, visual inspection for damaged containers

Codes of Practice, Legislation and Regulation, And Australian

Work Health and Safety Regulations 2011

Managing the risk of falls at workplaces Code of Practice 2011

Hazardous Manual Tasks Code of Practice 2011

AS/NZS 2865-2001 Safe working in a confined space

How to manage WHS Risks in the workplace Code of Practice 2011

Document No.: AS-SAFEWMS-011 Prepared by: Wayne Stevens Revision: 24/05/2021

AS/NZS 1715-1992 Selection, use and maintenance of respiratory protective devices

“A” Monitor “C” Corrective Action for identified failure

Document No.: AS-SAFEWMS-011 Prepared by: Wayne Stevens Revision: 24/05/2021

Document No.: AS-SAFEWMS-011 Prepared by: Wayne Stevens Revision: 24/05/2021

Document No.: AS-SAFEWMS-011 Prepared by: Wayne Stevens Revision: 24/05/2021

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