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CAQA Polyform Plastics and Cable · Simulated workplace

Job Safety Analysis Form

FormControlled document
PFM-FRM-002
v1.5
Document ownerRubber and Belting Manager
Version1.5
Approved22 April 2026
Next review22 April 2027
StatusCurrent

Purpose. Crew leaders and setters complete this form before non-routine tasks, site jobs, new tool trials and any task not fully covered by a procedure, breaking the job into steps with hazards and controls.

1.When this form is required

A Job Safety Analysis is required for every site splice, belt replacement or repair job, every new tool or die trial, every maintenance task on a machine that is not covered by a written procedure, and any task a supervisor judges to need one. It is completed by the person leading the task with the people who will do it, before work starts.

2.Completing the analysis

Break the job into its steps in order. For each step identify what can go wrong and what can cause harm, including machine motion, stored energy, hot surfaces, chemicals, manual handling, height, traffic and the customer's plant. For each hazard record the control that will be in place, following the hierarchy: eliminate, substitute, isolate, engineer, administer, protect. Name who is responsible for each control.

3.Review with the crew

Read the analysis through with everyone who will do the job, invite questions and changes, and have everyone sign. Stop and revise the analysis if the job changes, a new hazard appears or the customer's conditions differ from what was planned.

4.Records

File the completed analysis with the job card. Site crews leave a copy with the customer where the customer requires it. The Technical, Quality and WHS Manager reviews a sample of analyses each month.

5.Related documents

Read this form with the Work Health and Safety Policy, the Machine Safety and Isolation Policy and the procedure for the task.

6.Complete the form

PFM-FRM-002 v1.5 · CAQA Polyform Plastics and CableUncontrolled when printed. Simulated document created by CAQA for training and assessment.