Title Page
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Conducted on
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Prepared by
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Location
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Task:
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SWMS Reference:
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Do I understand the scope of work?
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Are all hazards identified, assessed and controlled?
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Are all energy sources controlled?
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What training do I have for this task?
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What plant and equipment will I be using for this task?
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I have discussed the task with person(s) who are involved or may be impacted?
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Names of involved:
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Other Identified Hazards
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What Are You Doing To Control Them?
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I am satisfied that all hazards have been controlled and the task can be performed safely
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If no, contact your Supervisor – do not start work
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Name of Site Manager:
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Signature:
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Signature:
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Signature:
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Signature:
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Signature:
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Signature:
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Signature:
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Signature:
