C1.4 Safe Work Method Statement Monitoring Record

• Site Address

• Conducted on

  Date

• Document No.

• Prepared by

• Who is the PCBU: name and contact details

• List the workers names doing the activity being inspected on site;

• Have all the workers listed above been inducted into the SWMS?

  Yes

  No

  N/A

• List those not inducted/trained

• Make sure an action is taken to ensure these workers will be inducted into the SWMS

• Is there a high-risk work task to be inspected?

  Yes

  No

• Tick the task(s) being inspected

• Risk of a person falling more than 2 metres

• Work on a telecommunication tower

• Demolition of load-bearing structure

• Likely to involve disturbing asbestos

• Temporary load-bearing support for structural alterations or repairs

• Work in or near a confined space

• Work in or near a shaft or trench deeper than 1.5 m or a tunnel

• Use of explosives

• Work on or near pressurised gas mains or piping

• Work on or near chemical, fuel or refrigerant lines

• Work on or near energised electrical installations or services

• Work in an area that may have a contaminated or flammable atmosphere

• Tilt-up or precast concrete elements

• Work on, in or adjacent to a road, railway, shipping lane or other traffic corridor in use by traffic other than pedestrians

• Work in an area with movement of powered mobile plant

• Work in areas with artificial extremes of temperature

• Work in or near water or other liquid that involves a risk of drowning

• Diving work

Management of risks

• Identify the key HSE risks for the task(s)

• Are these risks listed in the SWMS?

  Yes

  No

  N/A

• List any risks you've identified or work steps that are not covered in the SWMS

• Further raise a ‘Non-Conformance Report’ for any significant implementation non-conformances - form I1.6

• Comment on overall level of SWMS implementation.

• Please update your SWMS to address any deficiencies

Sign Off

• Name & Signature of Inspector

  Sign