CDC Australia- Safe Work Method Statement

Title Page

Site conducted
This Safe Work Method Statement is to be completed prior to conducting any High Risk Construction type works that include:
- Risk of falls from greater than 2 metres;
- Work on a telecommunications tower;
- Demolition of load-bearing structure;
- Likely to involve disturbing asbestos;
- Temporary load-bearing support structures;
- Work in confined spaces;
- Work in or near shaft or trench with an excavated depth greater than 1.5m or a in tunnel;
- Involves the use of explosives (Explosive Powered Tools do not fall under this category);
- Carried out on or near pressurised gas mains or piping;
- Carried out on or near chemical, fuel or refrigerant lines;
- Carried out on or near energised electrical installations or services;
- Carried out in an area that may have contaminated or flammable atmosphere;
- Involves tilt up or Pre Cast Concrete;
- Carried out on, in or adjacent to a road, railway, shipping lane or other traffic corridor that is in use by traffic other than pedestrians;
- Carried out in an area at a workplace in which there is any movement of powered mobile plant;
- Carried out in an area in which there are artificial extremes of temperature;
- Carried out in or near water or other liquid that involves a risk of drowning;
- Exposure to Respirable Silica;
- Involves diving work.
PCBU Name, Address and ABN-
Who is responsible for implementation and monitoring of this SWMS?
Conducted on
Prepared by
Location
Worksite Name
Work Activity (What is being done at the site that requires this SWMS)

Safe Work Method Statements

Select the appropriate High Risk Construction Work being undertaken
- Risk of Falls greater than 2 metres
- Work on a telecommunications tower
- Demolition of a load bearing structure
- Likely to involve disturbing asbestos
- Temporary load-bearing support structure
- Work in a confined space
- Work in or near a shaft or trench with an excavated depth greater than 1.5m or in a tunnel
- Use of explosives
- Work on or near pressurised gas pipes or mains
- Work on or near chemical, fuel or refrigerant lines
- Work on or near energised electrical installations or services
- Work in an area with contaminated or flammable atmosphere
- Work with tilt up or pre-cast concrete
- Work on, in or adjacent to road, rail shipping or other major traffic corridor
- Work in an area with movement of powered mobile plant
- Work in areas with artificial extremes in temperature
- Work in or near a drowning risk
- Exposure to Respirable Silica
- Diving work
- Other, add in Notes
What is the work being being conducted?
All workers that have been inducted onto this SWMS need to sign the last page as evidence of this induction.

Principal Contractor (PC)

Safe Work Method Statement supplied to Principal Contractor(PC)?
Who received/ accepted the SWMS?
Last PC review date of SWMS?

High Risk Works (HRW) Controls

Which HRW are you addressing?
- Risk of Falls greater than 2 metres
- Work on a telecommunications tower
- Demolition of a load bearing structure
- Likely to involve disturbing asbestos
- Temporary load-bearing support structure
- Work in a confined space
- Work in or near a shaft or trench with an excavated depth greater than 1.5m or in a tunnel
- Use of explosives
- Work on or near pressurised gas pipes or mains
- Work on or near chemical, fuel or refrigerant lines
- Work on or near energised electrical installations or services
- Work in an area with contaminated or flammable atmosphere
- Work with tilt up or pre-cast concrete
- Work on, in or adjacent to road, rail shipping or other major traffic corridor
- Work in an area with movement of powered mobile plant
- Work in areas with artificial extremes in temperature
- Work in or near a drowning risk
- Exposure to Respirable Silica
- Diving work
- Other, add in Notes
Use this Risk Matrix to determine the Risk Ratings
What are the levels of CONTROL currently in place?
- None
- 1. Elimination Control
- 2. Substitution Control
- 3. Isolation Control
- 4. Engineering Control
- 5. Administrative Control (Signage)
- 6. PPE
What is the UNCONTROLLED Risk Rating?
What are the CONTROLS being put in place?
- None
- 1. Elimination Control
- 2. Substitution Control
- 3. Isolation Control
- 4. Engineering Control
- 5. Administrative Control (Signage)
- 6. PPE
What is the ADMIN CONTROL being put in place?
- High Risk Licence
- Vehicle License
- Construction Induction Card
- Asbestos Awareness Card
- Other
Attach evidence of the High Risk License (photo) per operator
How many workers require High Risk License (Work @ Height/ Plant License/ Competency/ Riggers etc.)?
How many workers require Vehicle License?
Attach evidence of the Construction Induction Card (photo, can be grouped) per operator
Attach evidence of the Asbestos Awareness Card (photo, can be grouped) per operator
What are the OTHER controls being implemented?
What is the CONTROLLED Administrative Risk Rating?
What is the ENGINERING CONTROL being put in place?
What is the CONTROLLED Engineering Risk Rating?
What is the ISOLATION CONTROL being put in place?
What is the CONTROLLED Isolation Risk Rating?
What is the SUBSTITUTION CONTROL being put in place?
What is the CONTROLLED Substitution Risk Rating?
What is the ELIMINATION CONTROL being put in place?
What is the CONTROLLED Elimination Risk Rating?
What PPE is required to be used?
What is the CONTROLLED PPE Risk Rating
What is the CONTROLLED Risk Rating?
What is the HIGHEST CONTROLLED Risk Rating for this SWMS? (What is the highest of the controlled Risk Ratings above)
Work is not to be conducted without further investigation, or stringent controls put in place.
Ensure that all personnel working to this SWMS have been consulted and have signed off on this prior to commencing any work.
Issues raised by worker/s?
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