Title Page
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Job:
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Conducted on
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Prepared by
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Location
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Job No:
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Site Induction Required?
Safe Work Method Statement
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Instructions & Risk Rating Guide
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1. Refer to this guide when answering the "Consequence or Impact of Hazards without controls" in the sections below
2. Select the relevant risk rating with and without controls.
3. Confirm you have reviewed this SWMS form and assessed the hazard by providing your digital signature
Traffic Accident/Signs & Equipment
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Possible Hazard:
Traffic Accident/Signs & Equipment
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Safety Controls:
Current Drivers Licence.
Comply with road rules.
Break long drives every 2 hours.
Setup warning & traffic signs as per ACSV Surveyors Field Guide to Safe Work Practices Within Road Reserves.
Park legally.
Wear vest before you start work.
If vehicle is used as barrier against traffic it must have flash light on.
Unload on the kerb side.
Set up cones.
Establish presence of hazards where possible. -
Risk rating without controls
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Can Risk mitigation measures be implemented?
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Risk rating with controls
Manual Handling Injury
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Manual Handling Injury
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Safety Controls:
-Do not lift by bending your back.
-Do not lift heavy loads by yourself.
-Undertake work practices safely. -
Risk rating without controls
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Can Risk mitigation measures be implemented?
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Risk rating with controls
On Site Vehicles
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Possible Hazard:
On Site Vehicles – crush injuries, hearing damage, airborne particulates
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Safety Controls:
-Follow on site rules and make your presence known.
-Keep away from earthmoving machinery at all times.
-Keep away from haul roads, driveways.
-Park on firm ground.
- Remain within identified safe work zones.
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Personal Protective Equipment:
- High Visibility
- Flashing lights or engage hazard lights
- Hearing Protection
- Eye Protection -
Risk rating without controls
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Can Risk mitigation measures be implemented?
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Risk rating with controls
Noise
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Possible Hazard:
- Noise
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Safety Controls:
- Wear ear muffs or plugs as necessary -
Risk rating without controls
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Can Risk mitigation measures be implemented?
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Risk rating with controls
Existing Services
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Possible Hazard: Existing Services
Safety Controls:
No work to be undertaken beneath uninsulated powerlines or cables.
Do not use poles or staves made of conductible material unless clearance of at least 6.4m is kept at all times. -
Risk rating without controls
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Can Risk mitigation measures be implemented?
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Risk rating with controls
Confined Spaces/Pits/Trenches
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Possible Hazard: Confined Spaces/Pits/Trenches
Safety Controls:
Do not enter Confined Space without proper equipment, training and without completing CSE permit requirements.
Document PS2-4B Confined Space Entry -
Risk rating without controls
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Can Risk mitigation measures be implemented?
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Risk rating with controls
Weather - Sun/Wind/Rain
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Possible Hazard: Weather - Sun/Wind/Rain
Safety Controls:
Wear appropriate PPE including hat, sunglasses, long sleeves and long pants.
Use sun screen.
Avoid large trees in windy conditions.
Avoid flash flooding area during heavy rain. -
Risk rating without controls
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Can Risk mitigation measures be implemented?
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Risk rating with controls
Animals/Insects/Reptiles
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Possible Hazard: Animals/Insects/Reptiles
Safety Controls:
Avoid animal hazards.
Avoid tall grass (when possible and appropriate).
Wherever possible remain on paths or trails. -
Risk rating without controls
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Can Risk mitigation measures be implemented?
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Risk rating with controls
Fire & Flood
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Possible Hazard:Fire & Flood
Safety Controls:
Avoid going into bushfire areas on hot, dry and windy days.
Maintain awareness of any concerns.
Keep in contact with office staff. -
Risk rating without controls
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Can Risk mitigation measures be implemented?
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Risk rating with controls
Fumes
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Possible Fumes
Safety Controls:
Evacuate to safe area. -
Risk rating without controls
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Can Risk mitigation measures be implemented?
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Risk rating with controls
Public Traffic/Pedestrians
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Public Traffic/Pedestrians
Safety Controls:
Set up cones.
Wear PPE and establish presence of hazards where possible. -
Risk rating without controls
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Can Risk mitigation measures be implemented?
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Risk rating with controls
Equipment
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Equipment
Safety Controls:
Set up cones.
Rain - Cover Instrument. Wind - Use sand bags.
Use cones to avoid trip hazards to staff and public.
Place equipment in secure locations. -
Risk rating without controls
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Can Risk mitigation measures be implemented?
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Risk rating with controls
Slips,Trips & Falls
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Possible Hazard:
- Slips, Trips & Falls
Safety Controls:
- Determine safe approach to site to be assessed.
- Take care to identify trip hazard / unstable surfaces.
- Do not work on unstable surfaces or steep slopes.
- Keep clear of open trenches and work areas
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Personal Protective Equipment:
- Boots with ankle support and steel toecaps -
Risk rating without controls
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Can Risk mitigation measures be implemented?
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Risk rating with controls
Sign off - Safe Work Method Statement
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Add person
Person
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All people below who have provided signatures confirm that they have read and understand this Safe Work Method Statement
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Name:
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Add signature
