Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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SAFE WORK METHOD STATEMENT –
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SITE SPECIFIC
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SWMS - Site Surveillance
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Note: Work must be performed in accordance with this SWMS
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This SWMS must be kept and be available for inspection until the high risk construction work to which this SWMS relates is completed
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If the SWMS is revised, all versions should be kept
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If a notifiable incident occurs in relation to the high risk construction work in this SWMS, the SWMS must be kept for at least 2 years from the date of the notifiable incident
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Work Activity:
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(Job Description)
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Site Surveillance
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Workplace location:
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High Risk Work
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Indicate if any of the HIGH risk activities are performed by workers
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Work on, in or adjacent to a road, or other traffic corridor in use by traffic other than pedestrians
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Work in an area with movement of powered mobile plant
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Work on or near energised electrical installations or services
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High Risk Work
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Indicate if any of the HIGH risk activities are performed by workers
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Work in or near a shaft or trench deeper than 1.5 m or a tunnel
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Risk of a person falling more than 2 metres (note: in some jurisdictions this is 3 metres.)
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Work in or near a confined space
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High Risk Work
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Indicate if any of the HIGH risk activities are performed by workers
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Work in an area that may have a contaminated atmosphere
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Work in or near water or other liquid that involves a risk of drowning
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Likely to involve disturbing asbestos
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High Risk Work
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Indicate if any of the HIGH risk activities are performed by workers
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High Risk Work
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Indicate if any of the HIGH risk activities are performed by workers
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High Risk Work
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Indicate if any of the HIGH risk activities are performed by workers
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Person responsible for ensuring compliance with Site Specific SWMS:
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Supervisor
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Date Site Specific SWMS completed:
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What measures are in place to ensure compliance with the SWMS?
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Compliance with SWMS / Work Health & Safety Regulations 2019
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Site Inspections by Surveillance Officer / Safety Implementation Officer / WHS Team
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Developed by:
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Name and signature:
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Date:
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*SWMS are to be reviewed as per the Document Control Procedure or when there has been a change to the Task / Process or Legislation
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What are the tasks involved?
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What are the hazards and risks?
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What are the control measures?
List the work tasks in logical order
Identify the hazards and risks that may cause harm to workers or the public
Describe what will be done to control the risk. What will you do to make the activity as safe as possible?
Step 1. On site arrival, complete a Site
Specific Risk Assessment – by and for the Surveillance Officer
Injury
Illness
Fatality
Damage to property and environment
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Complete site-specific risk assessment and implement
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specified risk controls for your entry to site
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Where possible park vehicle clear of the work area
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Awareness of traffic entering /existing site
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Assess site conditions (potential fall hazards & slip hazards)
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At site induction run by the contractor,
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discuss details of any TGS, pedestrian, plant
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movement plans that effect your site inspections
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Wear appropriate PPE: Safety Boots, High Viz Clothing, Hard Hat and Hearing Protection available and on your person
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Follow all safety directions given by contractor controlling site
Step 2. Conducting Inspection
Struck by Moving Traffic or Plant
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Establish contact with the plant operator
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Always stay in view of operator
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Keep safe working distance from plant
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Wear required PPE: Safety Boots, High Viz Clothing, Hard Hat
Step 2. Conducting Inspection
Open Trenches / Pits - Falls
Do not enter trenches greater than 1.5 unless correct battering or shoring in place. Consult Corporate SWMS Excavation Work Deeper than 1.5m
Step 2. Conducting Inspection
Overhead Powerlines
Underground Services
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Request information regarding overhead powerlines or underground services
a If overhead powerlines impact your inspection, complete P18.F01 Risk Assessment Checklist – Working Near Overhead Powerlines
Step 2. Conducting Inspection
Inspecting On, Near or In a Confined Space
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Do Not Enter - Confined Spaces cannot be entered by you as a solo inspector
Step 2. Conducting Inspection
Entry onto Scaffolding
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Scaffolding must have a current ticket
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Wear required PPE: Safety Boots, High Viz Clothing, Hard Hat to be worn at all times when under or on scaffolding
Step 2. Conducting Inspection
Hazardous Chemicals, Dangerous Goods
Hazardous Substances
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Do Not Enter areas that contain or have been marked as containing or be suspected to contain Hazardous Chemicals, Dangerous Goods or Hazardous Substances
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a If required to complete you inspection, complete the appropriate Risk Assessment, EG:
P11.F01 – Risk Assessment Checklist Hazardous Chemicals
P19.F01 – Risk Assessment Checklist Asbestos Management
Step 3. Leaving Site
Struck by Moving Traffic or Plant
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Establish contact with the plant operator
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Always stay in view of operator
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Keep safe working distance from plant
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Wear required PPE: Safety Boots, High Viz Clothing, Hard Hat
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Acknowledgement register
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All workers are to sign this register to indicate they have read and understood this document prior to commencing work
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Name
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Signature
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Date
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Supervisor/Manager Sign off:
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Supervisor/Manager Name:
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Supervisor/Manager Signature:
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Date:
