Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Schools Safe Work Method Statement -
This document is to be used by property management personnel or contractors undertaking repairs to buildings and other associated repairs to equipment and plant on the school campus
General Information
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Company Name
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Company Address
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Name of Responsible Person
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Commencement Date
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Signature
Task Information
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Description of the work?
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Specific work location?
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What are the hazards associated with the work?
- Working at height
- Objects falling from height
- Slips, trips and falls
- Moving parts
- Protruding objects
- Using chemicals
- Moving vehicles
- Hot or cold surfaces
- Manual handling
- Collapsing
- Overturning
- Electricity
- Environmental Contamination
- Fumes or dusts
- Flying particles
- Fire or flammable atmospheres
- Bursting, explosion, over pressure
- Vibration
- Noise
- UV Radiation
- Oxygen Enrichment
- Asphyxiation
- Drowning
- Adverse weather
- Faulty equipment
- Hot works
- Confined spaces
- Health issues
- Sharp objects
- Overhead loads
- Working alone
- Shattering objects
- Poor lighting
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Take photo's of any major hazards
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Select the general control measures for the task here
- Certified plant and equipment
- Tested and tagged equipment
- Equipment checked before use
- Certified height safety equipment
- Rated anchor points
- Moving parts guarded
- Edge protection
- Lifting to own capacity
- Good lifting techniques
- Isolation of services
- Good housekeeping
- Fire checks
- Purging or ventilation
- Dust extraction
- Waste chemical or substance containment
- Correct slinging of loads
- Chemicals correctly stored and labelled
- Chemicals used according to instructions
- Area sealed off
- Safety signage posted
- Equipment secured
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List all site specific control measures here?
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Select the plant and equipment required for the task?
- Scaffolding
- Ladders (3 points of contact)
- Forklift
- Elevated Work Platform
- Power Tools
- Hand Tools
- Ventilation/Extraction equipment
- Crane and Hiabs
- Spraying Equipment
- Crawler Boards
- Harnesses
- Lanyards/Inertia Reels/Karabiners
- Certified Anchor Point(s)
- Slings
- Suction Cups
- Extension Leads/Multiplugs
- RCD's
- Tractors Compressor
- Mowers
- Quad Bikes
- Cones, Barriers, Warning Tape
- Chainsaw
- Weed Eater
- Compressor
- Gas Powered Nail Gun
- Edge Protection
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Take pictures of certified plant labels here
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Select the personal protective equipment (PPE) required for the task?
- Hard Hat
- Gloves
- Respirator
- Dust Mask
- Overalls
- Wet Weather Gear
- Hearing Protection
- Safety Glasses
- Safety Goggles
- Safety Visor
- Hi Vis Vest
- Chainsaw Chaps
- Safety Footwear
- Thermal Clothing
- Harness
- Life Jacket
- Sun Hat/Sunscreen
Permits
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Select the permits required for the task here?
- Hot Work
- Confined Space
- Asbestos
- Working at Height
Photo's
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Add photo's to show how the area/task has been made safe before work commences
SSWMS Briefing and Acknowledgement
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I hereby confirm that I have been briefed on the above information and will comply with all the controls listed in the Safety Work Method Statement
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Person(s) undertaking the work please sign here
Signature(s)
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Signature
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Date
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List the person's qualifications here
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Add a photo of the person(s) qualifications here