Pre Start Safe Work Method Statement

• Location
  Address

• Task

• Conducted by

• Conducted on

  Date

• Main Contractor

Stop and Think Through the Task

• Do I Clearly Understand What Is Required?

  Yes

  No

  N/A

• Am I Trained To Do The Work and Familiar With The Equipment/Task?

  Yes

  No

  N/A

• Are The Tools and Equipment In A Safe Condition?

  Yes

  No

  N/A

• Do I Have The Correct Documentation For The Task?

  Yes

  No

  N/A

• Have I Informed Others Who May Be Affected By My Work?

  Yes

  No

  N/A

• Do I Have The Correct PPE For The Task ?

  Yes

  No

  N/A

Identify & Assess The Hazards

• Please add below any identified Hazards

Hazard

• Hazard Type

  Select Working On Or Near Live Electrical Items Use Of Ladders Noise Persons Entering Work Area Use Of Power Tools Working at Heights Manual Handling Working On Or Near Asbestos Containing Materials Sun Exposure Poor Lighting Environmental Confined Space Traffic Flammable Atmosphere Use of Mobile Plant Trenching - Deeper Than 1.5M Other

  • Working On Or Near Live Electrical Items
  • Use Of Ladders
  • Noise
  • Persons Entering Work Area
  • Use Of Power Tools
  • Working at Heights
  • Manual Handling
  • Working On Or Near Asbestos Containing Materials
  • Sun Exposure
  • Poor Lighting
  • Environmental
  • Confined Space
  • Traffic
  • Flammable Atmosphere
  • Use of Mobile Plant
  • Trenching - Deeper Than 1.5M
  • Other

• Please Specify Hazard Type

• Take Or Attach Photo Evidence Of Hazard Identified

  Media

• Describe The Risks Associated With The Hazard

  Select Electrocution That May Cause Serious Injury Or Death Falls From Ladder/s, Damage To Property Or Injury To Persons Due To Incorrect UseOf Ladder/s Temporary or Permanent Hearing Loss Or Injury Persons Entering Work Area & Injuring Themselves Or NEE Team Member/s Potential Serious Injury To Persons Due To Incorrect Use Of Power Tool/s Potential Exposure To Asbestos Which May Lead To Asbestosis For NEE Team Member Or Any Person Surrounding Work Area. Potential Sun Burn Other

  • Electrocution That May Cause Serious Injury Or Death
  • Falls From Ladder/s, Damage To Property Or Injury To Persons Due To Incorrect UseOf Ladder/s
  • Temporary or Permanent Hearing Loss Or Injury
  • Persons Entering Work Area & Injuring Themselves Or NEE Team Member/s
  • Potential Serious Injury To Persons Due To Incorrect Use Of Power Tool/s
  • Potential Exposure To Asbestos Which May Lead To Asbestosis For NEE Team Member Or Any Person Surrounding Work Area.
  • Potential Sun Burn
  • Other

• Hazard:

• Refer to image below for likelihood

  

• Likelihood

  Almost Certain

  Likely

  Possible

  Unlikely

  Rare

• Refer to image below for consequence

  

• Consequence

  Extreme Risk

  High Risk

  Medium Risk

  Low Risk

• Control Measures Required

  Select Isolate, Test & Tag Electrical Supply As Required Inline With Company Standard Procedure Inspection Of Ladders Required To Perform Task To Ensure Fit For Use. Ensuring Correct Use Of Ladders To Prevent Falls. Determining Suitable PPE & Wear Correctly To Prevent Injury Warning Surrounding Persons of Future Loud Noise & Asking To Leave A 20M Radius From The Work Site. Determining Suitable PPE For Team Members & Wear Correctly To Prevent Injury Creating Suitable Barriers Using Bollards, Cones, Bunting, ETC To Prevent Persons From Entering Work Area Correct Use Of Power Tools, Determining Any PPE Required & Wearing Correctly Follow Company Asbestos Handling Standard Operating Procedure Apply Sun Cream As Often As Stated By Manufacturer, Wear Suitable Hat, Take Frequent Breaks & Re Hydrate As Needed Other

  • Isolate, Test & Tag Electrical Supply As Required Inline With Company Standard Procedure
  • Inspection Of Ladders Required To Perform Task To Ensure Fit For Use. Ensuring Correct Use Of Ladders To Prevent Falls.
  • Determining Suitable PPE & Wear Correctly To Prevent Injury
  • Warning Surrounding Persons of Future Loud Noise & Asking To Leave A 20M Radius From The Work Site. Determining Suitable PPE For Team Members & Wear Correctly To Prevent Injury
  • Creating Suitable Barriers Using Bollards, Cones, Bunting, ETC To Prevent Persons From Entering Work Area
  • Correct Use Of Power Tools, Determining Any PPE Required & Wearing Correctly
  • Follow Company Asbestos Handling Standard Operating Procedure
  • Apply Sun Cream As Often As Stated By Manufacturer, Wear Suitable Hat, Take Frequent Breaks & Re Hydrate As Needed
  • Other

• Control Measure:

• Refer to image below for likelihood

  

• Likelihood - After Control Measures Implemented

  Almost Certain

  Likely

  Possible

  Unlikely

  Rare

• Refer to image below for consequence

  

• Consequence - After Control Measures Implemented

  Extreme Risk

  High Risk

  Medium Risk

  Low Risk

• Refer to Risk Matrix - If Risk Remains High or Catastrophic After Control Measures - Contact Operations Manager Immediately & Stop Work.

  

• What Is The Risk Level After Controls Measure Implemented

  Extreme Risk

  High Risk

  Medium Risk

  Low Risk

Control and Monitor

• Are All Hazards Identified & Controlled To An Acceptable Level Or Removed?

  Yes

  No
Team Member Sign Off

• Sign Off - On Site Team Member

  Sign

Company details

• Company Name

• Company Contractor Licence number

• Company address