Safe Work Method Statement

• 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;
  - Involves diving work.

• PCBU Name, Address and ABN

• Who is responsible for implementation and monitoring of this SWMS?

• Principal Contractor (Name, ABN, Office Address)

• Conducted on

  Date

• Prepared by

• Location
  Address

• Worksite Name

• Work Activity (What is being done at the site that requires this SWMS)

• Select the appropriate High Risk Construction Work being undertaken

  Select 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

  • 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)?

  Date

• Who received/ accepted the SWMS?

  Sign

• Last PC review date of SWMS?

  Date

Controls

• Which HRW are you addressing?

  Select 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

  • 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 are the levels of CONTROL currently in place?

  Select None Administrative Control (PPE/ Signage) Engineering Control Isolation Control Substitution Control Elimination Control

  • None
  • Administrative Control (PPE/ Signage)
  • Engineering Control
  • Isolation Control
  • Substitution Control
  • Elimination Control

• What is the UNCONTROLLED Risk Rating?

  Low

  Moderate

  High

  Critical

• What are the CONTROLS being put in place?

  Select None Administrative Control (PPE/ Signage) Engineering Control Isolation Control Substitution Control Elimination Control

  • None
  • Administrative Control (PPE/ Signage)
  • Engineering Control
  • Isolation Control
  • Substitution Control
  • Elimination Control

• What is the ADMIN CONTROL being put in place?

• What is the CONTROLLED Risk Rating?

  Low

  Moderate

  High

  Critical

• What is the ENGINERING CONTROL being put in place?

• What is the ISOLATION CONTROL being put in place?

• What is the SUBSTITUTION CONTROL being put in place?

• What is the ELIMINATION CONTROL being put in place?

• What is the CONTROLLED Risk Rating?

  Low

  Moderate

  High

  Critical

• What is the HIGHEST CONTROLLED Risk Rating for this SWMS?

  Low

  Moderate

  High

  Critical

• Ensure that all personnel working to this SWMS have been consulted and have signed off on this prior to commencing any work.

Consultation and Sign off

• Issues raised by workers?

• Add signature

  Sign