Title Page
Address
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Add location
If working alone, monitoring control to be:
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A (accompanied)
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B (welfare monitor)
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C (man down)
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D (check-in)
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E (not required)
SWMS Applicable
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SWMS/001 Electric Shock
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SWMS/002 NST Testing
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SWMS/003 HVI
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SWMS/004 Prescribed Inspection
General Hazard(s) Identified (Tick if applicable)
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Working with live equipment
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Manual handling
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Lighting
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Trips, slips & falls
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Traffic hazard assessment
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Non restrained animals
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Inclement weather
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Sharp objects (eg. Syringes)
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Restricted (site) access
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Public area clearances
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Confined space
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Parking congestion
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Dangerous/hazardous materials
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Limits of approach
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Falls from holes
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Hard hat site or area
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Not safe with single man
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Customer acting in a threatening or dangerous manner
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Unsafe worksite or area
General Hazard Control Measures
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Visual inspection
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Clear access obtained
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Full PPE in serviceable condition
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Reflective safety vest
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Eye and hearing protection
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LV safety gloves
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Safety helmet
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Safety harness or belt
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Spotlight or torch
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Ladder and/or LV sticks
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Traffic management - signs, cones
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Signs/labels/tags/barriers
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Housekeeping
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First aid kit
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Fire extinguisher
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Syringe disposal container
Environmental Hazard(s) Identified (tick if applicable)
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Asbestos
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Weeds, erosion, etc.
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Vehicle use - grass fires, emissions
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Oil and fluid spills
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Flora, water and minerals
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RF antenna
Environmental Hazard Control Measures
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Asbestos - isolate and report
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Wash car, take alternate route
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Maintain clearance
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Location of fire prevention equipment
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Site evacuation plan and emergency process
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Hazardous substance procedure
Live Works Hazard(s) Identified (tick if applicable)
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Working with and in the vicinity of live electrical apparatus
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Electrocution
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Damaged assets
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Reverse polarity
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Back feed
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Alternate generator supply
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Metal meter box
Live Works Hazard Control Measures
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Isolate supply
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Appropriate clearance
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LV mats
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Tags, labels and barriers
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Control physical movements
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Full PPE in serviceable condition
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LV safety gloves
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Eye protection
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Insulated tools
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Visual inspection
Additional Hazard(s) identified
Additional Hazard Control Measures
Working From Heights
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Fall from heights greater than 2 meters or over 2 meters near edge
Working from Heights Hazard Controls (Hierarchy)
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1st - Complete Task on Ground
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2nd - EWP or Guarding/Scaffold
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3rd - Restraint System
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4th - Lanyard/Harness/Belt
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5th - Ladder
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6th - Observer / Temporary Barrier (eg. Signs, witches hats, barricade tape)
Additional Personnel Hazards/Controls
Mandatory Section - Signature Required
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The risk assessment has been completed in accordance with the appropriate Safe Work Method Statement (SWMS), and all mandatory tests have been performed in accordance with TSA procedures
By signing this form you acknowledge that you understand the Work Instructions and are authorised to carry out this work -
LEI Name
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Signature
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LEI Name
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Signature
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LEI Name
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Signature
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LEI Name
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Signature
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LEI Name
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Signature
