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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Job location
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Description
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Completed By
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Generic safe work method Statment/s (SWMS) for this job is?
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A) General chicklist
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Are all workers present for this induction and hazard assessment and control discussion
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Are there enough works to completed the job safely?
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Are all workers appropriately qualified or supervised as required?
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Have all services been located? e.g. Electricity, water, phone and gas etc.
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Are control measures for hazardous substances implemented?
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Have you endured radio/ telephone communication are suitable?
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Have all workers been briefed and roles/ responsibility clearly identified?
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Can manual handing task be minimised?
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Have trip hazard, ground depressions or obstacles been identified?
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Are all works aware of the accident emergency and evacuation procedures?
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Make all workers that are unaware of the procedures aware.
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Are all workers aware of the statutory requirements/ site specific requirement for this job?
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Explain to all workers unaware of the statutory requirements specific to the site.
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Is access to confined space necessary?
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Please complete the confined space entry permit.
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Have working at heights issues been identified?
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List controls measures
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Please write down any additional hazard and control measures implemented below
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B) Work-site Traffic Management (if not applicable go to section C)
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If a control plan has been developed has it been fully implemented? (TRAFFIC PLAN NO.)
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Has access for emergence vehicles been considered?
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Is a vehicle access plan required
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Is a work-site speed restriction required?
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Are all additional warning signs in place. e.g. slippery when wet, gravel on road, etc?
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Please write down any additional hazard and control measures implemented below
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ELECTRICAL HAZARD IDENTIFICATION/ CONTROL (if not applicable go to section E)
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Have HV and / or LV mains / apparatus Identified?
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If HV/LV mains/ apparatus are live are the Safe Work Procedures Being followed?
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Have all electrical hazard been identified?
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Are appropriate clearances being maintained?
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Are sufficient barriers in place to secure the work area
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Have lock out and tag out procedures been implemented where applicable?
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place lock out and tag out procedures implemented
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D) WORK METHOD STATEMENT (If not applicable go to E)
Must complete for short task when no SWMS exits. -
Work Steps
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Hazards & Risk Identification Control
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Control Measures
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Work Steps
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Hazards & Risk Identification
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Control Measures
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Work Steps
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Hazards & Risk Identification
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Control Measures
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Work Step
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Hazards & Risk Identification
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Control Meassures
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E) ALL STAFF ON THE WORK-SITE HAVE PARTICIPATED IN AND ACKNOWLEDGE THIS INDUCTION
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NAME
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NAME
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NAME
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NAME
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NAME
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NAME
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AUDITOR
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COMMENTS
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Checked/Filled by Supervisor
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