Task Name
SWMS No Project Date
ConsequenceRisk Score Calculator
Disaster VerySerious
Serious Substantial MinorLikelyhood
Almost certain
Likely
Possible
RemotelyPossible
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
3
3 3
Likelyhood / Consequence Risk Class
The hazard has the potential to:
• cause major damage to the structure
• have significant impact on the surrounding population and environment
The hazard has the potential to:
• cause minor damage to the structure
• cause minor damage to the structure
• breach the site boundary and pollute local environment
The hazard has the potential to:
• cause minor injuryψ
• be contained within the site boundary
1
2
3
Yes,risk score
1-High3-Low
Hazards Identified(describe the hazards which could cause
injury)For Each Job Step
Where there is a risk, describe the control measures proposedDateDoneJob Step
Address Phone ABN
• permanently disable or kill
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ByWho?
Check
Form: OHS/0081AUS STATE
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CheckYes,
risk score1-High3-Low
Hazards Identified(describe the hazards which could cause
injury)For Each Job Step
Where there is a risk, describe the control measures proposedJob Step
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ByWho?
DateDone
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Codes of Practice / applicable to this work (access from site office)
Certificates, WorkCover Approvals required
Legislation applicable to this work (access from site office)
Standards Relevant to the Work
Environmental Risks Environmental Controls ByWho?CheckDate
Done
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PLANT AND EQUIPMENT MAINTENANCE AND INSPECTION CHECKS
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Duties and responsibilities ofsupervisory Staff
Names of Supervisory Staff include Qualificationsand experience
This SWMS has been developed through consultation with our employees and has been read & signed by All employees involved with this activity
Inspect and approve work areas,methods, safety controls, plant
equipment and tools.
Duties and responsibilities ofsupervisory Staff
Names of Supervisory Staff include Qualificationsand experience
Trainer Name
Date Name Signature
SKILLS AND/ OR TRAINING REQUIRED
Date Name Signature
Signed by a Senior ManagementRepresentative of the Company for use Signed:
Position & Name:Date
I, the undersigned have read this document and approve it as site specific.
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