safe work method statement - clifford...
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SAFE WORK METHOD STATEMENT
SWMS No.________
Revision: 1
SWI011.011
Approval Date:04/06/2014 Page 1 of 13
ORGANISATION DETAILS
Organisation Name: Contact Name:
ACN/ABN Contact Position:
Address: Contact Phone No:
PROJECT DETAILS:
Project: Address:
Activity:
This SWMS has been developed in consultation with:________________________Date:____________
This SWMS has been approved by:_______________________________________Date:____________
Resources/Trades Involved:
Plant & Equipment Used:
Frequency of Testing:
Materials Used:
Hazardous Substances Used:
Method of Consultation &
Communication:
This SWMS is read and signed by all workers involved with this procedure. If changes occur, they will be noted on the amendments page (last
page). The changes be conveyed to the workers and they will sign off that they have read and understood those changes.
Process & frequency of
reviews: This SWMS must be reviewed on a job by job basis, or before, if any changes to work environment occur.
SAFE WORK METHOD STATEMENT
SWMS No.________
Revision: 1
SWI011.011
Approval Date:04/06/2014 Page 2 of 13
PPE required:
WHS Legislation: WHS Act 2011
WHS Regulations 2011
Codes and/or Standards applicable to the
works:
SAFE WORK METHOD STATEMENT
SWMS No.________
Revision: 1
SWI011.011
Approval Date:04/06/2014 Page 3 of 13
RISK MATRIX
Level Description of Consequence or Impact Consequence
Likelihood/Probability
L
Likely
M
Moderate
U
Unlikely
H (1)
(High Level of Harm)
Potential death, permanent disability or major structural failure/damage.
Off-site environmental discharge/release not contained and significant
long-term environmental harm.
H (1)
High 1 1 2
M (2)
(Medium Level of Harm)
Potential temporary disability or minor structural failure/damage. On-site
environmental discharge/release contained, minor remediation required,
short-term environmental harm.
M (2)
(Medium) 1 2 3
L (3)
(Low Level of Harm)
Incident that has the potential to cause persons to require first aid On-site
environmental discharge/release immediately contained, minor level clean
up with no short-term environmental harm.
L (3)
(Low) 2 3 3
LEVEL LIKELIHOOD/PROBABILITY
Likely Could happen frequently
Moderate Could happen occasionally
Unlikely May occur only in exceptional circumstances
CONTROLS CONSIDERED TO MANAGE RISKS
Elimination Substituting Isolating Engineering Administration PPE
SAFE WORK METHOD STATEMENT
SWMS No.________
Revision: 1
SWI011.011
Approval Date:04/06/2014 Page 4 of 13
Item Job Steps Hazards Risk Rate
Before Controls
Risk Rate
After Person Responsible
SAFE WORK METHOD STATEMENT
SWMS No.________
Revision: 1
SWI011.011
Approval Date:04/06/2014 Page 5 of 13
Item Job Steps Hazards Risk Rate
Before Controls
Risk Rate
After Person Responsible
SAFE WORK METHOD STATEMENT
SWMS No.________
Revision: 1
SWI011.011
Approval Date:04/06/2014 Page 6 of 13
Item Job Steps Hazards Risk Rate
Before Controls
Risk Rate
After Person Responsible
SAFE WORK METHOD STATEMENT
SWMS No.________
Revision: 1
SWI011.011
Approval Date:04/06/2014 Page 7 of 13
Item Job Steps Hazards Risk Rate
Before Controls
Risk Rate
After Person Responsible
SAFE WORK METHOD STATEMENT
SWMS No.________
Revision: 1
SWI011.011
Approval Date:04/06/2014 Page 8 of 13
PERSONNEL ON SITE QUALIFICATIOINS &/OR LICENCE NUMBERS ADDITIONAL TRAINING REQUIRED TO COMPLETE WORK
All personnel must be site inducted before commencing work on this site
1st Supervisor
2nd Supervisor
ENGINEERING DETAILS/CERTIFICATES/WORKCOVER APPROVALS ETC
SAFE WORK METHOD STATEMENT
SWMS No.________
Revision: 1
SWI011.011
Approval Date:04/06/2014 Page 9 of 13
THIS SWMS HAS BEEN DEVELOPED THROUGH CONSULTATION WITH OUR EMPLOYEES AND HAS BEEN READ, UNDERSTOOD AND SIGNED BY ALL EMPLOYEES UNDERTAKING
THE WORKS
NAME SIGNATURE DATE
SAFE WORK METHOD STATEMENT
SWMS No.________
Revision: 1
SWI011.011
Approval Date:04/06/2014 Page 10 of 13
AMENDMENTS TO ORIGINAL SWMS
Item Job Steps Hazards Risk Rate
Before Controls
Risk Rate
After Person Responsible
SAFE WORK METHOD STATEMENT
SWMS No.________
Revision: 1
SWI011.011
Approval Date:04/06/2014 Page 11 of 13
THESE AMENDMENTS HAVE BEEN READ, UNDERSTOOD AND SIGNED BY ALL EMPLOYEES UNDERTAKING THE WORKS
NAME SIGNATURE DATE
Review 1 2 3 4 5 6
Initial
SAFE WORK METHOD STATEMENT
SWMS No.________
Revision: 1
SWI011.011
Approval Date:04/06/2014 Page 12 of 13
Plant ID Register
The plant listed below will be brought onto site and operated by _______________________. None of the listed mobile plant will be operated or static plant used, until appropriate plant inspection and maintenance records have been provided to the head contractor. All inspection and maintenance records will, as a minimum
standard, comply with the manufacturers recommendations or relevant Australian Standard where appropriate The following static (e.g. scaffold) or mobile (e.g. Manitou) plant will be used on site:
Type Static (s)/ Mobile (m)
Date Registration Purpose (use on site)
Inspection Frequency
Inspected by whom (qualified person)
SAFE WORK METHOD STATEMENT
SWMS No.________
Revision: 1
SWI011.011
Approval Date:04/06/2014 Page 13 of 13
HAZARDOUS SUBSTANCES USED ON THIS SITE
Name of Hazardous Substance MSDS Provided