Safe Work Method Statement Worksheet

Use of Master Builders Generic Safe Work Method Statements

Disclaimer:
The Master Builders Association of Victoria expressly disclaim all and any liability to any person in respect of anything, and of
consequence of anything done or omitted to be done by any or such person in reliance, whether wholly or partially on this generic
safe work method statement.
Rules for the use of Master Builders generic SWMS
1. This generic SWMS is provided as a sample. It is not to be used by a builder or subcontractor for the purpose of managing
safety on their projects. It can be used as a template to enable builders and subcontractors to produce their own SWMS.
Master Builders have carbon copy pads available for sale to enable builders/subcontractors to produce their own SWMS.
2. Employers intending to use this SWMS as a template for their own SWMS must ensure they consult with their employees,
including their Health and Safety Representatives, prior to its introduction.
3. Builders and subcontractors must ensure that their SWMS is relevant to the project at hand. Generic SWMS should not be
used unless precautions have been taken to ensure that the document adequately addresses the hazards and risks relevant
to each particular project.
4. Builders and subcontractors intending to use this sample SWMS as a template for their own generic SWMS, without making
any changes to the detail, must ensure that they adhere to and implement all of the relevant risk controls.
5. The range of generic SWMS provided by Master Builders are not sufficiently broad enough to cover all hazards or risks
encountered by builders and subcontractors. It does not cover the full list of requirements for which SWMS are specifically
required under the OHS Construction Regulations. It is important that the builder or subcontractor undertake their own hazard
identification and risk control process relevant for each particular task.
It is highly recommended that persons who are responsible for preparing and reviewing SWMS undertake training so as to
understand the process of identifying and controlling risks in the workplace.

Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.

Safe Work Method Statement Worksheet

Company Name

Site Name

Safe Work Method Statement

No ______ Page

Contractor

Activity

Piling

of

Permit to Work Requirement

Yes

No

Tasks

Hazards and Risks

Risk control measures

Who is responsible?

List the tasks required to perform

the activity in the sequence they are
carried out.

What can harm you - Hazards?

What can happen - Risks?

List the control measures required to eliminate or reduce the risk of injury
and detail how the control measures will be put in place.

Write the name of the person

responsible (supervisor or
above) to implement the
control measures identified.

Site induction.
Meeting regarding safety
and job procedures

Various

Inspection for underground

services

Potential that work activities come in

contact with possible underground
services such as power, gas, water,
communication cables etc.

Inspection of overhead
services.

Potential that work activities come in

contact with overhead services such as
power lines, communication cables etc.

Traffic management on
adjacent roads and upon
entry and exit to the site.

Injury / death to the public. Property

damage including damage to vehicles.

Providing a clear and safe

work area (site setup)

Injury to the general public.

Providing a clear and safe

work area (site setup)

Injury to personnel and damage to

property and equipment / vehicles on
site

Staff will be inducted prior to the commencement of work on all sites.

Regular toolbox meetings are also required to discuss issues and
review SWMS and procedures for amending as necessary for
improvement.
Ensure relevant service providers have been contacted including dial
before you dig, to identify where these services are. The building
contractor is to notify and mark these service locations before piling
works commence. An excavation permit from the builder may be
required.
Ensure service providers have been contacted to arrange any
permits if necessary. Building contractor is to notify and provide a
specified no working zone to contractor if working under power lines
etc.
Ensure appropriate and adequate traffic management measures
have been established. Workers to be inducted into the traffic
management plan so they are familiar with the entry/exit points, site
speed limit, etc.
Temporary fencing to be provided by principal contractor with
signage as Construction site keep out along boundary fences and
gates.
Ensure piling work activities are isolated and segregated from other
activities on site. All vehicles and property not involved in piling
activities should be isolated from the work area.

Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.

Safe Work Method Statement Worksheet

Incorporating appropriate
safety wear

The hazard risk increases substantially

when the appropriate safety apparel is
not worn.

All staff must wear the appropriate safety wear including: hard hat,
safety vest, eye and ear protection, safety boots and gloves. Long
sleeved shirts and long pants will be worn if required. Sunscreen 30+
is also to be used if working outdoors.

Machinery and equipment

plant condition check

Injury from plant failure

Off loading of drilling

equipment from vehicles and
set up of drill rigs

Damage to property and equipment.

Injury to personnel including: crushing,
striking, strains, back injuries. Lifting
chains break. Falling loads. Excavator
tilting over.

Rigging of machines

Contact with onsite personnel or

machinery

A machinery and equipment pre-start check is to be done each day

before work commences. The checklist to be completed is supplied
within the operators hire book. All defects to be rectified and
recorded before commencement of work. Ensure all plant has been
risk assessed and serviced/maintained at the required hour reading.
Work is to be done by qualified and experienced personnel. Off
loading area is clear of hazards. All personnel not involved to keep
well clear. No loads are to travel or be suspended over personnel.
Ensure the load is within the SWL of the machinery and is secured.
Lifting chains to be in working order and rated / tagged. All PPE to be
worn. No manual lifting of heavy loads. Machinery to be used on a
stable ground.
Piling rigs not allowed to work outside nominated areas. Piling
personnel only within restricted area.
Rig machinery as per manufacturers manual.
Spotter to be used at all times to observe power lines/services and
other machinery and personnel.
Select firm, level work area for rigging.
Rig machine as per manufacturers manual.
Suitably qualified personnel or trainee under supervision only to rig
machine.
Fall protection for heights over 2m.
EWP to be used when applicable. Ensure a high risk work licence is
held if used over 11 metres in height.
Harness used where applicable as a last resort.
All persons wearing harnesses must be trained in correct use.
Work to be done by qualified and experienced personnel. All
operators to hold current excavator ticket or supervised by ticketed
operator. No loads are to travel or be suspended over personnel.
Clear spoil from vicinity of pier. Drill offsider to be in full view of
machine operator at all times.

Machine collapse

Falling from height

Drilling / bored piers

Entanglement, falling, tripping, crushing,

striking. Excavator tilting over and or
colliding with objects / personnel.
Machinery / drilling noise.

Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.

Safe Work Method Statement Worksheet

Handling drilling equipment

while in operation

Hands caught in drill tools during

changeover

Removal of spoil from drill

rig using bobcat

Bobcat hitting/running over personnel.

Collision with other onsite traffic.

Placement of hole covers

Pinched fingers, strains, back injuries

Hole inspection

Falling

Placement of reinforcement
cage

Personnel, objects, equipment being

struck, falling load, pinched fingers,
lifting chains / slings breaking. Excavator
tilting over.

Placement of concrete
including vibrating

Striking, pinched fingers, concrete

splashing in the eyes, strains, back
injuries, contamination of waterways and
environment.

Unauthorised personnel to keep well clear of all activities. Machinery

to be used on stable ground. All PPE to be worn. All personnel to
keep clear of all rotating plant.
Shovelling around a hole is only to occur when the Kelly bar is down
the hole. Spotter to ensure all onsite personnel keep clear of the spinoff area.
Use palms rather than fingers when guiding locking pins into position.
Wear gloves where practicable. Keep tight tolerances on equipment
joints
All personnel to work within full view of plant operator. Only qualified
and experienced operator or trainee under supervision to operate drill
rig.
Only ticketed, competent operator or supervised trainee to drive
bobcat. All onsite personnel to maintain safe working distance from
bobcat during operation. Never walk behind bobcat during operation.
Bobcat operator to communicate and make eye contact with drill rig
operator or offsider prior to entering slew radius to remove bored
spoil.
All onsite vehicles to be fitted with flashing orange lights and
reversing beepers.
Hole covers to be used between drilling and pouring concrete. No
manual lifting of heavy loads. PPE to be worn at all times. Machinery
or two people to be utilised for the large hole covers.
Hole cover to be in place when the hole is inspected and tested if
required
Work to be done by qualified and experienced personnel. Licenced
dogman to perform all chaining works. Swing area for excavator to be
clear of personnel. The load to be within the MRC of the machine. No
loads are to travel or be suspended over personnel. All personnel to
wear PPE. Lifting chains / slings to be tagged / rated and in working
order. Machinery to be used on stable ground. Load to be secured.
Chain register to be maintained.
All PPE to be worn. No lifting of heavy loads. The use of the
excavator may be required to lift the vibrator. Refer to Concrete
Pumping SWMS. Cleaning of the concrete chute to be washed in an
area that will not contaminate any waterways, drains, and or the
surrounding environment etc. Tremie pipes used where required.

Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.

Safe Work Method Statement Worksheet

Receiving and sending
deliveries to and from the
work area
Oxycutting, welding and
grinding

Ground collapses, personnel run over,

colliding with objects, machinery and
equipment. Services above and below
ground being struck.
Radiation burns, foreign objects in the
eyes, welders flash, hot metal, possible
fire.

I have read and understood the content of this Safe Work Method
Statement
Workers name
Signature

Delivery driver to be directed by our spotter. Delivery truck to have

flashing light and reverse beeper activated. No personnel or items to
be in the path of the truck.
Refer to SWMS for Use of Grinder.
Ensure Flashback arrestors in place on bottles and handset if
required. Have fire extinguisher in place at all times. Bottles to be
secured onto a trolley.
Ensure welding shield in place as applicable.
Watch for fire outbreaks, remove flammable materials if required.
Do not wear polyester fluoro vests as they are highly flammable.
A Hot Work permit may be required.
Date

Ap
pro
ved
By

Workers name

Signature

Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.