OHS FORM 005 SAFE WORK METHOD STATEMENT (SWMS) – also known as Job Safety Analysis (JSA)

This SWMS has been developed and authorised by:

Name:

Company Name: Position: Date:

ABN: Signature: Phone:

Mobile:

DESCRIPTION OF WORK ACTIVITY: Concrete Placement (General)

Trades involved with undertaking this Work Activity:

This SWMS is submitted to: (principle contractor)

COMPANY:

CONTACT NAME: PHONE NUMBER:

SITE ADDRESS: PROJECT DESCRIPTION:

This SWMS was review by: (principle contractor)

NAME: POSITION:

SIGNATURE: DATE:

PHONE NUMBER: MOBILE NUMBER:

Person responsible for OHS on the contractor’s behalf:

NAME: POSITION:

SIGNATURE: DATE:

PHONE NUMBER: MOBILE NUMBER:

Safe Work Method Statement (SWMS) Page 1 of 1

List plant, equipment and List Hazardous Substances MSDS List PPE to be worn (Tick) List Hazards to consider (Tick)
tools to be used to be used or handled available?
(Tick)
eg. Electric generator eg. Unleaded petrol Hard Hat Fall from ladder
Safety Boots Fall from heights
High-visy clothing Fall from scaffold
Gloves Contact with electricity
Hearing Protection Falling objects
Safety Glasses Collapse
30+ Sunscreen Slips, trips and falls
Dust Masks Manual handling
Other (specify): Exposure to noise
Struck by moving plant
Inhalation of dust or fumes
Cuts
Other (specify):

How LIKELY is it to be that bad? How to complete the following form

Note: If a hazard is rated 1, 2 or 3, action must be taken immediately.
1. List the step-by-step sequence of tasks required to carry out
What VERY LIKELY UNLIKELY VERY
Health Risks and Likelihood of Damage

damage LIKELY Could Could UNLIKELY

the work activity from start to finish.
could it Could happen happen happen, but Could happen, but 2. Listing of potential hazards associated with each step, and the
cause? anytime sometimes only rarely probably never will related OHS risks.
Death or
permanent 1 1 2 3 3. Using the risk table, rating the identified risks.
disability 4. List what controls you will implement to reduce the risks to the
Long term lowest possible level.
illness or
serious
1 2 3 4 5. Rate the level of risk once those controls have been
injury implemented (must be 4-6 before you can start work).
Medical
attention or 6. List the names or positions of the persons responsible for
several 2 3 4 5 ensuring the controls are implemented.
days off
work

First Aid
needed
3 4 5 6

Safe Work Method Statement (SWMS) Page 2 of 2

 Job Step Hazard Identification Controls Implemented Person

Revised Risk
Responsible

Rating (1-6)

Rating (1-6)
Initial Risk
Identify any potential hazards Decide what controls to use to eliminate or minimise the risks.
STEP

Beak the job down into steps.

List the steps in this column. associated with each step – and Detail the controls in this column, and enter the revised risk rating in
any related risks. Detail the hazards the next column.
and risks in this column, and enter
the risk rating in the next column. Note: If the risk rating is still 1-3, do not begin work.

1. Entry to Site Entry to unsafe area Report to site office for site induction.

Movement of site Risk assessment of site conditions.

personnel, vehicles, plant
& equipment Training of all employees
2. Unloading Equipment Fall from vehicle Training employees in manual handling and team
lifting
Manual handling injuries,
cuts, splinters & abrasions Wear gloves (PPE)

Being struck by equipment Training employees in manual handling

Crush hands The use of P.P.E equipment such as gloves
Team lifting

Slips, trips & falls Unload equipment on a level clear area

3. Setting out / up Trips & falls Ensure site is clear of any debris, obstructions.
equipment
Define & barricade work area & fall areas

4. Drilling piers Hit by auger or bobcat Only suitably trained personnel to work with plant
excavator
Plant & equipment to be maintained, operator
must be licensed

The training and use of P.P.E equipment such as

high visible vests, hard hats
Fall in holes Personnel to be trained on relevant works.
Site Induction

Safe Work Method Statement (SWMS) Page 3 of 3

 Job Step Hazard Identification Controls Implemented Person

Revised Risk
Responsible

Rating (1-6)

Rating (1-6)
Initial Risk
Identify any potential hazards Decide what controls to use to eliminate or minimise the risks.
STEP

Beak the job down into steps.

List the steps in this column. associated with each step – and Detail the controls in this column, and enter the revised risk rating in
any related risks. Detail the hazards the next column.
and risks in this column, and enter
the risk rating in the next column. Note: If the risk rating is still 1-3, do not begin work.

5. Placing Concrete in piers Run over by concrete Truck drivers to be made aware of site entry,
pump or trucks driver to be aware of the whereabouts of the
offsider
Reverse siren to be in working order on concrete
pumps & trucks.

Relevant personnel to be in sight of driver at all

times

Pump operators to supply maintenance checklist &

log books
6. Installing pegs for edge Back injury from using All relevant personnel to be trained in the use and
boards sledgehammer. shown the correct procedure in using a
sledgehammer.
Missing target when using
sledgehammer. Use P.P.E equipment

Cuts, splinters and Training in manual handling and correct use of

abrasions sledgehammer

Arm & shoulder injuries

Training in manual handling

Keep hands and limbs out of rage

Workers to keep others in sight

Safe Work Method Statement (SWMS) Page 4 of 4

 Job Step Hazard Identification Controls Implemented Person

Revised Risk
Responsible

Rating (1-6)

Rating (1-6)
Initial Risk
Identify any potential hazards Decide what controls to use to eliminate or minimise the risks.
STEP

Beak the job down into steps.

List the steps in this column. associated with each step – and Detail the controls in this column, and enter the revised risk rating in
any related risks. Detail the hazards the next column.
and risks in this column, and enter
the risk rating in the next column. Note: If the risk rating is still 1-3, do not begin work.

7. Installation of formwork Back and shoulder injuries Training in manual handling

Injury from nail gun
Hit by materials Keep hands and limbs out of range.

Workers to keep others in sight

8. Benching / fill slab Hit by machines / plant Training in the use of shovels and wheelbarrows.
Back and shoulder injury
P.P.E equipment eye protection.
Eye injury from dust
Sunburn Sun protection P.P.E equipment such as
sunscreen hats and shirts.
9. Laying of plastic Slips and Trips Clear waste materials from work area.

Care taken when walking on plastic.

10. Carrying steel Back and shoulder Training provided in cutting and placing steel.
injuries.

Cuts and abrasions.

11. Cutting and placing steel Back and shoulder Training provided in cutting and placing steel.
injuries.

Cuts and abrasions from Care taken when stepping over formwork onto
trips & slipping on steel. steel or plastic.

Cuts from cut ends of Wear gloves (PPE)

steel.

12. Set up of electrical leads Tripping over leads Training in the set up of electrical leads.

Safe Work Method Statement (SWMS) Page 5 of 5

 Job Step Hazard Identification Controls Implemented Person

Revised Risk
Responsible

Rating (1-6)

Rating (1-6)
Initial Risk
Identify any potential hazards Decide what controls to use to eliminate or minimise the risks.
STEP

Beak the job down into steps.

List the steps in this column. associated with each step – and Detail the controls in this column, and enter the revised risk rating in
any related risks. Detail the hazards the next column.
and risks in this column, and enter
the risk rating in the next column. Note: If the risk rating is still 1-3, do not begin work.

13. Grinder use Pieces of metal P.P.E. equipment use – wear ear and eye
penetrating eyes protection

Electrocution Training in correct use of grinder

Electrical test & tagging. Register of all equipment

14. Use of Oxy Acetylene Burns Wear Gloves

High visibility vests to be removed prior to using

Oxy Acetylene as the vests are highly flammable.
Sparks hitting eyes Wear safety glasses (PPE)

Explosion and Fire All Oxy Acetylene equipment to have flash back
arrestors and have fire extinguishers
accompanying them.

15. Tying Steel Cuts and abrasions Wear gloves

Penetrating wounds Bar caps to be installed on all exposed vertical

bars.

16. Installing bar chains Back Injury Bend knees as placing chairs under reo bar

All relevant personnel to be trained in manual

handling

Clear all waste materials

Safe Work Method Statement (SWMS) Page 6 of 6

 Job Step Hazard Identification Controls Implemented Person

Revised Risk
Responsible

Rating (1-6)

Rating (1-6)
Initial Risk
Identify any potential hazards Decide what controls to use to eliminate or minimise the risks.
STEP

Beak the job down into steps.

List the steps in this column. associated with each step – and Detail the controls in this column, and enter the revised risk rating in
any related risks. Detail the hazards the next column.
and risks in this column, and enter
the risk rating in the next column. Note: If the risk rating is still 1-3, do not begin work.

17. Set up of concrete pump Concrete pump (boom Truck drivers / operators to be made aware of site
line) not stable and tipping entry, driver to be aware of the whereabouts of the
over offsider and site personnel.

Machine failure Reverse siren to be in working order on concrete

pump

Set up of concrete pump Pump operators to supply maintenance checklist

(continued) and log books
Concrete pump to be set up in accordance with
the Code of Practice. (concrete pumps are to be
registered with WorkCover)
18. Placing Concrete Hit by concrete No persons to be standing in front of concrete
hose

Back injury from shovelling Relevant personnel shown correct posture for
shovelling
Concrete burns
Avoid contact to skin, wash skin and clothing after.

Sun burn, skin cancer, eye Sun protection P.P.E equipment such as sun
damage cream, hats, shirts , sunglasses to be worn

Safe Work Method Statement (SWMS) Page 7 of 7

 Job Step Hazard Identification Controls Implemented Person

Revised Risk
Responsible

Rating (1-6)

Rating (1-6)
Initial Risk
Identify any potential hazards Decide what controls to use to eliminate or minimise the risks.
STEP

Beak the job down into steps.

List the steps in this column. associated with each step – and Detail the controls in this column, and enter the revised risk rating in
any related risks. Detail the hazards the next column.
and risks in this column, and enter
the risk rating in the next column. Note: If the risk rating is still 1-3, do not begin work.

19. Run over by concrete Truck drivers to be made aware of site entry.
pump or truck
Relevant personnel to be in sight of drivers at all
times.

Personnel to be trained in the use of hazardous

substances e.g. cement.
20.

THESE ARE STANDARD SWMS, THEY MUST BE MODIFIED TO SUIT YOUR WORKERS, YOUR EQUIPMENT AND
YOUR SITE.

Safe Work Method Statement (SWMS) Page 8 of 8

 CHECKLIST OF ITEMS THAT MAY BE REQUIRED FOR THIS WORK ACTIVITY

QUALIFICATIONS

TRAINING

Codes of Practice

OHS Consultation
OHS Induction Training for Construction
CODES OF PRACTICE OR AS/NZS Amenities for Construction Work
STANDARDS TO BE COMPLIED WITH
Australian Standard

AS 1012

Safe Work Method Statement (SWMS) Page 9 of 9

Declaration by contractors & workers:
1. I have been consulted and assited in the development of this SWMS.
2. I have been given the opportunity to comment on the content of this SWMS.
3. I have read and understand how I am to carry out the activities listed in this SWMS.
4. I have been supplied with the personal protective equipment identified on this SWMS and I have been given training in the safe use of this equipment.
5. I have read and understand the requirements set out in the mateial safety data sheets for the hazardous substances identified in this SWMS.

NAME: SIGNATURE: DATE:

Safe Work Method Statement (SWMS) Page 10 of 10