SSWP Civil Engineering Form
SSWP Civil Engineering Form
WORK PLAN
(SSWP)
REMEMBER “IF IT’S NOT SAFE DON’T DO IT, AND INFORM SITE MANAGEMENT”
© Copyright The Health and Safety Authority January 2006. All Rights Reserved. “The Health and Safety Authority”, the “HSA” and associated logos are trade marks of
The Health and Safety Authority.
FORM 5
SAFE SYSTEM OF WORK PLAN (SSWP)
CONSTRUCTION FORM 5 (CIVIL ENGINEERING) Plan No.
Job Details Resources Required Emergency Details
Employer Name: Worker Skills: Contact Names & Tel No.
Supervisor/Lead Person: 1.
Number of Workers: 2.
Specific Location: 3.
Description of Works: Plant/Equipment: First Aider:
PART 1
Supervision Safe Pass Plant/Eq. Cert. CSCS Communication/Induction WC & Washing Canteen Drying/Changing Drinking Water First Aid Smoking Control
SELECT
SELECT All controls identified below must be in place before work starts
✔ ✔
HAZARD
OR ACTIVITY CONTROL Tick the box to identify controls required; Tick the circle when control is in place.
General Fire
Drawings Risk Assess Method Statement Housekeeping Access Route Ground Conditions Lighting Warning Signs Control/Assembly Weather
Gas Over
Services Service Supplier Divert / Off Detector & Mark Permit to Work Hand Dig Isolate/Lock Out Barriers No Flames Bottle Storage Head Lines
Lifting
Operations
Check
SWL/Plan Lift Banksman Exclusion Zone Lifting Gear Man Cradle Concrete Skips Pallets/Secure Loads Pedestrian Route Examination & Inspection Other
Hand Held
Generators Compressor Jack Dust
Equipment Selection/Suitability Voltage Check Cable Guards Outside & Whip Checks Hammer/Kango Suppression Hot Works Chain Saw
Revised July 2007 © Copyright The Health and Safety Authority January 2006
HAZARD OR CONTROL
ACTIVITY
Tick the ✔ box to identify controls required; Tick the ✔ circle when control is in place.
Excavation
Batter Back Trench Box Sheet Piling Shoring Back Fill Spoil Back Chock No Undermining Underpinning Ladder Access
Environment
Exclusion Zone Barriers Pumping Risk Assess Safe Stacking Propping Access/Egress Air Supply Examination & Inspection Other
Falls and
Falling Objects Scaffold/
Working Platform Edge Protection Open Holes Safe Ladder MEWP Mobile Scaffold Propping Nets/Bean Bags Trestle Platform Other
Structures
Proprietary Proprietary Guard
Steel Fixing Rebar Lifting Rebar Working Platform Edge Protection All Opes Temporary Works Bearings & Fixings Prop Types Prop Supports
In-Situ
Precast
Steel Work
PART 2
Traffic
Flagman/ Vehicle Traffic Rock Blasting
Management Liaison Diversion Road Signage Competence Warning/Sequence Exclusion Zone
Stop-Go Man Crash Barriers Speed Control
Working close
Flagman/
to the public Liaison Fencing/Hoarding Barriers Pedestrian Routes Security Traffic Control Stop-Go Man Banksman Lighting Dust/Muck
Working close
to water Personal Safety Fall
Floatation Device Life Ring Boat Edge Protection Line/Grab Line Arrest & Rescue Diving Coffer Dam Pontoon & Crane Dredger
X X
ex
PPE
Safety Respiratory
Helmet/Boot/Hi-Vis Eye Protection Safety Gloves Ear Protection Dust Mask Equipment Face Protection Safety Harness Tripod Communication
The controls to be used as per this form have been brought to my attention.
Signed by Team:
NOTE: This list of Hazards and Controls is not exhaustive and is in no particular order.
IF IT’S NOT SAFE DON’T DO IT AND INFORM SITE MANAGEMENT
Revised July 2007 © Copyright The Health and Safety Authority January 2006
FOR THE RECORD (OPTIONAL)
PLAN NO. START DATE LOCATION PREPARED BY
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
Safe System of Work Plan (SSWP)
Civil Engineering
Achieving a
Healthy
Safe
and
Working Life
-Together
HEALTH AND SAFETY
AUTHORITY HEADQUARTERS
10 Hogan Place, Dublin 2
Tel. 1890 289 389
Callers outside Republic of
Ireland 00353 1 6147000
Fax. (01) 6147020
website: www.hsa.ie