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Safe Work Method Statement Template

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Focus of Quality
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9 views

Safe Work Method Statement Template

Uploaded by

Focus of Quality
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Safe Work Method Statement -Template

Note: Work must be performed in accordance with this safe work method statement (SWMS). This SWMS must be kept and be available for inspection
until the high-risk construction work to which this SWMS relates is completed. If the SWMS is revised, every version should be kept. If a notifiable incident
occurs in relation to the high-risk construction work in this SWMS, the SWMS must be kept for at least 2 years from the date of the notifiable incident
Person conducting a business or undertaking (PCBU): Click or tap here to enter text.
Principle Contractor (PC): Click or tap here to enter text.
Works Manager: Click or tap here to enter text. Date SWMS provided to PC: Click or tap here to enter text.
Work activity: Click or tap here to enter text. Workplace location: Click or tap here to enter text.

High risk construction work


Risk of a person falling more than 2 metres ☐ Demolition of load-bearing structure ☐
Work on a telecommunication tower ☐ Temporary load-bearing support for structural alterations or repairs ☐
Likely to involve disturbing asbestos ☐ Work in or near a shaft or trench deeper than 1.5 m or a tunnel ☐
Work in or near a confined space ☐ Work on or near pressurised gas mains or piping ☐
Work on or near chemical, fuel or refrigerant lines ☐ Work on or near energised electrical installations or services ☐
Work in an area that may have a contaminated or flammable Tilt-up or precast concrete elements
atmosphere
☐ ☐

Work on, in or adjacent to a road, railway, shipping lane or other traffic Work in areas with artificial extremes of temperature
corridor in use by traffic other than pedestrians
☐ ☐

Work in an area with movement of powered mobile plant ☐ Diving work ☐


Work in or near water or other liquid that involves a risk of drowning ☐ Use of explosives ☐

Click or tap to enter a date.


Person responsible for ensuring compliance with SWMS: Click or tap here to enter text. Date SWMS received:
What measures are in place to ensure compliance with the SWMS? Click or tap here to enter text.
Click or tap to enter a date.
Person responsible for reviewing SWMS control measures: Click or tap here to enter text. Date SWMS received by reviewer:
How will the SWMS control measures be reviewed? Click or tap here to enter text.
Review date: Click or tap to enter a date. Reviewer’s signature:
What are the tasks involved? What are the hazards and risks? What are the control measures?
List the work tasks in a logical order. Identify the hazards and risks that may cause harm Describe what will be done to control the risk. What will
to workers or the public. you do to make the activity as safe as possible?
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Name of worker(s): Worker signature:


Click or tap here to enter text.
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Date SWMS received by workers: Click or tap to enter a date.

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