SAFE WORK METHOD STATEMENT

Company Details

Company Name: Contact Name:

ABN: Contact Position:

Address: Contact Phone No:Project Details

Project Name:

High Risk Activities: Leave blank if none are expected during the work.

Client:

Expected start date of work: Expected finish date:

Date SWMS Created: Next Review Date: :

Authorising Name &Signature: Position: :

Mandatory PPE: Leave blank if none are expected during the work.

Equipment Used:

Maintenance checks: Leave blank if none are expected during the work.

Chemicals Used: Leave blank if none are expected during the work.

Resources Involved:

Other:

Other:

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Date______________________________________________________________

This document is provided as a guide only. It is the responsibility of the contractor to ensure that safety documentation is complaint with the relevant statutory laws.

Tasks Hazards and Risk Control Measures*Is the risk after controls acceptable?

Control Responsibility

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Risk Assessments Using Hierarchy of ControlsFollow the guidelines and steps in the following diagram to assess hazards and risks.

REFERENCE: HOW TO MANAGE WORK HEALTH AND SAFETY RISKS, SAFE WORK AUSTRALIA

Legislation

The following legislation has been consulted in order to develop these safe work methods.Environmental Protection Act 1994Work Health and Safety Act 2011Work Health and Safety Regulation 2011

Codes of Practice (COP)

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PRO

BABL

E

MED RISK UNACEPTABLE

HIGH RISK UNACCEPTABLE

IMPR

OBA

BLE

LOW RISK ACCEPTABLE

MED RISK UNACCEPTABLE

MINOR MAJOR

CONSEQUENCE

Control measures have been identified using the Hierarchy of Control. Elimination ->Substitution ->Engineering -> Admin -> PPE

Licensing

The following licenses and qualifications will be utilized on site:

LICENCE/QUALIFICATION TYPE PERSON LICENCE No.

Emergency Response

Unplanned Event Control Measures or Response

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Safe Work Method Statement – Sign Off

I understand and accept the proposed work method and controls described above.I have the competency and training listed in this document.

Name Employee Signature Date Name Employee Signature Date

SWMS Review

Review No. 1 2 3 4 5 6 7 8 9

Name:

Date:

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