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Safe Work Method Statement Template Sample
Safe Work Method Statement Template Sample
ORGANISATION DETAILS
Principal contractor:
Contact number:
JACK SMART
Contact number:
Contact number:
JACK SMART
Contact number:
Position:
SITE SUPERVISOR
Reviewed by:
Date prepared:
17/6/2012
Review date:
20/10/2012
PROJECT DETAILS
What is the scope of the work?
Excavation work associated with plumbing of sewerage and storm water from connection at boundary into new residence.
Install access scaffolding to enable installation of flashing on second story roof and connecting downpipes into storm
water
Powered mobile plant in operation. Heights of more than 2 metres above ground. Work adjacent to a road used by traffic
other than pedestrians
References: Legislation,
Australian Standards, Codes of
Practice, MSDS and SOPs.
3 tonne rubber tracked CAT excavator, prefabricated scaffolding components, 10 yard dump truck, delivery vehicles,
worker vehicles, personal fall arrest devices, PVC plumbing components, portable hand tools
Scaffolding Class SB, SI or SA, Vehicle Loading Crane Class CV, Dogging Class DG
Codes of practice: How to prevent falls at workplaces, Scaffolding, Risks of plant at workplaces, Excavation work
ORGANISATION DETAILS
RISK MANAGEMENT
Identify each task in
order
Mobile machinery
Delivery of
scaffolding and
Manual handling
plumbing materials to
site
Storage of materials
Trips and falls
associated with the
Cuts on sharp edges
work site
Objects falling from above
Striking body against
materials
Hi-ab crane mounted on delivery vehicle. Driver Jack Smart to check HRL.
holds appropriate HRL for crane and dogging.
Workers to observe PPE
Team lifting of lighter items. Workers to wear
and safe lifting practices
gloves when handling materials
Segregate stored materials away from work
areas
Place bunting around sharp corners of flashings
Scaffolding components to remain in storage
cradles, cradles to be stacked on level ground
Hard hats, gloves and safety glasses to be worn
during all work
Manual handling
(ramps)
Mobile machinery
proximity to
workers
Other vehicles
moving in the area
Struck/crushed by machine
Excavator undermines or
knocks down scaffold
Fall into open excavations
Buried in trench collapse
ORGANISATION DETAILS
Manual handling
Bruising
Falling objects
Lacerations
Sharps edges
Fractures
Structural collapse
Fatalities
Working from
scaffold
Bruising
Lacerations
Fatalities
Fractures
This SWMS has been developed in consultation and has been read, understood and signed by all workers undertaking the scope of works:
Print Names:
Signatures:
Dates:
John Brown
17 June 2012
Sam Smith
17 June 2012
Bill Robinson
17 June 2012
Sally Stone
17 June 2012