OHSE SUBBYPACK

Section two
OHSE Management Plan
Word format version
Tale of contents
OHSE Management Plan!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"
OHSE ##"$%oc&ment control!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!'
OHSE ##'$Pro(ect details and introd&ction!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!)
OHSE ##)$Occ&*ational +ealt+ safet, and environment *olic,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!-
OHSE ##-$Ha.ard identification/ ris0 assessment and control!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1
OHSE ##1$ Ha.ard categories!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!2
OHSE ##2$3is0 matri4!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!5
OHSE ##67Safe Wor0 Met+od Statement 8SWMS9!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!:
OHSE ##57O(ectives and targets!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!")
OHSE ##:7Personal Protective E;&i*ment 8PPE9!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"-
OHSE #"#73oles and res*onsiilities!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"1
OHSE #""7Training and com*etenc, register!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"5
OHSE #"'7Cons&ltation!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!":
OHSE #")7Toolo4<*re$start tal0s!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!'#
OHSE #"-7Wor0*lace ins*ection c+ec0list!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!''
OHSE #"17Plant and e;&i*ment!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!'1
OHSE #"27Plant and e;&i*ment register!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!'2
OHSE #"67Plant and e;&i*ment *re$start c+ec0list!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!'6
OHSE #"57Plant and e;&i*ment reg&lar c+ec0list!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!'5
OHSE #":7Ha.ardo&s s&stances<dangero&s goods!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!)#
OHSE #'#7Ha.ardo&s s&stances<dangero&s goods register!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!)"
OHSE #'"7Electrical e;&i*ment!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!)'
OHSE #''7Electrical e;&i*ment register!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))
OHSE #')7Ha.ard re*orting!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!)-
OHSE #'-7Ha.ard re*ort!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!)1
OHSE #'17=n(&r, and incident investigation!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!)2
OHSE #'273egister of in(&ries!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!)6
OHSE #'67=ncident investigation re*ort!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!)5
OHSE #'57OHSE management *lan c+ec0list!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!):
OHSE Management Plan
P3O>ECT ?AME
O3@A?=SAT=O? ?AME
A%%3ESS
PHO?E
AAB
EMA=C
AC?<AB?
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OHSE ##"$%oc&ment control
......................................................................................INSERT NAME OF ORGANISATION D
Maintains an &* to date version of t+is OHSE Management Plan!
3etains all osolete *ages of t+e Plan for a minim&m of 6 ,ears to demonstrate a record of OHSE
management *ractices!
Provides a co*, of t+e c&rrent version of t+e Plan to !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
=?SE3T PRINCIPAL CONTRACTOR NAME.
3eviews t+e Plan on a !!!!!!!!!!!!!!!!!!!!!!!!!!!!asis
INSERT TIME PERIOD
Ens&res all amendments to t+e Plan are recorded in t+e 3egister of Amendments!
Register of Amendments
%ate Page<Aorm no Fersion ?o! %escri*tion of amendments Pre*ared , A**roved ,
Distribution Register
Fersion no! %ate of iss&e ?ame of reci*ient Position<organisation
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OHSE ##'$Pro(ect details and
introd&ction
Organisation details
B&siness<Trading name
AC?<AB?
Contract >o ?&mer
%irector<Manager
Address
P+one
Aa4
Moile
Email
T+e following tale sets o&t a rief descri*tion of t+e wor0 to e carried o&t , INSERT NAME OF
ORGANISATION d&ring t+e co&rse of t+e INSERT TRADE/ACTIVITY contract<agreed wor0s on t+e INSERT
SITE NAME *ro(ect managed , INSERT PRINCIPAL CONTRACTOR NAME .
Date Description of Works No of Employees
Date Description of works
No of employees
(inc subcontractors)
T+e tale elow identifies t+e designated *erson on site res*onsile for t+e management of occ&*ational
+ealt+ safet, and environment!
Name Contact Details
INSERT ORGANISATION DOES/DOES NOT intend to s&contract all or *art of t+e wor0s!
=f engaged/ t+e s&$s&contractors intended to e &sed on t+is site areD
usiness Contact Details
INSERT ORGANISATION will ens&re t+at t+e aove mentioned s&contractors *rovide a SWMS for t+eir
s*ecialised wor0/ and t+at INSERT ORGANISATION s+all review t+e SWMS/ and a**end t+e SWMS to
t+is Plan! =f t+e, are an em*lo,er/ INSERT ORGANISATION will also ens&re t+at evidence relating to a
c&rrent wor0ers com*ensation *olic, is *rovided!
Director ! "anager############################## Date####!####!####
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OHSE ##)$Occ&*ational +ealt+
safet, and environment *olic,
At INSERT ORGANISATION, a commitment to occ&*ational +ealt+/ safet, and t+e environment is *art of
t+e &siness!
T+is is ac+ieved t+ro&g+D
com*l,ing wit+ stat&tor, re;&irements/ codes/ standards and g&idelinesG
setting &* o(ectives and targets wit+ t+e aim of eliminating wor0 related incidents in relation to o&r
activities/ *rod&cts and servicesG and
defining roles and res*onsiilities for occ&*ational +ealt+/ safet, and environment!
Strategies will incl&deD
ens&ring occ&*ational +ealt+/ safet, and environment management *rinci*les are incl&ded in all
organisational *lanning activitiesG
*roviding ongoing ed&cation and training to all of o&r em*lo,eesG
cons&lting wit+ em*lo,ees and ot+er *arties to im*rove decision$ma0ing on occ&*ational +ealt+/
safet, and environment mattersG
ens&ring incidents are investigated and lessons are learnt wit+in t+e organisationG
distri&ting occ&*ational +ealt+/ safet, and environment information/ incl&ding t+is *olic,/ to all
em*lo,ees and interested *artiesG
*roviding eno&g+ reso&rces to ens&re occ&*ational +ealt+/ safet, and environment is a central *art
of t+e organisationG and
ens&ring effective in(&r, management and re+ailitation is *rovided to all em*lo,ees!
Director ! "anager############################ Date####!####!####
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OHSE ##-$Ha.ard identification/
ris0 assessment and control
INSERT ORGANISATION will not commence constr&ction wor0 at a *lace of wor0 &nlessD
t+e *rinci*al contractor +as *rovided INSERT ORGANISATION wit+ a co*, of t+e relevant *arts of
its wor0*lace OHSE Management Plan 8or e;&ivalent9G
INSERT ORGANISATION +as &nderta0en an assessment of t+e ris0s associated wit+ t+e wor0
activities and +as *rovided to t+e *rinci*al contractor a written Safe Wor0 Met+od Statement
8SWMS9G and
INSERT ORGANISATION +as *rovided ind&ction training to all em*lo,ees!
INSERT ORGANISATION maintains and &*dates t+e SWMS/ and *rovides t+e &*dated SWMS to t+e
*rinci*al contractor!
INSERT ORGANISATION identifies t+e *otential +a.ards of t+e *ro*osed wor0 activities/ assess t+e ris0s
involved and develo*s controls meas&res to eliminate/ or minimise/ t+e ris0s! T+e ris0 management
*rocess is carried o&t in cons&ltation wit+ em*lo,ees!
$DEN%$&' (A)ARD*+
INSERT ORGANISATION rea0downs s*ecific wor0 activities into (o ste*s to assist in identif,ing all
*otential +a.ards! T+ese wor0 activities are detailed in a SWMS! T+e SWMS is a list of (o ste*s and ot+er
wor0 related *ractices!
Aor eac+ of t+e wor0 activities and associated (o ste*s identified in t+e SWMS/ INSERT ORGANISATION
+as identified *otential +a.ards and t+eir ris0s!
To assist in identif,ing +a.ards and ris0s/ INSERT ORGANISATION +as considered t+e &se of reso&rces
s&c+ as codes and standards/ ind&str, *&lications 8i!e! safet, alertsG +a.ard *rofiles for s*ecific trade
gro&*s9/ wor0*lace e4*erience and cons&ltation 8i!e! Toolo4 Tal0s9!
A**E** R$*,*+
INSERT ORGANISATION +as identified a ris0 class<ran0ing for *otential wor0*lace +a.ards , referring to
t+e categories ranging from +ig+ to low in a 3is0 Matri4!
T+e 3is0 Matri4 is &sed to determine t+e level of danger or serio&sness 8i!e! t+e conse;&ence9 of t+e ris0/
+ow li0el, it is t+at t+is ris0 will occ&r 8i!e! li0eli+ood<*roailit,9 and t+erefore +ow detailed control
meas&res will need to e to eliminate or minimise t+e ris0!
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OHSE ##1$ Ha.ard categories
T+e following is a list of t+e +a.ards INSERT ORGANISATION +as identified arising from t+e
contracted<agreed wor0 activities! T+ese +a.ards are addressed wit+in t+e Safe Wor0 Met+od
Statement8s9!
Occ&*ational Healt+ and Safet,
Occupational -ealt- and safety

Access H egress

Confined<enclosed s*aces

Coring<c+asing

%angero&s @oods 8O4,<ot+er9

%emolition<dismantling

Electricit, 8*ower tools<ot+er9

E4*losive<*ne&matic *ower tools

Aatig&e 8s+ift wor0<+o&rs of wor09

Aormwor0 erection<dismantling

Aire<e4*losion

A&mes<gas

Ha.ardo&s s&stances

Al,ing<falling o(ects<deris

Heig+t H falls

Ha.ardo&s material

Hot<cold wor0ing environment

Hot wor0 8c&tting<welding<grinding9

Casers

Cig+ting

Man&al +andling 8lifting or twisting9

Mac+ine<e;&i*ment g&arding

Moving *lant<traffic

Materials +andling 8crane<for0lift<ot+er9

Plant H e;&i*ment o*eration

?oise 8+earing9

Str&ct&ral alterations<s&**ort

P&lic 8*edestrians<ot+er9

Services 8&ndergro&nd<over+ead9

S&sidence

Ultra Fiolet Cig+t 8s&nlig+t9

Trenc+ing<e4cavation

Ot+erIIIIIIIIII!

Wor0 near<over water

Ot+erIIIIIIIIII!

Yo&ng wor0ers<&ns0illed lao&r

Ot+erIIIIIIIIII!

Biological<acteria

Ot+erIIIIIIIIII!
En.ironment

Air ;&alit, 8d&st<emissions9

B&l0 e4cavation<s*oil

Concrete or *aint wastes

Contaminated soil<water

%ewatering<*&m* o&t

Haitats 8*rotected flora<fa&na9

Heritage H Arc+aeolog,

?oise or viration

?ois, wor0 8neig+o&r+ood9

S*ills H res*onse

Sl&rr, or ot+er disc+arges

Traffic H *ar0ing

Waste +a.ardo&s 8*aint sl&dge/ s,nt+etic min

fire/ asestos<ot+er

%angero&s @oods<Ha.ardo&s S&stances
8&se<storage<s*ills9

Stormwater<sediment control

Ot+erIIIIIIIIII!

Waste dis*osal

Ot+erIIIIIIIIII!
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OHSE ##2$3is0 matri4
INSERT ORGANISATION +as identified a ris0 class<ran0ing for *otential wor0*lace +a.ards , referring to
t+e categories in t+e matri4 elow!
Ste* "D T+e organisation identifies t+e conse;&ence for eac+ *otential ris0 , &sing t+e tale elow! ?oteD
=f a comination of +arm/ loss or damage co&ld occ&r t+e worst case conse;&ence is selected!
/e.el Description of Conse0uence
Hig+ 8"9
8Hig+ level of +arm9
Potential deat+/ *ermanent disailit, or ma(or str&ct&ral fail&re<damage!
Off$site environmental disc+arge<release not contained and significant
long$term environmental +arm!
Medi&m 8'9
8Medi&m level of +arm9
Potential tem*orar, disailit, or minor str&ct&ral fail&re<damage! On$site
environmental disc+arge<release contained/ minor remediation re;&ired/
s+ort$term environmental +arm!
Cow 8)9
8Cow level of +arm9
=ncident t+at +as t+e *otential to ca&se *ersons to re;&ire first aid! On$site
environmental disc+arge<release immediatel, contained/ minor level clean
&* wit+ no s+ort$term environmental +arm!
Ste* 'D Using t+e following tale/ t+e organisation determines +ow li0el, it is t+at t+e ris0 will occ&r and
res&lt in t+e conse;&ence identified aove!
/e.el /ikeli-ood!1robability
Ci0el, Co&ld +a**en fre;&entl,
Moderate Co&ld +a**en occasionall,
Unli0el, Ma, occ&r onl, in e4ce*tional circ&mstances!
Cevel Ci0eli+ood < Proailit,
Ste* )D Using t+e ris0 matri4 elow/ t+e organisation identifies t+e ris0 class<ran0ing!
Conse0uence
/ikeli-ood!1robability
Ci0el, Moderate Unli0el,
Hig+ 8"9 " " '
Medi&m 8'9 " ' )
Cow 8)9 ' ) )
Class!Ranking Description ! Re0uirements
"
Will re;&ire detailed *re$*lanning!
Actions will e recorded on a Safe Wor0 Met+od Statement
'
Will re;&ire o*erational *lanning!
Actions will e recorded on a Safe Wor0 Met+od Statement
)
Will re;&ire localised control meas&res
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INSERT ORGANISATION LOGO INSERT SWMS NUMBER
OHSE ##67Safe Wor0 Met+od Statement 8SWMS9
Organisation %etails
Organisation details
Organisation ?ameD Contact ?ameD
AC?<AB? Contact PositionD
AddressD Contract P+one ?oD
1ro2ect details
Pro(ectD AreaD
Activit,D
T+is SWMS +as een develo*ed in cons&ltation wit+D
3eviewed ,D EEEEEEEEEEEEEEEEEEEEEEEE
PositionD EEEEEEEEEEEEEEEEEE %ateD E < EE <
3eso&rces < Trades =nvolvedD
E;&i*ment UsedD
Maintenance c+ec0sD
Materials UsedD
Occ&*ational Healt+ Safet, or
Environmental CegislationD
Codes or Standards a**licale to
t+e wor0sD
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INSERT ORGANISATION LOGO INSERT SWMS NUMBER
/e.el Description of Conse0uence or $mpact Conse0uence
Ci0eli+ood<Proailit,
/
Likely
"
Mode!"e
3
Unli0el,
( 8"9
#$i%& le'el o(
&!)*
Potential deat+/ *ermanent disailit, or ma(or str&ct&ral fail&re<damage! Off$
site environmental disc+arge<release not contained and significant long$term
environmental +arm!
( 8"9
#$i%&*
4 4 5
" 8'9
#Medi+) le'el
o( &!)*
Potential tem*orar, disailit, or minor str&ct&ral fail&re<damage! On$site
environmental disc+arge<release contained/ minor remediation re;&ired/ s+ort$
term environmental +arm!
" 8'9
#Medi+)*
4 5 6
/ 8)9
8Lo, le'el o(
&!)*
=ncident t+at +as t+e *otential to ca&se *ersons to re;&ire first aid!
On$site environmental disc+arge<release immediatel, contained/ minor level
clean &* wit+ no s+ort$term environmental +arm!
/ 8)9
#Lo,*
5 6 6
/e.el /ikeli-ood ! 1robability
Ci0el, Co&ld +a**en fre;&entl,
Moderate Co&ld +a**en occasionall,
Unli0el, Ma, occ&r onl, in e4ce*tional circ&mstances
$tem 7ob steps (a8ards
Risk
Class!
Ranking
Controls
Name of persons
responsible for
work
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INSERT ORGANISATION LOGO INSERT SWMS NUMBER
9ualifications and e:perience re0uired to
complete t-e task
1ersonnel; Duties and Responsibilities
(*uper.isory staff and ot-ers)
%raining Re0uired to Complete Work
Engineering Details ! Certificates ! Work*afe Appro.als+
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INSERT ORGANISATION LOGO INSERT SWMS NUMBER
%-is *W"* -as been de.eloped t-roug- consultation wit- our employees and -as been read; understood and signed by all employees undertaking t-e works+
1rint Names+ *ignatures+ Dates+
Re.iew No <4 <5 <6 <= <> <? <@ <A <B
=nitialD
%ateD
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OHSE ##57O(ectives and
targets
INSERT ORGANISATION +as estalis+ed t+e following o(ectives and targets to s&**ort and maintain
t+e effectiveness of t+e OHSE Management Plan!
1lanning
Ob2ecti.e+
Em*lo,ees are *rovided wit+ reg&lar and &*$to$date information on OHSE for t+e d&ration of t+e
contracted<agreed wor0s!
%arget+
3eview t+e content of t+e OHSE Management Plan at ma4im&m ) mont+ intervals 8or more
fre;&ent as re;&ired9 to maintain t+e c&rrenc, of information *rovided to em*lo,ees and ot+ers
Risk "anagement
Ob2ecti.e+
Em*lo,ees are familiar wit+ +a.ards and ris0s associated wit+ t+e contracted<agreed wor0s t+at
are assessed as a medi&m to +ig+ ris0!
%arget+
Safe Wor0 Met+od Statement8s9 or t+e e;&ivalent list as a minim&m t+ose +a.ards and ris0s
associated wit+ t+e contracted<agreed wor0s t+at are assessed as a medi&m to +ig+ ris0!
Consultation
Ob2ecti.e+
Em*lo,ees are reg&larl, cons&lted on matters t+at affect OHSE!
%arget+
Toolo4<Pre$start or ot+er agreed met+ods of cons&ltation are &nderta0en on a reg&larl, asis!
%raining
Ob2ecti.e+
Em*lo,ees are *rovided wit+ training to enale wor0 *ractices to e &nderta0en t+at are safe and
minimise ris0 to t+e environment!
%arget+
All em*lo,ees involved wit+ t+e contracted<agreed wor0 +ave &nderta0en as a minim&m t+e t+ree
levels of ind&ction training/ i!e! general ind&str, 8safet, awareness9 training/ site s*ecific training and
wor0 activit, training as noted in t+e Safe Wor0 Met+od Statement8s9 s*ecific to t+e contracted<agreed
wor0s!
Ot-er
Ob2ecti.e+
%arget+
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OHSE ##:7Personal Protective E;&i*ment 8PPE9
INSERT ORGANISATION maintains t+e following register of all PPE s&**lied to em*lo,ees w+ere s&c+ PPE is s*ecified as a control meas&re in t+e Safe Wor0
Met+od Statement! INSERT ORGANISATION ens&res all items of PPE are man&fact&red/ &sed and maintained in accordance wit+ t+e relevant standard! Proof of
Standard com*liance will e *rovided/ e!g! laelling!
Eac+ em*lo,ee +as een instr&cted and trained in t+e correct &se of t+e PPE iss&ed!
Employee name Date of $ssue! replacement $tem supplied
*ignature of recipient
I &!'e e-ei'ed "&e li."ed PPE ,i"&
!//o/i!"e i0."+-"io0/"!i0i0% i0 i".
-oe-" +.e.
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OHSE #"#73oles and
res*onsiilities
INSERT ORGANISATION *rovides t+e following 0e, trained and com*etent *ersonnel on site!
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Organisation
INSERT NAME1111111111111111111111
Works "anager
INSERT NAME111111111111111111
Works *uper.isor
INSERT NAME11111111111111111
$n2ury "anagement Coordinator
INSERT NAME1111111111111111111111
O(*E Coordinator
INSERT NAME111111111111111111
Employees
RO/E* AND RE*1ON*$$/$%$E* DE&$NED
T+e roles and res*onsiilities of em*lo,ees wit+in INSERT ORGANISATION regarding OHSE are
elow!
WOR,* "ANACER
INSERT NAME is res*onsile for OHSE at t+e wor0*lace and d&ties incl&deD
im*lementing t+e OHSE Management PlanG
&sing t+e Hierarc+, of Controls in all design/ farication and constr&ct activities to
minimise OHSE ris0sG
comm&nicating wit+ t+e *rinci*al contractor to red&ce ris0sG
eing a *art of t+e *lanning and design stages of trade activitiesG
deciding w+en training on OHSE is re;&iredG
leading , e4am*le and *romoting so&nd OHSE *ractices at ever, o**ort&nit,G
ens&ring safe e;&i*ment and *lant is *rovided and maintainedG
reviewing OHSE re*orts and ins*ections/ and following &* on recommendationsG
coordinating incident investigations and re*orting to t+e controller of t+e wor0*lace and
relevant a&t+orities/ as re;&iredG
coordinating OHSE meetings and *rogramsG
monitoring com*liance wit+ t+e OHSE Management Plan/ incl&ding Safe Wor0 Met+od
StatementG and
assisting in(&red em*lo,ees to ret&rn to t+eir *re$in(&r, d&ties as soon as *racticale after
a wor0 related in(&r,!
*igned by+ ###################### Date+ ### ! ### ! ###
WOR,* *31ERD$*OR
INSERT NAME is res*onsile for OHSE at t+e wor0*lace and d&ties incl&deD
im*lementing t+e OHSE Management PlanG
oserving all OHSE r&les and reg&lationsG
ma0ing s&re t+at wor0 activities are carried o&t in a safe and environmentall, so&nd
mannerG
*lanning to do all wor0 safel, incl&ding an, interface wit+ ot+er wor0 activitiesG
*roviding advice and assistance on OHSE matters to em*lo,eesG
eing *art of t+e *lanning and design stages of trade activitiesG
deciding w+en training on OHSE is re;&iredG
actioning OHSE re*orts and carr,ing o&t wor0*lace ins*ectionsG
setting &* OHSE meetings and *rogramsG
+el*ing to *re*are Safe Wor0 Met+od Statements for t+e organisationJs wor0 activitiesG
investigating +a.ard re*orts and ens&ring t+at t+e, are com*leted and corrective actions
&nderta0enG
carr,ing o&t *ro(ect ind&ctions/ Toolo4 Tal0s and team meetingsG
eing a *art of incident investigationsG
leading , e4am*le and *romoting so&nd OHSE *ractices at ever, o**ort&nit,G
&nderta0ing ins*ection of t+e contracted or *lanned wor0s to ens&re t+at OHSE control
meas&res are im*lemented and effectiveG and
ot+er OHSE d&ties as directed , t+e Wor0s Manager!
*igned by+ ###################### Date+ ### ! ### ! ###
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OCC31A%$ONA/ (EA/%( AND *A&E%' END$RON"EN% COORD$NA%OR
INSERT NAME is res*onsile for OHSE at t+e wor0*lace and d&ties incl&deD
comm&nicating OHSE *erformance to t+e Wor0s ManagerG
assisting t+e Wor0s S&*ervisor to develo* and im*lement t+e OHSE PlanG
*roviding advice on OHSE to all em*lo,eesG
eing a *art of *lanning and design in wor0 activitiesG
determining OHSE legal re;&irements for t+e wor0 activit, or tradeG
ma0ing s&re OHSE wor0 *roced&res are followedG
coordinating in(&r, management < ret&rn to wor0 for in(&red em*lo,eesG
reviewing OHSE re*orts and ins*ectionsG
setting &* and eing a *art of OHSE meetings and *rogramsG
setting &* Toolo4 Tal0s on a reg&lar asisG
insisting on so&nd OHSE *ractices at all timesG
setting &* and cond&cting OHSE ind&ctionsG
cond&cting incident investigationsG
comm&nicating wit+ t+e Wor0s Manager<Wor0s S&*ervisor on OHSE mattersG
ma0ing s&re records are 0e*t &nder t+ese g&idelinesG
eing *art of ins*ections and ens&ring recommendations are com*letedG and
ot+er OHSE d&ties as directed , t+e Wor0s Manager!
*igned by+ ###################### Date+ ### ! ### ! ###
$N73R' "ANACE"EN% COORD$NA%OR
INSERT NAME is res*onsile for t+e management of in(&ries at t+e wor0*lace and d&ties incl&deD
assisting in(&red em*lo,ees to ret&rn to t+eir *re$in(&r, d&ties as soon as *racticale after
a wor0 related in(&r,G
ens&ring t+at/ w+ere a**ro*riate/ t+e in(&red em*lo,ee is given access to occ&*ational
re+ailitation servicesG
liaising wit+ an, *arties involved in t+e occ&*ational re+ailitation of/ or *rovision of
medical services/ to t+e in(&red em*lo,eeG
monitoring t+e *rogress of t+e in(&red em*lo,eeJs ca*acit, to wor0G
ta0ing ste*s to *revent rec&rrence or aggravation of t+e relevant in(&r, &*on t+e in(&red
em*lo,eeKs ret&rn to wor0G and
*roviding assistance to meet all legal re;&irements regarding in(&r, management and
ret&rn to wor0!
*igned by+ ###################### Date+ ### ! ### ! ###
E"1/O'EE*
Are res*onsile for t+e followingD
wor0ing in a safe manner wit+o&t ris0 to t+emselves/ ot+ers or t+e environmentG
com*l,ing wit+ t+e OHSE Management Plan incl&ding all Safe Wor0 Met+od StatementsG
re*orting all incidents to t+e Wor0s S&*ervisorG
re*orting all in(&ries and illnesses to t+e designated Airst Aid OfficerG
re*orting an, OHSE +a.ards to t+e Wor0s S&*ervisorG
*roviding s&ggestion/ t+ro&g+ agreed cons&ltation met+ods/ on +ow to im*rove OHSE
iss&esG
see0ing assistance if &ns&re of OHSE r&lesG
re*orting an, fa&lt, tools or *lant to t+e Wor0s S&*ervisorG
com*l,ing wit+ site r&lesG
correctl, &sing all *ersonal *rotective e;&i*mentG and
com*l,ing wit+ emergenc, and evac&ation *roced&res!
*igned by+ ###################### Date+ ### ! ### ! ###
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEE
"6
OHSE #""7Training and com*etenc, register
Having regard to t+e +a.ards and ris0s associated wit+ t+e wor0 activit,/ INSERT ORGANISATION +as ass&red t+at all em*lo,ees are trained and com*etent to *erform
all tas0s in a wa, t+at is safe and does not adversel, im*act on t+emselves/ ot+ers or t+e environment!
T+e following register contains details of t+e s0ills and com*etencies of t+e organisationJs em*lo,ees!
Course Duration
Employee Name Work on t-is pro2ect
*kills ! Competencies ! E:perience (eEgE
tickets ! 0ualifications)
Card NoE ! RegE
NoE
Date of course
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OHSE #"'7Cons&ltation
INSERT ORGANISATION *romotes t+e active *artici*ation of all em*lo,ees in OHSE decisions!
Em*lo,ees are cons&lted and given o**ort&nit,/ enco&ragement and training to e *roactivel,
involved in OHSE matters affecting t+e organisation and t+eir wor0 activities!
Cons&ltation occ&rs in reference to/ &t not limited to/ t+e following s&(ects < to*icsD
+a.ard identification and ris0 assessment *rocessesG
control meas&res for t+e management of +a.ards and ris0sG
c+anges to t+e organisationKs *olicies and *roced&res or wor0 ro&tines w+ic+ ma, affect
OHSEG
ma0e &* of and re*resentation on relevant committeesG and
election of OHSE and em*lo,ee re*resentatives!
All wor0*lace cons&ltation is recorded and occ&rs on a INSERT PERIOD asis!
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":
OHSE #")7Toolo4<*re$start
tal0s
All Toolo4 < Pre$start Tal0s &nderta0en on e+alf of INSERT ORGANISATION are recorded on t+is
form and signed , *artici*ants!
All corrective actions noted on t+is form are im*lemented and signed , t+e nominated *erson! =t
is t+e res*onsiilit, of t+e Wor0s S&*ervisor to ens&re t+at all corrective actions are com*leted and
reviewed for effectiveness!
%oolbo: ! 1reFstart %alks
Wor0*laceD
S&(ect of Tal0D
Presented ,D
%&rationD %ateD
1ersons 1resent
Print ?ameD Signat&reD Print ?ameD Signat&reD
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'#
1oints Raised ! Comments+
Correcti.e Action Action by
Action Complete
*ign off Date
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OHSE #"-7Wor0*lace ins*ection c+ec0list
INSERT ORGANISATION ins*ects t+e wor0 activit,8s9 and wor0 area/ and *rovide a com*leted Wor0*lace =ns*ection C+ec0list eac+ wee0 to t+e *rinci*al contractor for
t+e d&ration of t+e wor0s!
Workplace inspection
Workplace+ Date+
$nspected by *ignature+
$tem
$tem Correct
Yes ?o n<a
Action 1riority
" ' )
Action y Close Out y Close Out Date
Access!Egress
Access *at+s clear
Access *at+s defined 8signage ta*e/ ot+er9
Pro+iited areas dis*la, warning signs and arricaded
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
" ' )
Dust!Air 9uality
%&st s&**ressed<watered down
Stoc0 *iles *rotected from wind
Plant H e;&i*ment maintained to minimise emissions
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
" ' )
Electrical
Electrical e;&i*ment tested H tagged
3egister of tagging c&rrent
Portale generator fitted 3C%
Portale 3esid&al C&rrent %evice 83C%9 tested< tagged
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
" ' )
" ' )
&irst Aid!Emergency!$n2ury
Airst aid 0it *rovided
Kit stoc0s refres+ed
Airst Aid Officer availale
Evac&ation *roced&re in *lace
Emergenc, contacts dis*la,ed
Aire e4ting&is+er<e;&i*ment availale
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
" ' )
" ' )
" ' )
" ' )
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEEEEE
''
$tem
$tem Correct
Yes ?o n<a
Action 1riority
" ' )
Action y Close Out y Close Out Date
"anual (andling
Trolle,s<aids in &se
SWMS followed
Training<(o rotation &nderta0en
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
" ' )
(a8ardous *ubstances!Dangerous Coods
3egister c&rrent
MS%S availale
SWMS lists *reca&tions for &se
Storage area &nded
3ef&elling SWMS followed
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
" ' )
" ' )
" ' )
(eig-t work
Perimeter *rotection
Handrails in *lace
Penetrations covered
Aall restraint<arrest s,stem in &se
SWMS followed
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
" ' )
" ' )
" ' )
(ousekeeping
Materials stac0ed
Wor0 area lit
Bins availale H in &se
Signage in *lace
Ceads s&s*ended
Wal0wa,<stairs<wor0 area clear
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
" ' )
" ' )
" ' )
" ' )
Noise
Plant H e;&i*ment maintained
Site +o&rs oserved
?ois, wor0s identified
Hearing *rotection &sed 8SWMS9
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
" ' )
" ' )
1ersonal 1rotecti.e E0uipment
Used w+en re;&ired 8SWMS9
Correctl, &sed , em*lo,ees
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
1lant G E0uipment
Plant register c&rrent
Maintenance records *rovided
%ail, log oo0 com*leted
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
" ' )
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEEEEE
')
$tem
$tem Correct
Yes ?o n<a
Action 1riority
" ' )
Action y Close Out y Close Out Date
O*erator tic0eted<com*etenc, verified
SWMS followed
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
1ublic protection
Wor0 area sec&re from *&lic
Over+ead *rotection *rovided
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
*tormwater!run off
Silt control fences in *lace
Stormwater inlets *rotected
%isc+arges contained/ e!g! *&m* o&t/ sl&rr,<ot+er
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
" ' )
%raining
All em*lo,ees +aveD
$ @eneral ind&str, 8safet, awareness9 training
$ Site s*ecific ind&ction training
$ Wor0 activit, 8SWMS9 training
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
" ' )
Degetation
Aencing aro&nd dri* line of retained trees
?o material<e;&i*ment stored wit+in dri* line
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
Waste "anagement
Waste red&ction *lan in *lace
Waste contractor records availale
Bins for litter<cigarette &tts<ot+er *rovided
Ha.ardo&s wastes ca*t&red H correct dis*osal/ e!g!
*aint sl&dge< contaminated soil<ot+er
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
" ' )
" ' )
Ot-er
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
Yes ?o n<a
" ' )
" ' )
" ' )
" ' )
All items noted for correction have been rectified
?ame Signed
%ate Time
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEEEEE
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OHSE #"17Plant and e;&i*ment
INSERT ORGANISATION carries o&t reg&lar ins*ections and maintenance of all *lant and e;&i*ment!
INSERT ORGANISATION ens&res *lant and e;&i*ment is ins*ected and maintained in accordance
wit+ t+e relevant standard and man&fact&rerJs recommendations!
T+e ins*ection and maintenance +istor, of eac+ item is doc&mented!
Certain items of *lant and e;&i*ment will e L=tem 3egisteredJ and or L%esign 3egisteredJ , t+e
3eg&lator, A&t+orit, w+ere re;&ired , Cegislation!
INSERT ORGANISATION ens&res control meas&res are im*lemented and doc&mented for all *lant
and e;&i*ment/ incl&ding its o*eration/ deemed as +ig+ ris0! T+e effect of all *lant and e;&i*ment
on t+e wor0*lace is considered and doc&mented in t+e Safe Wor0 Met+od Statement!
Pre$start c+ec0s/ sc+ed&le of maintenance and fa&lt re*orts are notified to t+e Wor0s S&*ervisor/
doc&mented in *lant log oo0s and made availale to relevant *arties on re;&est!
W+ere *lant and e;&i*ment is +ired/ t+e same re;&irements as aove a**l,!
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEE
'1
OHSE #"27Plant and e;&i*ment register
T+e following register contains details of all *lant and e;&i*ment to e &sed , INSERT ORGANISATION d&ring t+e co&rse of t+e wor0 activities! E4am*les incl&de lifting
gear/ fire fig+ting e;&i*ment/ moile *lant/ fall restraint e;&i*ment and ot+er!
1lant %ype
*erial NoE !
Registration
NoE
"ake !
"odel
Registration
wit-
Aut-ority
Re0uiredH
'!N
Aut-ority
Registration
E:piry Date
(if
applicable)
Date last
ser.ice or
maintenance
record
a.ailable
Re0uired
"aintenance
&re0uency
Alteration
Details
' ! N ! NA
Date On *ite
/og ook
A.ailable
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEEEEE
'2
OHSE #"67Plant and e;&i*ment
*re$start c+ec0list
INSERT ORGANISATION com*letes t+e following c+ec0list *rior to initial *lant o*eration at t+e
wor0*lace!
$tem Description C-eck
3is0 assessment
A c+ec0list s+o&ld identif, general +a.ards and
associated ris0s relating to t+e &se of t+e *lant H
e;&i*ment e!g! entanglement/ cr&s+ing/ stri0ing/
electrical or ot+er! T+e c+ec0list s+o&ld t+en detail
control meas&res to eliminate or minimise ris0!
Yes ?o
Cog Boo0
A c&rrent log oo0 recording dail, safet, Pre$start
c+ec0s! T+ese are s&(ect to random ins*ection!
Yes ?o
Maintenance 3e*orts
Proof of ongoing maintenance/ i!e! maintenance
records! T+e records s+o&ld note t+e most recent
ins*ection and w+o cond&cted t+at ins*ection! =t ma,
also descrie an, re*air wor0 carried o&t on t+e *lant!
Most im*ortantl,/ t+ere s+o&ld e no o&tstanding
items noted for re*airs!
Yes ?o
O*eratorJs Man&al
An o*eratorJs man&al relevant to t+e item of *lant and
w+ic+ is to e 0e*t wit+ t+e *lant!
Yes ?o
O*erator Certification
Co*, of o*eratorJs certification or licence to o*erate
t+e *lant! W+ere no stat&tor, certification is re;&ired/
evidence of com*etence , t+e o*erator in t+e &se of
t+e *lant!
Yes ?o
1lant 1ro.ider
?ame Signat&re %ate
1lant $nspected
Plant T,*e<Ma0e
Serial ?o!
Com*an,
$nspection Derified y
?ame Signat&re %ate
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEE
'6
OHSE #"57Plant and e;&i*ment
reg&lar c+ec0list
T+e following c+ec0list is com*leted , INSERT SERVICE PROVIDER OR INSERT
ORGANISATION as a general and reg&lar c+ec0 on *lant o*eration at t+e wor0*lace!
1lant and E0uipment C-ecklist
Service Provider name
Plant t,*e < ma0e
Plant ?o! Serial ?oD Serial ?oD
Description C-eck
3is0 assessment
Yes ?o n<a
O*eratorJs man&al
Yes ?o n<a
Maintenance re*orts
Yes ?o n<a
Cog Boo0
Yes ?o n<a
Com*etenc, tic0et<licence of o*erator
Yes ?o n<a
Aire e4ting&is+er
Yes ?o n<a
Crac0 test re*orts
Yes ?o n<a
C+ains tested and tagged
Yes ?o n<a
3eg&lator, A&t+orit, *lant registration
Yes ?o n<a
Alas+ing lig+t
Yes ?o n<a
Aorward<reverse ee*er
Yes ?o n<a
Tested and tagged electricall,
Yes ?o n<a
Seat elt
Yes ?o n<a
3oll over Protection 83OPS9
Yes ?o n<a
1lant 1ro.ider
?ame Signat&re %ate
$nspection Derified y
?ame Signat&re %ate
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEE
'5
=n &nderta0ing reg&lar c+ec0s of *lant and e;&i*ment/ INSERT ORGANISATION incl&des
consideration of relevant as*ects as followsD
*cissor /ifts ! oom /ifts E:ca.ators ! ack-oes ! ob Cats
3is0 Assessment
SWMS
O*erators Man&al
Maintenance 3e*orts
Cog Boo0
Certification<Com*etenc, of O*erator
Safet, Boo0let
Com*an, ?ame
3is0 Assessment
SWMS
O*erators Man&al
Maintenance 3e*orts
Cog Boo0
Certification<Com*etenc, of O*erator
Aire E4ting&is+er
Seat Belt
Alas+ing Cig+t
Aorward H 3everse Bee*er
&ork /ifts ! "anatouIs Cranes
3is0 Assessment
SWMS
O*erators Man&al
Maintenance 3e*orts
Cog Boo0
Certification<Com*etenc, of O*erator
Aire E4ting&is+er
Seat Belt
Alas+ing Cig+t
Aorward H 3everse Bee*er
3is0 Assessment
SWMS
O*erators Man&al
Maintenance 3e*orts
Cog Boo0
Certification<Com*etenc, of O*erator
Aire E4ting&is+er
Crac0 Test 3e*ort
3eg&lator, A&t+orit, Plant 3egistration
C+ains Tested and Tagged
Concrete 1umps Ot-erJ
3is0 Assessment
SWMS
O*erators Man&al
Maintenance 3e*orts
Cog Boo0
Certification<Com*etenc, of O*erator
Aire E4ting&is+er
Crac0 Test 3e*ort
Cine t+ic0ness Testing
3eg&lator, A&t+orit, Plant 3egistration
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEE
':
OHSE #":7Ha.ardo&s
s&stances<dangero&s goods
INSERT ORGANISATION *rovides a c&rrent 8wit+in 1 ,ears of t+e date of iss&e9 MS%S to t+e
*rinci*al Contractor for all *rod&cts and s&stances to e &sed for t+e wor0 activit,!
Before a *rod&ct or s&stance is &sed for t+e wor0 activit,/ INSERT ORGANISATION reviews t+e
Material Safet, %ata S+eet 8MS%S9 to determine if t+e *rod&ct or s&stance is classified as
+a.ardo&s!
All em*lo,ees involved in t+e &se of *rod&cts classified as +a.ardo&s/ are *rovided wit+
information and training to allow safe com*letion of t+e re;&ired tas0!
As a minim&m standard/ all safet, and environmental *reca&tions for &se listed on t+e MS%S are
followed w+en &sing t+e s&stance and are incl&ded in t+e Safe Wor0 Met+od Statement!
?o *rod&cts or s&stances/ incl&ding c+emicals or firo&s materials/ are ro&g+t to t+e wor0*lace
wit+o&t a c&rrent MS%S!
All *rod&cts and s&stances to e ro&g+t to t+e wor0*lace are e doc&mented!
INSERT ORGANISATION considers t+e following w+en selecting c+emicals and s&stances for
&se on siteD
Alammailit, and e4cl&sivit,G
To4icit, 8s+ort and long term9G
Carcinogenic classification if relevantG
C+emical action and instailit,G
Corrosive *ro*ertiesG
Safe &se and engineering controlsG
Environmental +a.ardsG and
Storage re;&irements!
All storage and &se of +a.ardo&s s&stances and dangero&s goods is in accordance wit+ t+e
MS%S and legislative re;&irements!
All +a.ardo&s s&stances and dangero&s goods are stored in t+eir original containers wit+ t+e
lael intact at all times!
Ha.ardo&s s&stances and dangero&s goods of an, ;&antit, are not stored in amenities/
containers 8&nless *ro*erl, constr&cted for t+e *&r*ose9/ s+eds or offices!
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEE
)#
OHSE #'#7Ha.ardo&s s&stances<dangero&s goods register
T+e following +a.ardo&s s&stances e4ist in t+e wor0 *lace! A co*, of t+e MS%S +as een forwarded to t+e *erson res*onsile for Airst Aid!
1roduct Name Application 9uantity 1roduct labelled "*D*
Classified as (a8ardous in
t-e "*D*
Yes ?o Yes ?o Yes ?o
$f 'E*+
T+e ris0s
and control
meas&res
associated
wit+ t+e &se
of t+e
*rod&ct<
s&stance
and t+e
*reca&tions
for its &se
are o&tlined
in t+e Safe
Wor0
Met+od
Statement
Yes ?o Yes ?o Yes ?o
Yes ?o Yes ?o Yes ?o
Yes ?o Yes ?o Yes ?o
Yes ?o Yes ?o Yes ?o
Yes ?o Yes ?o Yes ?o
Yes ?o Yes ?o Yes ?o
Yes ?o Yes ?o Yes ?o
Yes ?o Yes ?o Yes ?o
Yes ?o Yes ?o Yes ?o
Yes ?o Yes ?o Yes ?o
Yes ?o Yes ?o Yes ?o
Yes ?o Yes ?o Yes ?o
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEEEEE
)"
OHSE #'"7Electrical e;&i*ment
INSERT ORGANISATION ens&res t+at t+e &se of electrical wiring/ e;&i*ment/ *ortale tools and
e4tension leads is in accordance wit+ a**licale codes and standards incl&ding AS)#"'/ Electrical
=nstallations 7 Constr&ction and %emolition Sites and AS)###/ Wiring 3&les!
INSERT ORGANISATION ens&res t+at all electrical e;&i*ment ro&g+t on site is listed in t+e
Electrical E;&i*ment 3egister! T+e register is com*leted *rior to commencement of t+e wor0s and
maintained for t+e d&ration of t+e wor0s on site!
All electrical e;&i*ment incl&ding leads/ *ortale *ower tools/ (&nction o4es and eart+ lea0age/ or
resid&al c&rrent/ devices is ins*ected and tested , a s&ital, ;&alified *erson and laelled wit+ a
tag of c&rrenc, efore eing &sed on site!
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEE
)'
OHSE #''7Electrical e;&i*ment register
INSERT ORGANISATION records all electrical e;&i*ment ro&g+t on site in t+e Electrical E;&i*ment 3egister!
No"e2 Te."i0% !0d T!%%i0% (e3+e0-y i. !. e3+ied 4y S"!"e o Tei"oy Le%i.l!"io0, -ode. !0d ele'!0" ."!0d!d..
Electrical e0uipment
Workplace Date
E0uipment Description
1lant !
*erial NoE
Date of
$nspection!
%est
Results and!or trip
current (less 6<mA)
for Eart- /eakage
De.ice
Date of ne:t
$nspection!%est
ElectricianIs
!0ualified
personIs
*ignature
/icense!
Registration NoE
Electrical item
&re0uency of inspection ! test 8in accordance wit+ relevant
re;&irements9
Tools H leads or electrical e;&i*ment
S&$oard eart+ lea0age device
Electrical
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEEEEE
))
OHSE #')7Ha.ard re*orting
INSERT ORGANISATION enco&rages all em*lo,ees to re*ort +a.ards immediately to t+e Wor0s
s&*ervisor!
W+ere t+e +a.ard cannot e corrected immediatel,/ INSERT ORGANISATION records t+e details
of t+e +a.ard in t+e Ha.ard 3egister!
INSERT ORGANISATION investigates all re*orted +a.ards and im*lements control meas&res to
eliminate and<or minimise t+e li0eli+ood of an incident or in(&r,!
INSERT ORGANISATION identifies a ris0 class<ran0ing for all +a.ards , referring to t+e
categories ranging from +ig+ to low in t+e 3is0 Matri4! T+e 3is0 Matri4 is &sed to determine t+e
level of danger or serio&sness 8i!e! t+e conse;&ence9 of t+e ris0/ +ow li0el, it is t+at t+is ris0 will
occ&r 8i!e! li0eli+ood<*roailit,9 and t+erefore +ow detailed control meas&res will need to e to
eliminate or minimise t+e ris0!
INSERT ORGANISATION reg&larl, reviews and eval&ates t+e effectiveness of control meas&res
&ntil t+e +a.ard is addressed and<or all ris0s +ave een mitigated or red&ced!
INSERT ORGANISATION will iss&e a co*, of an, com*leted Ha.ard 3e*ort form to t+e *rinci*al
contractor/ as re;&ired!
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEE
)-
OHSE #'-7Ha.ard re*ort
W+ere a +a.ard cannot e immediatel, corrected/ INSERT ORGANISATION records t+e +a.ard in
t+e Ha.ard 3e*ort!
Ceneral
%ate
Wor0*lace
S&mitted B, Signat&re
S&mitted To Signat&re
Details of (a8ard
Cocation
Wor0 Activit,
Ha.ard
identified in
relation to t+e
wor0 activit,
Details of Risk
3is0 Class
Hig+ 8"9 Medi&m 8'9 Cow 8)9
Control "easures
Corrective Action
3e;&ired
B, W+om
B, W+om W+en
=mmediate
Wit+in '- +rs
Wit+in 6 %a,s
Completion
Corrective Action
Com*leted B,
Signat&re
Time %ate
Confirmed B, Signat&re
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEE
)1
OHSE #'17=n(&r, and incident
investigation
$N73R$E*+
All in(&ries are re*orted to t+e designated Airst Aid Officer in t+e wor0*lace!
INSERT ORGANISATION records all in(&ries on t+e 3egister of =n(&ries!
W+ere t+e in(&r, re;&ires medical attention or off site treatment/ INSERT ORGANISATION
com*letes an =ncident =nvestigation 3e*ort!
Co*ies of =ncident =nvestigation 3e*orts are *rovided to t+e *rinci*al contractor/ as re;&ired!
$NC$DEN%*+
Aor all incidents involving near misses/ *ro*ert,<*lant damage or in(&r, to t+e *&lic or t+e
environment/ =?SE3T O3@A?=SAT=O? investigates and records t+e details in an =ncident
=nvestigation 3e*ort!
Co*ies of com*leted =ncident =nvestigation 3e*orts are *rovided to t+e *rinci*al contractor/ as
re;&ired!
NO%$&$A/E $NC$DEN%*+
=?SE3T O3@A?=SAT=O? re*orts all notifiale incidents to t+e relevant A&t+orit,!
W+ere s&c+ an incident +as occ&rred/ =?SE3T O3@A?=SAT=O? considers w+et+er t+e site needs
to e *reserved for investigation , t+e relevant A&t+orit,!
RECORD ,EE1$NC+
=?SE3T O3@A?=SAT=O? 0ee*s records of incidents and in(&ries in accordance wit+ Stat&tor,
re;&irements!
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEE
)2
OHSE #'273egister of in(&ries
INSERT ORGANISATION records all in(&ries in t+e following register!
Ceneral
Wor0*lace Cocation
=n(&red Persons ?ame
Home Address
%ate of Birt+
Male Aemale
Occ&*ation
Em*lo,ers ?ame
Em*lo,ers Address
Details of $n2ury
%ate of =n(&r,
Time of
=n(&r,
am *m
Activit, in w+ic+ t+e *erson
was engaged at t+e time of
in(&r,
E4act location w+ere in(&r,
occ&rred
?at&re of in(&r, e!g! fract&re/
&rn/ s*rain/ foreign od, in
e,e!
Bod, location of in(&r, e!g! ear/
e,e/ face/ nec0
Details of %reatment
Treatment *rovided
, Airst Aid Officer
Yes ?o
3emar0sD
Aollow &* treatment
re;&ired
Yes ?o
I( ye., !0 I0-ide0" I0'e."i%!"io0 Re/o" )+." 4e
-o)/le"ed ,i"& 56 &o+.
%octor< Medical
Centre attended
%ate attended
Medical Certificate
3eceived
Yes ?o
Treatment i!e! 4$ra,/
*rescri*tion
A&rt+er cons&ltation
re;&ired
Yes ?o
=n(&r, Management
re;&ired
Yes ?o I( ye., 0o"i(y "&e
Re"+07"o7Wok
Coodi0!"o
?ame of Witness
Address of Witness
?ame of Person
Providing Airst Aid
Signat&re %ate
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEE
)6
OHSE #'67=ncident investigation
re*ort
INSERT ORGANISATION com*letes an =ncident =nvestigation 3e*ort in t+e event of an, in(&r,
involving medical attention or off site treatment or in t+e event of an, incidents involving a near
miss/ *ro*ert,<*lant damage or in(&r, to t+e *&lic or t+e environment!
T+e *rinci*al contractor will e informed immediately in t+e event of t+e aove! Aollowing
disc&ssions wit+ t+e *rinci*al contractor/ a decision will e made as to w+o will cond&ct t+e
incident investigation! T+e *rinci*al contractor will e *rovided wit+ a co*, of t+e com*leted
=ncident =nvestigation 3e*ort!
Class of $ncident Reported
=n(&r, Pro*ert,<Plant %amage
Yes ?o %etailsD
?ear Miss Environmental &urt-er Action Re0uired
Ot+erIIIIIIII!
3e*ort to A&t+orities Ot+erD
Details of $ncident
%ate of =ncident Time of =ncident
am *m
Witness ?ame Witness Contact
?at&re of =ncident
Cocation of =ncident
%escri*tion of =ncident
%etails of damage to
e;&i*ment<*ro*ert,M
$n2ured 1erson!s (if applicable)
?ame
Address
%ate of Birt+
Occ&*ation Em*lo,er
3eferred<transferred to
Recommended 1re.enti.e Action
%etails
Completed y
?ame Position
Signat&re %ate
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEE
)5
OHSE #'57OHSE management
*lan c+ec0list
INSERT ORGANISATION reviews all OHSE *olicies and *roced&res on a INSERT TIME PERIOD
to determine t+e effectiveness of t+e OHSE Management Plan in addressing OHSE in t+e
wor0*lace!
Ceneral
Pro(ect ?ame
Cocation
A&ditor
Ot+er Attendees
Acti.ities Re.iewed Conforms
C+anges and distri&tion of t+e OHSE Mgt Plan are recorded
Yes ?o
Pro(ect details < %escri*tion of wor0s < Organisation details are
c&rrent
Yes ?o
OHSE Polic, signed and dated , %irector<Manager
Yes ?o
Ha.ards are identified and ris0s are assessed
Yes ?o
Controls for +ig+ ris0 activities are doc&mented 8Safe Wor0 Met+od
Statement8s99
Yes ?o
Training and Com*etenc, 3egister is c&rrent
Yes ?o
Site S*ecific =nd&ction Training records are c&rrent
Yes ?o
SWMS Training is c&rrent
Yes ?o
3oles and res*onsiilities are allocated and signed
Yes ?o
Cons&ltation arrangements 8nat&re/ to*ics/ intervals9 are
doc&mented
Yes ?o
Plant < E;&i*ment 3egister is c&rrent
Yes ?o
Ha.ardo&s S&stances < %angero&s @oods 3egister is c&rrent
Yes ?o
Personal Protective E;&i*ment 3egister is c&rrent
Yes ?o
Periodic Wor0*lace =ns*ection C+ec0lists are com*leted
Yes ?o
3egister of =n(&ries is c&rrent
Yes ?o
=ncident =nvestigation 3e*orts are com*leted
Yes ?o
Ha.ard 3e*orts are com*leted
Yes ?o
Electrical E;&i*ment 3egister is c&rrent
Yes ?o
=n(&r, Management and 3et&rn$to$Wor0 Program is dis*la,ed
Yes ?o
Wor0ers Com*ensation =nformation is c&rrent
Yes ?o
Ot+erD
Yes ?o
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEE
):
$tems $dentified for Correction
Outstanding $ssues and Recommendations
Aollow &* actions
re;&ired
Yes ?o
W+en
Completed y
?ame Position
Signat&re %ate
%ateDEEE<EEEEEE<EEEEEE Fersion ?oDEEEEEEE
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