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OHS FORM 005 SAFE WORK METHOD STATEMENT (SWMS) also known as Job Safety Analysis (JSA)

This SWMS has been developed and authorised by:

Name:
Company Name:

Position:

Date:

ABN:

Signature:

Phone:
Mobile:

DESCRIPTION OF WORK ACTIVITY:

Concrete Placement (General)

Trades involved with undertaking this Work Activity:


This SWMS is submitted to: (principle contractor)
COMPANY:
CONTACT NAME:

PHONE NUMBER:

SITE ADDRESS:

PROJECT DESCRIPTION:

This SWMS was review by: (principle contractor)


NAME:

POSITION:

SIGNATURE:

DATE:

PHONE NUMBER:

MOBILE NUMBER:

Person responsible for OHS on the contractors behalf:


NAME:

POSITION:

SIGNATURE:

DATE:

PHONE NUMBER:

MOBILE NUMBER:

Safe Work Method Statement (SWMS)

Page 1 of 1

List plant, equipment and


tools to be used
eg. Electric generator

List Hazardous Substances


to be used or handled

MSDS
available?
(Tick)

eg. Unleaded petrol

Hard Hat
Safety Boots
High-visy clothing
Gloves
Hearing Protection
Safety Glasses
30+ Sunscreen
Dust Masks
Other (specify):

Health Risks and Likelihood of Damage

How LIKELY is it to be that bad?


Note: If a hazard is rated 1, 2 or 3, action must be taken immediately.
What
damage
could it
cause?
Death or
permanent
disability
Long term
illness or
serious
injury
Medical
attention or
several
days off
work
First Aid
needed

VERY
LIKELY

VERY
UNLIKELY

LIKELY

UNLIKELY

Could happen
anytime

Could
happen
sometimes

Could
happen, but
only rarely

Could happen, but


probably never will

Safe Work Method Statement (SWMS)

List PPE to be worn

(Tick) List Hazards to consider

(Tick)

Fall from ladder


Fall from heights
Fall from scaffold
Contact with electricity
Falling objects
Collapse
Slips, trips and falls
Manual handling
Exposure to noise
Struck by moving plant
Inhalation of dust or fumes
Cuts
Other (specify):

How to complete the following form


1. List the step-by-step sequence of tasks required to carry out
the work activity from start to finish.
2. Listing of potential hazards associated with each step, and the
related OHS risks.
3. Using the risk table, rating the identified risks.
4. List what controls you will implement to reduce the risks to the
lowest possible level.
5. Rate the level of risk once those controls have been
implemented (must be 4-6 before you can start work).
6. List the names or positions of the persons responsible for
ensuring the controls are implemented.

Page 2 of 2

1.

2.

Identify any potential hazards


associated with each step and
any related risks. Detail the hazards
and risks in this column, and enter
the risk rating in the next column.

Decide what controls to use to eliminate or minimise the risks.


Detail the controls in this column, and enter the revised risk rating in
the next column.
Note: If the risk rating is still 1-3, do not begin work.

Entry to Site

Entry to unsafe area

Report to site office for site induction.


Risk assessment of site conditions.

Unloading Equipment

Movement of site
personnel, vehicles, plant
& equipment
Fall from vehicle
Manual handling injuries,
cuts, splinters & abrasions

3.

Controls Implemented

Setting out / up
equipment

Revised Risk
Rating (1-6)

Beak the job down into steps.


List the steps in this column.

Hazard Identification
Initial Risk
Rating (1-6)

STEP

Job Step

Person
Responsible

Training of all employees


Training employees in manual handling and team
lifting
Wear gloves (PPE)

Being struck by equipment


Crush hands

Training employees in manual handling


The use of P.P.E equipment such as gloves
Team lifting

Slips, trips & falls

Unload equipment on a level clear area

Trips & falls

Ensure site is clear of any debris, obstructions.


Define & barricade work area & fall areas

4.

Drilling piers

Hit by auger or bobcat


excavator

Only suitably trained personnel to work with plant


Plant & equipment to be maintained, operator
must be licensed

Fall in holes

Safe Work Method Statement (SWMS)

The training and use of P.P.E equipment such as


high visible vests, hard hats
Personnel to be trained on relevant works.
Site Induction
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5.

Placing Concrete in piers

Identify any potential hazards


associated with each step and
any related risks. Detail the hazards
and risks in this column, and enter
the risk rating in the next column.

Run over by concrete


pump or trucks

Controls Implemented
Decide what controls to use to eliminate or minimise the risks.
Detail the controls in this column, and enter the revised risk rating in
the next column.
Note: If the risk rating is still 1-3, do not begin work.

Revised Risk
Rating (1-6)

Beak the job down into steps.


List the steps in this column.

Hazard Identification
Initial Risk
Rating (1-6)

STEP

Job Step

Person
Responsible

Truck drivers to be made aware of site entry,


driver to be aware of the whereabouts of the
offsider
Reverse siren to be in working order on concrete
pumps & trucks.
Relevant personnel to be in sight of driver at all
times
Pump operators to supply maintenance checklist &
log books

6.

Installing pegs for edge


boards

Back injury from using


sledgehammer.

All relevant personnel to be trained in the use and


shown the correct procedure in using a
sledgehammer.

Missing target when using


sledgehammer.

Use P.P.E equipment

Cuts, splinters and


abrasions

Training in manual handling and correct use of


sledgehammer

Arm & shoulder injuries


Training in manual handling
Keep hands and limbs out of rage
Workers to keep others in sight

Safe Work Method Statement (SWMS)

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7.

8.

Installation of formwork

Benching / fill slab

Identify any potential hazards


associated with each step and
any related risks. Detail the hazards
and risks in this column, and enter
the risk rating in the next column.

Back and shoulder injuries


Injury from nail gun
Hit by materials
Hit by machines / plant
Back and shoulder injury

Controls Implemented
Decide what controls to use to eliminate or minimise the risks.
Detail the controls in this column, and enter the revised risk rating in
the next column.
Note: If the risk rating is still 1-3, do not begin work.

Revised Risk
Rating (1-6)

Beak the job down into steps.


List the steps in this column.

Hazard Identification
Initial Risk
Rating (1-6)

STEP

Job Step

Person
Responsible

Training in manual handling


Keep hands and limbs out of range.
Workers to keep others in sight
Training in the use of shovels and wheelbarrows.
P.P.E equipment eye protection.

Eye injury from dust


Sunburn
9.
10.

11.

12.

Laying of plastic
Carrying steel

Cutting and placing steel

Set up of electrical leads

Safe Work Method Statement (SWMS)

Slips and Trips


Back and shoulder
injuries.

Sun protection P.P.E equipment such as


sunscreen hats and shirts.
Clear waste materials from work area.
Care taken when walking on plastic.
Training provided in cutting and placing steel.

Cuts and abrasions.


Back and shoulder
injuries.

Training provided in cutting and placing steel.

Cuts and abrasions from


trips & slipping on steel.

Care taken when stepping over formwork onto


steel or plastic.

Cuts from cut ends of


steel.

Wear gloves (PPE)

Tripping over leads

Training in the set up of electrical leads.

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13.

Grinder use

Identify any potential hazards


associated with each step and
any related risks. Detail the hazards
and risks in this column, and enter
the risk rating in the next column.

Controls Implemented
Decide what controls to use to eliminate or minimise the risks.
Detail the controls in this column, and enter the revised risk rating in
the next column.
Note: If the risk rating is still 1-3, do not begin work.

Pieces of metal
penetrating eyes

P.P.E. equipment use wear ear and eye


protection

Electrocution

Training in correct use of grinder

Revised Risk
Rating (1-6)

Beak the job down into steps.


List the steps in this column.

Hazard Identification
Initial Risk
Rating (1-6)

STEP

Job Step

Person
Responsible

Electrical test & tagging. Register of all equipment


14.

15.

16.

Use of Oxy Acetylene

Tying Steel

Installing bar chains

Burns

Wear Gloves

Sparks hitting eyes

High visibility vests to be removed prior to using


Oxy Acetylene as the vests are highly flammable.
Wear safety glasses (PPE)

Explosion and Fire

All Oxy Acetylene equipment to have flash back


arrestors and have fire extinguishers
accompanying them.

Cuts and abrasions

Wear gloves

Penetrating wounds

Bar caps to be installed on all exposed vertical


bars.

Back Injury

Bend knees as placing chairs under reo bar


All relevant personnel to be trained in manual
handling
Clear all waste materials

Safe Work Method Statement (SWMS)

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17.

Set up of concrete pump

Identify any potential hazards


associated with each step and
any related risks. Detail the hazards
and risks in this column, and enter
the risk rating in the next column.

Placing Concrete

Decide what controls to use to eliminate or minimise the risks.


Detail the controls in this column, and enter the revised risk rating in
the next column.
Note: If the risk rating is still 1-3, do not begin work.

Concrete pump (boom


line) not stable and tipping
over

Truck drivers / operators to be made aware of site


entry, driver to be aware of the whereabouts of the
offsider and site personnel.

Machine failure

Reverse siren to be in working order on concrete


pump

Set up of concrete pump


(continued)

18.

Controls Implemented

Revised Risk
Rating (1-6)

Beak the job down into steps.


List the steps in this column.

Hazard Identification
Initial Risk
Rating (1-6)

STEP

Job Step

Person
Responsible

Pump operators to supply maintenance checklist


and log books
Concrete pump to be set up in accordance with
the Code of Practice. (concrete pumps are to be
registered with WorkCover)
Hit by concrete

No persons to be standing in front of concrete


hose

Back injury from shovelling

Relevant personnel shown correct posture for


shovelling

Concrete burns
Avoid contact to skin, wash skin and clothing after.
Sun burn, skin cancer, eye
damage

Safe Work Method Statement (SWMS)

Sun protection P.P.E equipment such as sun


cream, hats, shirts , sunglasses to be worn

Page 7 of 7

19.

Identify any potential hazards


associated with each step and
any related risks. Detail the hazards
and risks in this column, and enter
the risk rating in the next column.

Run over by concrete


pump or truck

Controls Implemented
Decide what controls to use to eliminate or minimise the risks.
Detail the controls in this column, and enter the revised risk rating in
the next column.
Note: If the risk rating is still 1-3, do not begin work.

Revised Risk
Rating (1-6)

Beak the job down into steps.


List the steps in this column.

Hazard Identification
Initial Risk
Rating (1-6)

STEP

Job Step

Person
Responsible

Truck drivers to be made aware of site entry.


Relevant personnel to be in sight of drivers at all
times.
Personnel to be trained in the use of hazardous
substances e.g. cement.

20.

THESE ARE STANDARD SWMS, THEY MUST BE MODIFIED TO SUIT YOUR WORKERS, YOUR EQUIPMENT AND
YOUR SITE.

Safe Work Method Statement (SWMS)

Page 8 of 8

CHECKLIST OF ITEMS THAT MAY BE REQUIRED FOR THIS WORK ACTIVITY

QUALIFICATIONS

TRAINING

Codes of Practice

CODES OF PRACTICE OR AS/NZS


STANDARDS TO BE COMPLIED WITH

OHS Consultation
OHS Induction Training for Construction
Amenities for Construction Work
Australian Standard
AS 1012

Safe Work Method Statement (SWMS)

Page 9 of 9

Declaration by contractors & workers:


1. I have been consulted and assited in the development of this SWMS.
2. I have been given the opportunity to comment on the content of this SWMS.
3. I have read and understand how I am to carry out the activities listed in this SWMS.
4. I have been supplied with the personal protective equipment identified on this SWMS and I have been given training in the safe use of this equipment.
5. I have read and understand the requirements set out in the mateial safety data sheets for the hazardous substances identified in this SWMS.

NAME:

Safe Work Method Statement (SWMS)

SIGNATURE:

DATE:

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