Dura-Line India Pvt. Ltd.

,
(Mexichem Specialty Compounds Division), Unit 2,
Introduced effective Plot 19-22 & 37-40,
17 Sep 2018 – with 16, 000 mm height Sancoale Industrial Area,
works beginning Sancoale Village,
Goa 403 726 Form No.
Tel: 0832- 6693251
pp

The contractor must complete a Safe Work Method Statement (SWMS) or equivalentprior to the commencement of any high-risk work.
Name of Contractor
responsible for Date:
compliance with SWMS:

Company name: Workplace location:

High Risk
(Lifting shifting)
High risk job 1. Shifting of sprinkler Completion of Confined Yes N/A (n/a should only be selected when not
description pipe lines, with help of Space Entry Permit? working in a confined space)
Scissor lift Boom lifter

Personal Protective Equipment (PPE) required to complete the job

Last Updated: 12 September 2018

 Safe Work Method Statement

Gloves Face mask Eye Welding mask Safety Hearing Protective

Safety helmet
protection footwear protection clothing

What are the tasks involved? What are the hazards and risks? How will hazards and risks be controlled?
Describe the steps required to perform Against each step list the potential List the control measure required to eliminate or minimize the
the task in the sequence they are hazards that could cause injury/damage risk of injury arising from the identified hazard, see Contractor
carried out. when the task step is performed. Hazard Identification and Control Table.

What are the tasks involved? What are the hazards and risks? How will hazards and risks be controlled?
Describe the steps required to perform Against each step list the potential List the control measure required to eliminate or minimize the
the task in the sequence they are hazards that could cause injury/damage risk of injury arising from the identified hazard, see Contractor
carried out. when the task step is performed. Hazard Identification and Control Table.

Hazard &risks: Precautions:

A. Hit by truck, cut/crush, full body hazard. a) Ensure the close supervision while movement of vehicle at working
premise.
B. Unauthorized operation.
b) Allow only authorized persons for designated job.
C. Failure of lifting tools & tackles.
c) All lifting tools and tackles must be free from damage and with valid
D. Slip of material due to improper griping
TPI.
during material handling.
d) Ensure proper griping of material with sling during lifting, shifting or
E. Fall of material from vehicle & while shifting.
erecting.
F. Not functioning of safety devices of vehicle
e) Ensure proper supporting of material before start the unloading
or crane.
activities. Tie the material properly with lifting tools.
G. Suspended load.
f) Inspect the all equipment's safety devices functioning properly.
H. Fall of person from height.
g) Do not stand under suspended load during the job. Ensure the close
I. Fall of material. supervision’s)
J. Hit by material.

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 Safe Work Method Statement
K. Pinching hazards Cut/crush.
 Operating Boom lifter & Scissor lift
L. Slip & trip hazard due to uneven surface, h) Use full body harness work at above 1.5 mtr height and ensure 100 %
obstruction in access etc... anchoring of harness at solid anchoring point. Ensure proper guardrail
M. Poor housekeeping surface. provision for height work. Only experienced persons allow for height
work. Ensure to lock all four leg (scissor lift) while work on it. Follow
three point contact while climb on ladder i)
i) Ensure all hand tools must protected against fall while work at height.
j) Use guide rope for handle material while handling. the material and
Body injury due to hit by maintain safe distance between man &
k) Use wooden sleepers for keeping the material. Use tools for handling
the material like pushing, pulling etc. Keep away body parts from
1. Injury to operator pinching hazards.
2. Injury to workers
l) Keep clear access and ensure work area free from obstruction.
3. Falling Of Person
4. Fall Of Material m) Conduct the area housekeeping before and after completion the job
5. Tripping hazards Labors / Workers Safety follows:
6. Electrical hazards Labor should wear Hand gloves, Safety Helmets, Goggles, Site jackets, Safety
7. Electrical injuries to operator & workers Shoes, Masks Safety Gloves, double lane full body Harness, labor should not be in
8. Inadequate inspection of the worksite effect of alcohol etc.
may result in property damage, injury, 1) Utilize the barricades, cones or caution tape to keep bystander a safe
illness or fatal injury distance from job.
2) Position lift away from traffic.
3) Building overhangs and power line
4) Inspect Aerial Lift (use aerial lift equipment inspection log) and PPE
before use
5) Operator dons harness and lanyard.
Drilling work 6) Operator enters the bucket and attaches lanyard to designated
lanyard anchorage point.
7) Never exceed the posted lift capacity (including worker, material, and
tools).
8) Never use lift as a crane or hoist to lift or lower material.
9) Always look in the direction of travel of bucket when operating lift.
10) Never run boom or bucket into conductors, cables, poles, trees, etc.

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 Safe Work Method Statement

1. Flying debris, swarf etc. ( Eye injury )

2. Noise 1. Use protective eyewear of face shield.
3. Vibration
2. Wear hearing protection if above 80 db or if uncomfortably
loud.
3. Select power tools with lowest vibration levels.
4. Minimize the time schedule use the equipment (eg. Job
rotation)

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 Safe Work Method Statement

Sign off Name Signature Date

I have provided site-specific risk controls to manage the hazards identified above and will comply with the controls listed above.

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 Safe Work Method Statement
Contractor:

I understand the risk controls listed above will be implemented to manage the identified hazards associated with the works to be undertaken.

Workplace Manager and/or

Management OHS Nominee:

Steps for filling out SWMS

1. Contractor to determine the tasks, and associated hazards, risks and controls.
2. In the ‘What are the tasks involved?’ column, list the work tasks in sequence to how they will be carried out.
3. In the ‘What are the hazards and risks?’ column, list the hazards and risks for each work task.
Control levels
1. Eliminate any risk to health or safety.
2. Reduce the risk to health or safety by any one or any combination of the following:
 Substituting a new activity, procedure, plant, process or substance
 Engineering controls, such as mechanical or electrical devices.
3. Use administrative controls, such as changing the way the work is done.
4. Provide appropriate personal protective equipment.
5. All contractors should be briefed on the SWMS before commencing work. Ensure all contractors know that work is to immediately stop if the SWMS is not being followed.
6. Observe work being carried out. If controls are not adequate, stop the work, review the SWMS, adjust as required and re-brief the team.
7. Retain this SWMS for the duration of the high-risk work.
8. Attach all permits associated with the job.
9.

Prepared by: Checked by: Work Allowed by:

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