SAFE WORK METHOD STATEMENT DOCUMENT

Document Title (to be completed by the Contractor / Service Provider

Project: SWMS No:
This SWMS will be reviewed on 3-yearly basis
SWMS Title: OR earlier if conditions and/or circumstances change that introduce
new hazard/s.
Contractor / Service Provider:
Document Status (to be completed by Hexacon)
Rev Contractor Hexacon Hexacon
Date Comments
No review by review by verification by

Hexacon Review, Verification & Endorsement

REVIEW
I have reviewed all aspects of this SWMS and am satisfied to the best of my knowledge that it meets all Hexacon acceptance criteria (including the
SWMS Checklist)

Supervisor / Engineer (print name): Signed: Date:

VERIFICATION
I have verified all aspects of this SWMS and am satisfied to the best of my knowledge that it meets all Hexacon acceptance criteria.

EH&S Personnel (print name): Signed: Date:

ENDORSEMENT
I have verified all aspects of this SWMS and am satisfied to the best of my knowledge that it meets all Hexacon acceptance criteria.

Project / Construction Manager (print name): Signed: Date:

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B APPLICATION (to be completed by Contractor / Service Provider)
Section 1: Scope of Works
Tasks / Activities:

Work Location (Attach Site Plan): Please refer to attached Duration: From

Remarks:

Section 2: Plant / Machinery / Equipment (Attach Inspection Certificates)

Type of Plant / Machinery / Equipment Is this equipment inspected? Remarks
Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Section 3: Key Personnel / Qualified Persons (Attach Training Qualification Certificates)

Name Appointment / Designation Remarks

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Section 4: Work Processes & Procedures
Inventory of Work Activities
Key Job Steps
Key Job Step breakdown (if required)
These steps are to be copied to:
Step breakdowns are to be copied to:
C – Section 2: Risk Assessment &
C Section 3: Safe Work Procedures
C Section 3: Safe Work Procedures

Special Instructions/Remarks:

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C RISK ASSESSMENT (to be completed by Contractor / Service Provider)
Section 1: General Information SWMS No:
PREPARED BY: REVIEWED / APPROVED BY:
(Competent Manager, Engineer or Supervisor directly responsible for managing this activity)

Name: Signed: Name: Signed:

Designation: Date: Designation: Date:

Date of Last Review: Date of Next Review:
Risk Assessment Team
Name Designation Signature

  
  
  
  
  

Risk Matrix

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1. Assessment of Severity – with the existing risk controls in consideration, each Risk Assessment Team (RAT) member is to rate the most
likely severity outcome of the possible injury or ill-health identified: see Table 1 below.

Table 1
Severity (S) Description
(5) Catastrophic Fatality, fatal diseases or multiple major injuries.
Serious injuries or life-threatening occupational disease (includes amputations, major fractures, multiple injuries,
(4) Major
occupational cancer, acute poisoning).
Injury requiring medical treatment or ill-health leading to disability (includes lacerations, burns, sprains, minor fractures,
(3) Moderate
dermatitis, deafness, work-related upper limb disorders).
(2) Minor Injury or ill-health requiring first-aid only (includes minor cuts and bruises, irritation, ill-health with temporary discomfort).
(1) Negligible Not likely to cause injury or ill-health

2. Assessment of Likelihood – with the existing risk controls in consideration, each Risk Assessment Team (RAT) member is to rate the
likelihood hazard that may cause the possible injury or ill-health: see Table 2 below.

Table 2

Likelihood (L) Description

(1) Rare Not expected to occur but still possible.
(2) Remote Not likely to occur under normal circumstances.
(3) Occasional Possible or known to occur.
(4) Frequent Common occurrence.
(5) Almost Certain Continual or repeating experience.

3. Risk Matrix provides the useful framework to classify risks identified: see Table 3 below.

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 Table 3
4. Acti
Likelihood (L)
(1) Rare (2) Remote (3) Occasional (4) Frequent (5) Almost Certain on
Severity (S)
for
(5) Catastrophic (5) Medium (10) Medium (15) High (20) High (25) High
(4) Major (4) Medium (8) Medium (12) Medium (16) High (20) High
(3) Moderate (3) Low (6) Medium (9) Medium (12) Medium (15) High
(2) Minor (2)Low (4) Medium (6) Medium (8) Medium (10) Medium
(1) Negligible (1) Low (2) Low (3) Low (4) Medium (5) Medium
[Risk Level: H = High Risk (15 ~ 25) M = Medium Risk (4 ~ 14) L = Low Risk (1 ~ 3)]
Risk Level – the following actions are to be implemented based on the current Risk Level, as shown in Table 4 below.

Table 4

Risk Level Risk Acceptability Recommended Actions

- No additional risk control measures may be needed.
Low Risk Acceptable - Frequent review and monitoring of hazards are required to ensure that the risk level assigned is accurate and
does not increase over time.
- A careful evaluation of the hazards should be carried out to ensure that the risk level is reduced to
as low as reasonably practicable (ALARP) within a defined time period.
Medium Risk Tolerable - Interim risk control measures, such as administrative controls or PPE, may be implemented while
longer term measures are being established.
- Management attention is required.
- High Risk level must be reduced to at least Medium Risk before work commences.
- There should not be any interim risk control measures. Risk control measures should not be overly
High Risk Not acceptable dependent on PPE or appliances.
- If practicable, the hazard should be eliminated before work commences.
- Management review is required before work commences.

Risk Control

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 Hierarchy of Control

The control of hazards and reduction of risks can be accomplished by following the WSH Hierarchy of Control (see Figure 1). These control measures are
not usually mutually exclusive. Generally, it may be more effective to use multiple control measures, for example, engineering controls work better with
administrative controls like training and Safe Work Procedures.

Figure 1

Inventory of Work Activities and Hazard Identification for the:

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S/No. Process / Location: Work Activities

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Section 2: Risk Assessment

Residual Risk Risk Owner (Action Officer)

Possible Accident Initial Risk Level
Additional Risk Level
No Work Activity Hazard / Ill Health & Existing Risk Control Name
Control S L R Follow-Up
Persons-at-Risk S L R Designation Date

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Section 3: Safe Work Procedures
Unless stated otherwise in this document, ALL WORKERS, will wear (at all times during this activity):-
MANDATORY:- (1) Hard hat (2) Safety glasses (3) Safety Gloves (4) Safety Boots (5) Hi-Visibility shirt/vest/jacket *Reflective
mandatory for night work (6) Long sleeve shirt (7) Long pants
Key Job Step
Safe Work Procedures Additional
Key Job Steps breakdown Permits
(include images / sketches if required Equipment / Remarks
(Copy from B – Section 4) (Copy from B – Required
for further clarity) PPE
Section 4)

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Section 4: Instruction & Communication
This Safe Work Method Statement has been developed through consultation with the following crew members and has been instructed through
induction, read and understood, and signed by all employees undertaking the works.
Name Designation Remarks / Comments Signature Date

Section 5: Verification
I have provided, accurate and sufficient information and instructions pertaining to this Safe Work Method Statement - the aspects / hazards associated
with each work process and activity, the type of potential impact, incident or accident, and the risk controls / practicable measures to be taken in the
course of work and during an emergency - to ensure its / their safe undertaking.

Instructed by (print name): Signed: Date:

Time: am / pm

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