Safe Work Method Statement (SWMS) Example

1 job safety and Environmental analysis (JSEA) / Safe Work Method Statement (SWMS). JSEAsy Demo (Your Business name will replace this). Part 1: Project and Task Identification Process Initiators of SWMSs are responsible for consulting the Project Supervisor, Quality WHS Manager or other persons directly in charge of the work and other personnel involved in the execution of the task (as appropriate) for input into the SWMS. Other persons may be consulted for technical advice or review of the SWMS to see that proposed measures are effective and workable. The task is to be broken up into steps. For each step, the safety hazards are identified. For each of the hazards identified, corrective action, precautions, equipment are identified to reduce the hazard.

2 All involved in the task must review and sign this SWMS form. Client: TotalTrack Pty Ltd Site: The Sample University, 99 Example Way Adelaide SA 5000. Contact Name Job Title Phone Mobile FAX Email Scott LeBlanc Director 08 8351 1540 0408 831 550 08 8261 9977 SWMS Initiated By Date: SWMS No. 1 Rev: 2 Rev. Date: 5/02/2017. Ben Workin Work Locations/Areas: Supervisor Review Date: All Will Bwatchin Management Review Date: Sample Guy Description of Work Construction of new entrance to be Undertaken: Sunday, 5 February 2017 JSEAsy Demo (Your Business name will replace this) JSEAsy Page 1 of 23. First, identify and assess the risks, then decide the best way to control them by applying the Hierarchy of Control as follows: LEVEL CONTROL DEFINITION.

3 Level 1 Elimination Controlling the Hazard at source Level 2 Substitution Replacing one substance or Activity with a less hazardous one Isolation Separating the hazard from the person Engineering Installing Guards on machinery Level 3 Administration Implementing policies and procedures for safe work practices Personal Protective Equipment Use of safety glasses, hardhats, protective clothing, etc. Hierarchy of Controls Effectiveness Eliminate the hazard Substitute the hazard Isolate the hazard Use engineering controls Use administrative controls Use PPE. Sunday, 5 February 2017 JSEAsy Demo (Your Business name will replace this) JSEAsy Page 2 of 23. Part 2: Worker Qualifications and Induction Record JSEAsy Demo (Your Business name will replace this).

4 Personal Qualifications and Experience Duties and Responsibilities of Personnel Formal or Specialised Training or Required To Carry Out the Works: Completing the Task: Licenses Required to Complete Work or Operate Specific Plant or Equipment: Completion of White Card Induction Adherence to company's and the site's WH&S policies Competency in the Safe Operating Procedure of the The ability to work unsupervised and part of a team and procedures selected power tools Roof Plumbing Trade Certificate (Preferred) or a Maintain adequate house-keeping on site Load Restraint Training (TLIA107C). competency level of installing metal sheeting materials Reporting of any injuries / incidents to your Project Heavy Vehicle Drivers licence with a class equal to or Certificate III in Wall and Floor Tiling Supervisor greater than the required for the mass of the truck Certificate III in Wall and Ceiling Lining (Preferred) or a Operate safely and perform daily pre-shift inspections Training and shown competency in the safe use of the competency level of installing wall and ceing materials vehicle loading device Certificate III in Painting and Decorating preferred or License To Operate A Vehicle Loading Crane (TLILIC.)

5 Shown competency in the application paint 0012A). Elevated Work Platform Train & Assess (TLILIC508A) - High Risk Licence Class WP. Dogman - Certificate of Competency SWMS Sign Off Your signature below indicates that you have been consulted in development of the SWMS and accept and will implement the requirements of the SWMS and control measures No. Name Classification Employed By Signature Date 1 Sample Guy Carpenter JSEAsy Demo 5/01/2017. 2 Ben Workin Labourer JSEAsy Demo 5/01/2017. 3 Bringit Down Demolition Worker Now you see it now you don't 19/01/2017. 4 Jean-Claude Van Man Driver We Deliver 19/01/2017. 5 Steele Recton Rigger JSEAsy Demo 19/01/2017. 6 Scott Mebuggerd Ceiling fixer Scott's Ceilings 7 Scott Mebuggerdto Ceiling fixer Scott's Ceilings 8 Phil McCrevice Flusher Scott's Ceilings 9 Slap Dabber Painter Slap's Painting 10 Bonnie Tiler Tiler We Layum 11 Surelock Homes Window and Door installer Fitum and Lockum Sunday, 5 February 2017 JSEAsy Demo (Your Business name will replace this) JSEAsy Page 3 of 23.

6 12. 13. 14. 15. 16. 17. Sample Guy Emergency Contact Name: Sample Girl Relationship: Wife Phone: 08 8351 1540 Mobile: 0408 000 000. Qualification Licence Number Completion of White Card Induction Boom Lift over 11m (WP) High Risk S123456. Certificate III in Carpentry Motor Vehicle C987654. Building Supervisor BLD 123456. Scissor Lift (SL) EWPA Yellow Card 987654. Forklift truck (LF) High Risk Licence 55555. Sunday, 5 February 2017 JSEAsy Demo (Your Business name will replace this) JSEAsy Page 4 of 23. Part 3: Hazard analysis , Control and Legislation Worksheet JSEAsy Demo (Your Business name will replace this). job safety and Environmental analysis (JSEA) Safe Work Method Statement (SWMS).

7 Process Steps Potential Hazard(s) Hazard Control Measures New Risk Step List the steps needed to do the job Rating Risk Action By Against each step list potential hazards that For each hazard, identify control measures No. in the sequence to be done. Rating could cause injury when the job is done. to eliminate or minimise the risk of injury. 1 Site Orientation/ Induction Report to client's reception Entering restricted areas 19 Follow posted signs and go directly to 1 All reception Undertake a site induction Unfamiliarity with emergency procedures 14 Listen and ensure you obtain information and 1 All site emergency and evacuation procedures Unawareness of site specific hazards 14 Listen and ensure you obtain information 1 All about any and all site hazards Unawareness of restricted areas 18 Listen and ensure you obtain information 1 All about any restricted areas Unawareness of other operations or hazardous 9 Listen and ensure you obtain information 5 All activities being undertaken on site about

8 Any other activities being undertaken on site 2 Claim Work Area Access the site Breaching minimum site PPE requirements 13 HI visibility clothing must be worn at all times 1 All whilst on site Steel toe safety boots must be worn at all 1 All times whilst on site safety glasses must either be worn or carried 1 All at all times whilst on site Breaching site rules or requirements 13 NO SMOKING on site-designated smoking 1 All area will be available and ALL butts to be placed in bin Progressive housekeeping clean as you go 1 All Establish safe perimeter People entering work area 25 Controlled by Site Manager 5 Site Supervisor Bunting or Caution tape shall define the work 3 All area by providing a 3 meter barrier or denying access whichever is more appropriate.

9 3 Inspect and drive truck Pre-operation Inspection Faulty equipment machine failure 14 Examine Tires and wheels for following 1 Driver hazards: lug nuts, cracked rims, cuts, tire pressure Check all hydraulic rams and lines, controls 3 Driver for leaks Check all safety devices 3 Operator Check rear view mirrors are present and in 1 Driver Sunday, 5 February 2017 JSEAsy Demo (Your Business name will replace this) JSEAsy Page 5 of 23. job safety and Environmental analysis (JSEA) Safe Work Method Statement (SWMS). Process Steps Potential Hazard(s) Hazard Control Measures New Risk Step List the steps needed to do the job Rating Risk Action By Against each step list potential hazards that For each hazard, identify control measures No.

10 In the sequence to be done. Rating could cause injury when the job is done. to eliminate or minimise the risk of injury. good condition Ensure Safe Working Limit is displayed and 1 Driver legible Board truck Falling from truck 13 Use hand hold and steps when 1 All entering/exiting cabin Do not jump from cabin 1 All Start the truck Vehicle running into objects and or persons 7 Ensure parking brake is on and operational 1 Driver Before starting motor, ensure transmission is 1 Driver in neutral and check throttle for proper operation Drive the truck Legislation Breach 18 Ensure seatbelt is worn 2 All Only persons with the appropriate licence are 1 Driver to dive the vehicle Do not drive or operate the vehicle while 2 Driver under the influence of drugs or alcohol Ensure the load does not exceed the safe 1 Driver work load/ limit of the vehicle Obey the road rules and speed limits of the 2 Operator state or territory at all times Unsecured load 15 Unsure load is secure with rated restraints 1 Driver Striking Overhead Tree branches 13 Ensure path of travel is clear of low-lying tree 2 Driver limbs Striking