Beruflich Dokumente
Kultur Dokumente
Phone
State Postcode
Email
2. Activity details
Activity/task Is the task High Risk Yes Please specify
described by SWMS Construction Work?
No
Site address
MITM description
3. SWMS preparation
Name of person who prepared
Date prepared
SWMS
Names of workers who have had input
into the development of this SWMS
Name of person responsible for implementation, review and monitoring of this SWMS
5. Hazardous substances and/or dangerous goods required for activity - Attach copies of Material Safety Data Sheets (MSDS)
Product name MSDS attached Quantity (Kg/L) Product name MSDS attached Quantity (Kg/L)
Yes No Yes No
Yes No Yes No
Safe Work Method Statement (SWMS) Page 2 of 4
6. Plant and equipment utilised (tick or add as applicable) – Attach evidence to this SWMS
Item (including all mechanical and electrical items) List inspections and maintenance requirements and attach evidence to this SWMS Is a licence/ticket
Note: All servicing MUST be in accordance with manufacturers recommendations. required to operate?
Yes No
Yes No
Yes No
Yes No
Construction industry induction (e.g. white card) Yes No Yes No Yes No Yes No Yes No
8. Emergency planning (tick or add as applicable) – Attach a copy of your emergency plan
Location of equipment
Location of equipment
Other
Safe Work Method Statement (SWMS) Page 3 of 4
(1) Rare – The event may occur but only in (1) Negligible – No medical attention
exceptional circumstances and may have required
occurred in the last ten years
Safe Work Method Statement (SWMS) Page 4 of 4
Step Relevant Task step Potential hazard(s) Risk assessment Risk control measures
List each individual step required to complete Against each step, list the potential hazards that could (use the risk For each hazard, identify the control measure to eliminate or control the risk
the activity cause injury or illness assessment matrix as far as reasonably practicable.
Yes No at Section 10)
L M H E
1 L M H E
2 L M H E
3 L M H E
4 L M H E
5 L M H E
6 L M H E
7 L M H E
8 L M H E
9 L M H E
10 L M H E