Safe Work Method Statement Worksheet
Safe Work Method Statement Worksheet
Safe Work Method Statement Worksheet
Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.
Site Name
Contractor
Activity
of
No
Tasks
Who is responsible?
List the control measures required to eliminate or reduce the risk of injury
and detail how the control measures will be put in place.
UV Exposure
Hot Weather
Electrical Equipment
All workers
Builder / Management
Builder
Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.
Noise
Manual Handling
All workers
Builder / Management /
All workers
Leading Hand
Leading Hand
Operator
Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.
Use of Cranes
Lighting
Constructing Formwork
Lift formwork components
and fit into position
Crane operator
Principal Contractor /
Leading Hand
Leading Hand
Leading Hand
Leading Hand
Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.
Leading Hand
Leading Hand
Leading Hand
Principal Contractor /
Leading Hand
Principal Contractor /
Leading Hand
Leading Hand
Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.
Tripping hazards.
Install access stairs and/or additional access ladders and tie access
ladders securely to structure.
Ladders to project at least 900mm above upper landing.
Provide guardrails at landing point.
Install guard rails to landing zone working off stairs. Prohibit access
to upper levels pending installation of guardrails.
Ensure correct blades and working guards are fitted to all power
tools.
Wear protective goggles or face shields when using power tools and
nail guns.
Check to ensure compressor air hoses and clippings are secure.
Ensure that electrical equipment is used as detailed above in
General Planning and General Safety Issues Electrical
Equipment.
Control as detailed above in General Planning and General Safety
Issues Access to Work Areas; and:
Principal Contractor /
Leading Hand
Leading Hand
Leading Hand
Leading Hand
Leading Hand
Leading Hand
Leading Hand
Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.
Formwork stripping
Structural collapse
I have read and understood the content of this Safe Work Method
Statement
Workers name
Signature
Ensure the minimum concrete cure time has been reached before
placing loads on the deck. Ensure any issues of load limits and backpropping of lower floors have been addressed.
Before the concrete pour is allowed to commence, the formwork is to
be inspected and certified by a structural engineer.
The engineer should supply an inspection certificate to verify the
structural integrity of the support structure and formwork system.
Ensure that no worker is allowed to access the immediate area
beneath the section of formwork where the concrete is being poured.
If an observer is to be positioned at a lower level during the pouring
operation, they must be located in a position that will safe guard them
from injury if the formwork fails during concrete placement. Generally,
neither the observer nor any other worker should be permitted to
access the area below the pour once concrete placement has
commenced, even to rectify problems.
Ensure fall protection has been provided and being maintained. i.e.
scaffold, screens or hand rails and any voids are adequately covered
over.
Ensure there is a specification for a minimum concrete cure time
before dismantling. Do not allow formwork to be removed prior to the
concrete reaching its required strength.
When stripping the underside of a suspended floor slab, barricade
the area off from other workers. Make sure people dismantling the
formwork are working from properly constructed scaffolds or properly
planked shoring frames. Never allow "drop stripping" of form ply and
falsework.
Leading Hand
Leading Hand
Date
A
p
pr
ov
ed
B
y
Workers name
Signature
Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.