Safe Work Method Statement Template Sample

Sample Safe Work Method Statement (SWMS)
ORGANISATION DETAILS
Principal contractor:
ABLE 2 CONSTRUCTIT4U PTY LTD
Contact number:
0404 772 277
Project manager or supervisor:
JACK SMART
Contact number:
0404 771 177
Other contractors (PCBUs):
NAUTILUS PLUMBING P/L and SUPERIOR SCAFFOLDING

P/L
Contact number:
6462 2222 and 0418 300 300
Person completing the SWMS:
JACK SMART
Contact number:
0404 771 177
Position:
SITE SUPERVISOR
Reviewed by:
TOM WISE (Project Manager)
Date prepared:
17/6/2012
Review date:
20/10/2012
PROJECT DETAILS
What is the scope of the work?
Excavation work associated with plumbing of sewerage and storm water from connection at boundary into new residence.
Install access scaffolding to enable installation of flashing on second story roof and connecting downpipes into storm
water
Who else was consulted/involved

in preparing this SWMS?
Tom Wise Project Manager for Able 2 Constructit4u P/L

Stinky Jones from Nautilus Plumbing
Dirk Ledger from Superior Scaffolding P/L
What high risk work activities are

covered by this SWMS?
Powered mobile plant in operation. Heights of more than 2 metres above ground. Work adjacent to a road used by traffic
other than pedestrians
References: Legislation,
Australian Standards, Codes of
Practice, MSDS and SOPs.
WHS Act and Regulations 2012
Plant involved in the scope of

work:
3 tonne rubber tracked CAT excavator, prefabricated scaffolding components, 10 yard dump truck, delivery vehicles,
worker vehicles, personal fall arrest devices, PVC plumbing components, portable hand tools
What high risk licence classes

will be required to do the work?
Scaffolding Class SB, SI or SA, Vehicle Loading Crane Class CV, Dogging Class DG
Codes of practice: How to prevent falls at workplaces, Scaffolding, Risks of plant at workplaces, Excavation work
RISK MANAGEMENT
Identify each task in
order
Specify the hazards

you have identified
What are the risks to health

and safety?
Describe your control measures, list as many as

possible
Who is responsible for

implementing and
monitoring controls?
Mobile machinery
Delivery of
scaffolding and
Manual handling
plumbing materials to
site
Crush or impact with body
Hi-ab crane mounted on delivery vehicle.

Driver holds appropriate HRL for crane and
dogging. Team lifting of lighter items. Workers
to wear gloves when handling materials
Jack Smart to check

HRL. Workers to
observe PPE and safe
lifting practices
Segregate stored materials away from work

areas
Jack Smart to supervise

Dirk and his crew to
wear PPE as designated
Muscular skeletal injuries
Storage of
Trips and falls
materials
Cuts on sharp edges
associated with the
work site
Objects falling from above
Striking body against
materials
Place bunting around sharp corners of

flashings
Stinky to maintain
separation from
Scaffolding components to remain in storage
scaffolding. Excavator to
cradles, cradles to be stacked on level ground
stay 5 metres from
scaffolders at all times
Hard hats, gloves and safety glasses to be
worn during all work
Maintain separation between the plumbing
activities and scaffolders while scaffolding is
being handled
Unloading excavator
on site
Manual handling
(ramps)
Mobile machinery
proximity to
workers
Other vehicles
moving in the area

Cuts and bruising
Tipping over during
unloading causing injuries
to excavator operator and
crush injuries for workers
Excavator will place its own ramps into

position and operator to hold industry
accreditation
Jack Smart to coordinate unloading

activity
Advance warning traffic signs to be used
Jack Smart to manage

traffic management of
people and vehicles
Able 2 constructit4u provide traffic

management for pedestrians and vehicles
during unloading excavator from 10 yard truck
All personnel to maintain a 6 metre clearance
Excavate and backfill Moving machinery

drainage trenches
Noise
Struck/crushed by machine Maintain safe distance from operating

machinery
Excavator undermines or
Complete excavation in scaffold area and
Jack Smart to coordinate works program

Stinky Jones to install
Open excavations
knocks down scaffold

Fall into open excavations
Buried in trench collapse
backfill before scaffolding work starts
para-web
Machine has reverse beeper and flashing light Excavator operator to

alert others when
All workers to wear high visibility garments
tramming
Operator to blast horn twice prior to tramming All workers wear
Trench edges delineated with para-web fence
designated PPE
Trench in stages and backfill each day

Bench and batter edges over 1.5m
Construct access
scaffold for plumbers
Manual handling
Prestart stretching and flexing by scaffolders
Falling from
heights
Bruising
Buddy lifting techniques and job rotation

applied
Falling objects
Sharps edges
Structural collapse
Lacerations
Fractures
Fatalities
Struck by falling materials
Scaffold designed and erected by qualified

scaffolders who install edge protection at
every lift during construction as work
proceeds
Maintain 6 metre exclusion zone
Hard hats, gloves, safety glasses and
footwear worn by all on site
Superior Scaffolding
supply scaffold design
drawing
Dirk Ledger to supervise
scaffold construction
Jack Smart to coordinate site work
Tom Wise to obtain
copies of HRLs
Handover certificate
reqd
Scaftag fitted as sign off
Working from scaffold Falling from the

structure
Falling objects
Electric shock
Bruising
Access ladder secured to scaffold to prevent

movement when accessing scaffold
Jack Smart to coordinate works program
Fatalities
Materials not to be carried up access ladder,

use ropes and buddy system to handball up
materials
Slips/falls (on wet sealant)
All electrical equipment tagged and tested
Stinky Jones to
supervise his workers
compliance and provide
PPE
Lacerations
Fractures
Remain on scaffold deck at all times, no

trestles or climbing rails for additional height
or reach
Contact Dirk
0418300300 to make
changes to scaffold
Plumbers to work
No alterations to scaffold by plumbers after

handover by scaffolders
according to SWMS
This SWMS has been developed in consultation and has been read, understood and signed by all workers undertaking the scope of works:
Print Names:
Signatures:
Dates:
John Brown
17 June 2012
Sam Smith
17 June 2012
Bill Robinson
17 June 2012
Sally Stone
17 June 2012

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Sample Safe Work Method Statement (SWMS)

ABLE 2 CONSTRUCTIT4U PTY LTD

0404 772 277

Project manager or supervisor:

0404 771 177

Other contractors (PCBUs):

NAUTILUS PLUMBING P/L and SUPERIOR SCAFFOLDING

6462 2222 and 0418 300 300

Person completing the SWMS:

0404 771 177

TOM WISE (Project Manager)

Who else was consulted/involved

Tom Wise Project Manager for Able 2 Constructit4u P/L

What high risk work activities are

WHS Act and Regulations 2012

Plant involved in the scope of

What high risk licence classes

Specify the hazards

What are the risks to health

Describe your control measures, list as many as

Who is responsible for

Crush or impact with body

Hi-ab crane mounted on delivery vehicle.

Jack Smart to check

Segregate stored materials away from work

Jack Smart to supervise

Muscular skeletal injuries

Place bunting around sharp corners of

Muscular skeletal injuries

Excavator will place its own ramps into

Jack Smart to coordinate unloading

Advance warning traffic signs to be used

Jack Smart to manage

Able 2 constructit4u provide traffic

Excavate and backfill Moving machinery

Struck/crushed by machine Maintain safe distance from operating

Jack Smart to coordinate works program

knocks down scaffold

backfill before scaffolding work starts

Machine has reverse beeper and flashing light Excavator operator to

Trench in stages and backfill each day

Muscular skeletal injuries

Prestart stretching and flexing by scaffolders

Buddy lifting techniques and job rotation

Scaffold designed and erected by qualified

Working from scaffold Falling from the

Access ladder secured to scaffold to prevent

Jack Smart to coordinate works program

Materials not to be carried up access ladder,

Slips/falls (on wet sealant)

All electrical equipment tagged and tested

Remain on scaffold deck at all times, no

No alterations to scaffold by plumbers after

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