Safe Work Method Statement

Company: (Name, Contact Person & Phone)

Project/Site: Principal Contractor:

Job Task: Boom Lift – Working from SWMS No.:

Date Created: Revision Number: Review Date:

Workers Involved in Developing this SWMS

Print Name: Signature: Print Name: Signature:

Relevant Australian Standards / Codes of Practice / Legislation

Material Safety Data Sheets Required

Plant & Equipment Required

Licenses / Competencies Required

Hot Work Permit ☐ Yes Confined Space Permit ☐ Yes Crane Lift Plan / Permit ☐ Yes Other Permit ☐ Yes

Applicable Permit Number(s):

PPE Required:

High Risk Work: ☐Structural Collapse ☐Confined Spaces ☐Work in Tunnel ☐Explosives

☐Fall from Heights > 2m ☐Demolition of Structures ☐Excavation >1.5m ☐Mobile Plant ☐Drowning

☐Asbestos ☐Pressurised Gas Pipes/Mains ☐Electrical ☐Traffic ☐Tilt-up/Precast Concrete

☐Telecommunication Towers ☐ Contaminated/Flammable Atmosphere ☐ Extremes of Artificial Temperature ☐ Chemical/Fuel/Refrigerant Lines

Task/Location Specific Risks: ☐Ground Conditions ☐Noise ☐Water Pollution ☐Weather

☐Access & Egress ☐Compressed Air ☐Cultural / Heritage Area ☐Soil Pollution ☐Obstacles / Buildings

☐Overhead Obstructions ☐Quick Cut Saw ☐Snakes / Vermin ☐Rotating Machinery ☐

☐Underground Services ☐Angle Grinder ☐Dust ☐Fatigue ☐

☐Pedestrians / Workers ☐Hot Work / Burns ☐Significant Trees ☐Exposure to UV ☐

☐Unauthorised Persons ☐Poor Lighting ☐Flora & Fauna ☐Ignitions Sources ☐ Other (refer to hazard prompt list)

Safe Work Method Statement

Step 1

Consequences

5 – Severe Potential to be fatal. Permanent disability. Destruction of property or plant.

4 – Major Serious injury. Long term disability. Major damage to plant, property or environment.

3 – Moderate Potential for injury resulting in medical attention. Damage to plant, property or environment.

2 – Minor Injury requiring First Aid treatment and / or short term discomfort.

1 – Negligible Cause a near miss, needs to be reported

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 Step 2

Potential (Likelihood)

A – Almost Certain This event is expected to occur in most circumstances

B – Likely The event will probably occur in most circumstances

C – Possible The event might occur at some time

D – Unlikely The event could occur at some time

E - Rare The event may occur only in exceptional circumstances

Step 3

Matrix Consequences

Potential 1 – Negligible 2 – Minor 3 – Moderate 4 – Major 5 – Severe

A – Almost Certain M (9) S (15) S (19) H (24) H (25)

B – Likely L (7) M (11) S (18) S (21) H (23)

C – Possible L (5) L (6) M (13) S (17) H (22)

D – Unlikely L (3) L (4) M (10) M (14) S (20)

E - Rare VL (1) L (2) M (8) M (12) S (16)

Legend
Risk Rating

High Activity to be re-planned and/or re-designed. If this is not possible, an independent Hazard Assessment of the activity is to be completed by the Project Manager prior to completing the SWMS

Significant Activity Must be reviewed by Senior Site Management Representative and have identified risk controls built into the SWMS and work procedure

Medium Site Supervisor must review method of task.

Low Some action may be required, Supervisor to determine and monitor

Very Low Minimal risk, monitor where work changes

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 Safe Work Method Statement

Job Step Potential Hazard Risk Rating Control Residual Risk Person Responsible for Controls
What can cause harm at each step
Break the job into steps S (17) Describe the control measures and how they will be used M (8) EXAMPLE
High risk work is to be kept to its own cell

Only workers trained in correct manual handling techniques to complete task

Manual Handling S M [insert responsible person]
Team lifts and mechanical lifting devices to be used where possible

Work area to be kept clear of trip hazards at all times

Preparation
Appropriate PPE to be worn at all times
Slips, trips, falls Cuts, lacerations, abrasions M L [insert responsible person]
Daily checks and log book entries to be completed by competent operator, all faults and
service requirements to be reported to the site supervisor.

Noise M Correctly attenuated hearing protection to be used at all times when unit is in use L [insert responsible person]

Ensure operator trained and competent.

All tools to be checked & in working order.
Fume inhalation from resigns in disc or from materials S M [insert responsible person]
All cords to be inspected prior to use.
Work area to be well ventilated when in operations

Slips, trips, falls Cuts, Work area to be kept clear of trip hazards at all times
M L [insert responsible person]
lacerations, punctures Appropriate PPE to be worn at all times -including long clothing.
Moving plant onto site

Guards to be in place and eye protection to be used at all times when unit in use.
Foreign body in eye Noise M Erect safe defined work zones or have spotter in place as required L [insert responsible person]
Correctly attenuated hearing protection to be used at all times when unit is in use

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 All electrical tools to be tested & tagged in accordance with AS 3760 & 3012.
Electrocution H Tested and tagged RCD protection to be used S [insert responsible person]
All cables checked for damage prior to use

Safety Harness with competent operator to be used at all times

Refer to 'Safety Harness Use' SWMS
Working from basket whilst aloft Fall from heights H S [insert responsible person]
Fall safety equipment to be inspected daily prior to use, faults reported, lanyards to be
attached to the certified anchor point

Have you considered the site specific hazards? e.g. IN PREPARING A SAFE WORK METHOD STATEMENT YOU MUST:
- lay of the land 1. Consider any site specific potential hazards and include any identified risks in Safe Work Method Statement (SWMS)

- obstacles (buildings, workers, excavations, plant) 2. Assess the risk

- changes to site conditions 3. Insert controls using the hierarchy of controls for the hazards identified i.e. Elimination, Substitution (materials, equipment, and chemicals), Isolation, Engineering (guarding), Administration (training) or PPE
- other contractors’ work in progress 4. Review the residual risk to ensure controls are adequate to safely perform the work

Have you considered weather conditions? Eg. 5. Document the matters contained in items 1 – 4, above, in this SWMS
- wind 6. Complete the SWMS and Delete these notes to demonstrate that you have considered all relevant matters
- rain
7. Ensure that all workers involved in the job task have read, understood and signed off on the SWMS
- heat
8. Ensure that work is carried out in a safe manner in accordance with the SWMS
- cold etc
NB: If you are unsure of anything seek professional advice. Master Builders WHS department can assist members in developing and implementing safety plans, including SWMS.
Have you considered job specific details?
- different material

- different equipment

Any other factor that may make affect the risks associated with performing this task?

I, the undersigned Supervisor, confirm that I have checked all qualifications provided and verify that they are applicable and current. I have also ensured that all inductions have taken place and that all tools and equipment are properly maintained and safe to use. I have issued all
relevant permits and have ensured to the best of my ability that the work area is safe and that the work will not damage any property or injure any persons.

Supervisor Name Supervisor Signature Date _______________

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