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

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 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

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
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
High 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

Risk Residual Person Responsible for

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

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

Correctly attenuated hearing protection to be used

Noise M L [insert responsible person]
at all times when unit is in use

Ensure operator trained and competent.

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

Work area to be kept clear of trip hazards at all

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

Guards to be in place and eye protection to be

used at all times when unit in use.
Foreign body in eye Erect safe defined work zones or have spotter in
M L [insert responsible person]
Noise place as required
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 S [insert responsible person]
Tested and tagged RCD protection to be used
All cables checked for damage prior to use

Safety Harness with competent operator to be

used at all times
Working from basket Refer to 'Safety Harness Use' SWMS
Fall from heights H S [insert responsible person]
whilst aloft 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
- obstacles (buildings, workers, excavations, plant) (SWMS)
- changes to site conditions 2. Assess the risk
- other contractors’ work in progress 3. Insert controls using the hierarchy of controls for the hazards identified i.e. Elimination, Substitution (materials,
Have you considered weather conditions? Eg. equipment, and chemicals), Isolation, Engineering (guarding), Administration (training) or PPE
- wind 4. Review the residual risk to ensure controls are adequate to safely perform the work
- rain 5. Document the matters contained in items 1 – 4, above, in this SWMS
- heat 6. Complete the SWMS and  Delete these notes to demonstrate that you have considered all relevant matters
- cold etc 7. Ensure that all workers involved in the job task have read, understood and signed off on the SWMS
Have you considered job specific details? 8. Ensure that work is carried out in a safe manner in accordance with the SWMS
- different material
- different equipment 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.
Any other factor that may make affect the risks associated with performing this task?

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 Safe Work Method Statement

WORKERS INVOLVED IN JOB TASK

We, the undersigned, confirm that we have been consulted regarding the above SMWS and that its content is clearly understood. We also confirm that our required qualification(s) etc. to
undertake this activity, is\are current and that we are competent to complete the work safely and without risk to our own health or the health and safety of others. We clearly understand
that the control(s) in this SWMS must be applied as documented, otherwise work is to cease immediately, and we will ensure that the work area is made safe, as far as reasonably
practicable.
Print Name: Company: Signature: Date:

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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