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SAFE WORK METHOD STATEMENT TEMPLATE

By Evelyn Brown,2014-04-05 12:08
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SAFE WORK METHOD STATEMENT TEMPLATE. USE THIS DOCUMENT FOR ANY RISK ASSESSMENT ? IDENTIFY THIS PROCESS WITH EMPLOYEES AND CONTRACTORS AT INDUCTION AND

SAFE WORK METHOD STATEMENT TEMPLATE

    USE THIS DOCUMENT FOR ANY RISK ASSESSMENT IDENTIFY THIS PROCESS WITH EMPLOYEES AND

    CONTRACTORS AT INDUCTION AND REQUALIFY COMPETENCY DURING TOOLBOX TRAINING

Name of Hazard or Risk: ________________________________________

Location: ____________________________________________________

Assessed by: ________________________________________________

Date: ____________________

Section 1: Task Description

Section 2: Use the risk matrix to rate the risks involved with each step when

    performing this task.

    QuickTime?and a

    TIFF (Uncompressed) decompressor

    are needed to see this picture.

    QuickTime?and a

    TIFF (Uncompressed) decompressor

    are needed to see this picture.

    QuickTime?and aTIFF (Uncompressed) decompressor

    are needed to see this picture.

    QuickTime?and aTIFF (Uncompressed) decompressor

    are needed to see this picture.

TASKS INVOLVE THE FOLLOWING SAFETY ISSUES:

     PPE: [ ] MANUAL HANDLING [ ]

     LADDERS [ ] ELECTRICAL EQUIPMENT [ ]

     HEIGHT [ ] CONFINED SPACES [ ]

     PERMITS [ ] OTHER [ ]

Section 3: Training required by employees/contractors before tasks can be

    carried out

    QuickTime?and a

    TIFF (Uncompressed) decompressor

    are needed to see this picture.

Section 4: The Task needs to be broken up into individual steps making them

    easier for assessment of the risks involved. Once a particular risk is identified

    you then need to set out how the risk will be controlled or eliminated by a

    Control Measure.

Control Measures:

     1. Eliminate the Hazard

     2. Substitute the Hazard

     3. Isolate the Hazard

     4. Redesign to reduce or remove the Hazard

     5. Administrative processes to counter Hazard

     6. PPE

Enter details of Control measures into the following table identifying the

    steps.

    QuickTime?and aTIFF (Uncompressed) decompressorare needed to see this picture.

Section 5: In the following table you need to identify the overall Hazard and the

    controls needed to perform the task.

    QuickTime?and a

    TIFF (Uncompressed) decompressor

    are needed to see this picture.

SWMS Completed by: _____________________________________________

Position: __________________________ Date Completed: ______________

SWMS No: __________

SWMS Sign-Off

    Identify employees/contractors who have been/are involved with task/s:

    Name: ____________________________ Signed: ___________________________

    Name: ____________________________ Signed: ___________________________

    Name: ____________________________ Signed: ___________________________

    Name: ____________________________ Signed: ___________________________

    Name: ____________________________ Signed: ___________________________

    Name: ____________________________ Signed: ___________________________

    Name: ____________________________ Signed: ___________________________

    Name: ____________________________ Signed: ___________________________

    Name: ____________________________ Signed: ___________________________

    Name: ____________________________ Signed: ___________________________

    Name: ____________________________ Signed: ___________________________

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