Safe Work Method Statement (SWMS)CLAIM NOREV. NO.DATE: Date Format: DD slash MM slash YYYY BRAND:LOCATION:Job Description - SWMS DEVELOPMENT TEAM MEMBERS [All persons involved in developing the SWMS ]List all the members name all who are involved in developing the SWMSPOTENTIAL ENVIRONMENTAL HAZARDS: Noise Pollution Spills to Ground Air Pollution (Dust, Fumes) Soil Erosion Hazard to Flora or Fauna Spills to Water HAZARDOUS MATERIALS [List hazardous materials & attach MSDS]:List hazardous materialsWORK PERMITS [Check permits required for your work]: Confined Space Dog Box Exiting elevated EWP Isolation Plan Work at Heights & Floor/Handrail Removal Hot Work High Voltage Access Excavation Supervisor Checklist Job Completion Checklist Mono Hoist Logbook WORK TEAM MEMBERS [All members of the team undertaking the work]Team Members Entry Date Date Format: DD slash MM slash YYYY Team Members Entry SignatureTeam Members Entry NameTeam Members Entry PositionREVIEW & AUTHORISATION [Work is not permitted to proceed until this SWMS has been signed by the appropriate AUTHORITY}OH&S Rep/Supervisor (REVIEW) Date Date Format: DD slash MM slash YYYY OH&S Rep/Supervisor (REVIEW) SignatureOH&S Rep/Supervisor (REVIEW) NameScafflink Supervisor/Manager AUTHORISATION Date Date Format: DD slash MM slash YYYY Scafflink Supervisor/Manager AUTHORISATION SignatureScafflink Supervisor/Manager AUTHORISATION NameScafflink Supervisor AUTHORISATION Date Date Format: DD slash MM slash YYYY Scafflink Supervisor AUTHORISATION SignatureScafflink Supervisor AUTHORISATION Name Australian Standards, Codes of Practice and Other Legislation / Requirements that work carried out is to comply with. AS/NZ 4576 – Guidelines For Scaffolding AS/NZ 1576 – Scaffolding Standard Work Near Over Head Powerlines – Code of Practice 2006 *4mtr Exclusion Zone to live unprotected power lines. HAZARDSElectrical HazardsLowMediumHighN/AHeight HazardsLowMediumHighN/AEngulfment HazardsLowMediumHighN/AVehicles & Civil Plant HazardsLowMediumHighN/AChemical HazardsLowMediumHighN/ANoise HazardsLowMediumHighN/AGasses HazardsLowMediumHighN/AAccess HazardsLowMediumHighN/ALighting HazardsLowMediumHighN/AInclement Weather HazardsLowMediumHighN/ABacteria HazardsLowMediumHighN/AVibration HazardsLowMediumHighN/APressure HazardsLowMediumHighN/ACranes HazardsLowMediumHighN/ALifting Equipment HazardsLowMediumHighN/AUV Rays HazardsLowMediumHighN/AManual Handling HazardsLowMediumHighN/ADust HazardsLowMediumHighN/AHeat HazardsLowMediumHighN/ALow Over Head Objects HazardsLowMediumHighN/ASlips, Trips and Falls HazardsLowMediumHighN/AAsbestos HazardsLowMediumHighN/ADehydration HazardsLowMediumHighN/AHot/Cold Objects HazardsLowMediumHighN/AAdditional Identified Hazards: Please describe each of your individual Hazard by Step 1, Step 2, Step 3 formation and refer / continue each step number on next Hazard Detail Work Method Step Describe the task (step by step)Describe the task (step by step) ie. Step 1, Step 2Potential Hazard / Risk What are the hazards of each step?What are the hazards of each step?Probability of each StepConsequence of each StepRisk Rank of each StepCurrent Controls of each StepNew Risk Rank of each StepNameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.