SWMS DETAILS

Brief Description of Work Activity:

Location: Work Area Date:

Date to be Reviewed:

Personnel Responsible for Monitoring this Activity:

Legislation / Codes of Practice / Standards Consulted:

These must be complied with.

Plant and Equipment Required for this Activity:

Details of Maintenance Checks Required for this Activity:

Materials Used:

SDS Required? (Yes / No)

Personnel Qualifications Required for this Activity:

Relevant state certification for task has been undertaken or plant being operated

Specific Training Required for this Activity:

All personnel to have completed a Site Induction. Must be trained in
this SWMS and have all relevant certification for this task.

Personnel consulted on development of SWMS:

Name: Position Industry Experience
Company Name
ABN: Phone:
Address Fax:
P.O Box Email:

Person Responsible for Updating SWMS: Signature: Date:

High Risk Work involves:
Risk of falls from greater than 2 Work on a telecommunications Demolition of load-bearing structure
metres tower
Likely to involve disturbing Temporary load-bearing support Work in confined spaces
asbestos structures
Work in or near shaft or trench Use of Explosives Work on or near pressurised gas pipes or
with an excavated depth greater mains
than 1.5m or a in tunnel
Work on or near chemical, fuel or Work on or near energised Work in an area with contaminated or
refrigerant lines electrical installations or services flammable atmosphere
Work with tilt up or pre-cast Work on, in or adjacent to road, Work in an area with movement of powered
concrete rail shipping or other major traffic mobile plant
corridor
Work in or areas with artificial Work in or near a drowning risk Diving work
extremes of temperature
Other [please
specify]: .................................................................................................................................................................................................
..............

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Company Name
ABN: Phone:
Address Fax:
P.O Box Email:

RISK ASSESSMENT

Step 1 – Determine Consequence (Impact) (C) Step 2 - Determine Probability Step 3 – Assess Risk Level ( R ) Determine the risk
(Likelihood) of Event Occurring ( P) level by combining Consequence with Probability
I Consequence (Impact) Table Probability (Likelihood) Table Risk Consequence (Impact) Table
Probability Assessment Negligible Minor Moderate Major Substantial
Environment Description
Impact band Health & Safety
& Heritage
Reputation
band Matrix (1) (2) (3) (4) (5)
International The threat Almost Very
Permanent Almost can be Common / More than Moderate High Extreme Extreme
Substantial Fatal Incident widespread
negative media Certain High
coverage. Loss of Certain expected to Frequent 1 event per (5) (10) (20) (25)
(5) (Class 1) ecological (5) (15)
business from key (5) occur 75% - Occurrence month
damage 99%

Probability (Likelihood)
sector. Very
Damage, which The threat will Likely Moderate High Extreme Extreme
Heavy Sustained national Is known to High
permanently alters a quite More than (4) (4) (8) (16) (20)
Major Permanent ecological negative media Likely occur or “It (12)
person’s future (e.g. commonly 1 event per
Injury damage, coverage. Loss of (4) has happened
(4) quadriplegia, occur 50% - year
(Class 1) costly long term key regularly" Very Very
paraplegia, amputation
restoration client.
75% Possible Low Moderate High
of a limb). High High
The threat Could occur (3) (3) (6) (9)
Major but Regional/short Possible may occur or “I’ve heard
1 event per (12) (15)
Lost Time Damage, which 1 to 10
Moderate recoverable negative media (3) occasionally of it
Injury temporarily alters a years
(3) (Class 2) person’s future.
ecological coverage. Loss of 25% - 50% happening” Unlikely Low Moderate Moderate High High
damage Client / project. The threat (2) (2) (4) (6) (8) (10)
Damage, which Local negative could Not likely to 1 event per
Medical Limited but Unlikely
Minor temporarily media coverage. infrequently occur very 10 to 100
Treatment medium term (2) occur 10% - often years
(2 (Class 2)
inconveniences a
damage
Site or project Rare Low Low Low Moderate Moderate
person problem 25%
(1) (1) (2) (3) (4) (5)
The threat
First Aid Actual injury which Brief local may occur in - Conceivable
Negligible Short term Rare exceptional but only in
Less than
Treatment requires no treatment negative media 1 event per
(1) (Class 3) or simple first aid
damage
coverage. (1) circumstances exceptional
100 years
circumstances
0% - 10%

HIERARCHY OF CONTROLS

Highest Level of Control Lowest Level of Control

Elimination Substitution Engineering Administration Personal Protective Equipment

PROBABILITY: CONSEQUENCE:
5=Almost Certain 5=Substantial
4=Likely 4=Major
3=Possible 3=Moderate
2=Unlikely 2=Minor
1=Rare 1=Negligible
1-6 Acceptable 7-10 Acceptable with Strict Control Measures or Short Duration 11-25 Unacceptable

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Company Name
ABN: Phone:
Address Fax:
P.O Box Email:

Activity Potential Safety and Risk Control Measures Risk Person Responsible
Break the job down Environmental Rating Rating To ensure management method
into steps applied
Hazards After
What can go wrong Controls
C P R C P R

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Company Name
ABN: Phone:
Address Fax:
P.O Box Email:

SIGNOFF

We the undersigned, confirm that the SWMS nominated above has been explained and its contents are clearly understood and accepted. We also confirm that our
required qualifications to undertake this activity are current. We also clearly understand the controls in this SWMS must be applied as documented; otherwise work is to
cease immediately.

Name Qualification Required for this Signature Date Time High Risk Licence number &
Activity Expiry (if required)
                 

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