SAFE WORK METHOD STATEMENT FORM - TAFE NSW



SAFE WORK METHOD STATEMENT FORM

| |[pic] |REPRESENTATIVE RESPONSIBLE FOR PREPARATION OF THE SAFE |

|Insert Workplace Name( | |WORK METHOD STATEMENT AND THE DATE SIGNED |

| | |Signature______________________________ Date ______/______/______ |

| | |*Eg. Supervisor |

|Description of the work to be undertaken(|Oilstone Case Exercise |Work Location ( | |

| | |Eg. Block A, Ground Floor Fitting & | |

| | |Machining | |

|Step by step sequence involved in doing the work ( (attach additional |Risk and rating for each step ( |Safety Controls that will be in place to minimise these hazards/risks ( |

|page if more room is needed to list steps) |Safety / Environmental Risk Rating | |

|Access and isolate work area |Cuts, abrasions, amputations. |1 |All personnel attended Joinery Shop Induction |

| |Manual handling injury |2 |Team lifting, lifting aids, trolley, keep access clear |

| |Dust |2 |Wear safety eyewear/dust mask as appropriate |

|Movement of materials to & from work location |Manual handling injury, trips |2 |Team lifting, lifting aids, trolley, keep access clear |

| |Cuts |2 |Gloves if appropriate |

|Cut Material to size |Cuts, abrasions, amputations |1 |All personnel attended Joinery Shop Induction. Appropriate PPE worn as per induction |

| | | |Wear approved ear protection |

| |Noise |2 |Team lifting, lifting aids, trolley, keep access clear |

| |Manual handling injury |2 |Wear safety eyewear/dust mask as appropriate |

| |Dust |2 | |

|Movement and use of tools and equipment |Manual handling injury, trips |2 |Team lifting, lifting aids, training and keep access clear. . Tools operated as per the Safe Operating |

| | | |Procedure |

| |Cuts, scratches |2 |Gloves if appropriate |

| |Electrical shock |1 |Inspection and tagging of all electrical tools & equipment |

| |Noise |2 |Wear approved ear protection |

|Plane/ Route of Recess |Manual handling injury, trips |2 |Team lifting, lifting aids, training and keep access clear. . Tools operated as per the Safe Operating |

| | | |Procedure |

| |Cuts, scratches |2 |Gloves if appropriate |

| |Electrical shock |1 |Inspection and tagging of all electrical tools & equipment |

| |Noise |2 |Wear approved ear protection |

|Job assembly |Manual handling injury, trips |2 |Team lifting, lifting aids, trolley, keep access clear |

| |Electrical shock |1 |Inspection and tagging of all electrical tools & equipment |

|Clean up and restore area |Manual handling injury, trips, slips |2 |Refer manual handling checklist, team lifting, lifting aids, keep access clear |

| |Cuts |2 |Gloves if appropriate |

| |Environmental contamination – dust/waste | |Contain all waste and take off site |

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|Site Specific Requirements | | | |

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|List all Codes of Practice, Legislation, Standards applicable to the |Electrical Code of Practice, OH&S Regulation and Safe Operating Procedures are available from the store on request |

|work and details of where these are kept ( | |

|RISK ASSESSMENT |

|RISK |AFFECT |RISK CLASS RATING |ACTION REQUIRED |

|The hazard has the potential to kill or permanently disable |High Risk |1 |SWMS must be completed |

|you | | | |

|The hazard has the potential to cause you serious injury or |Medium Risk |2 |SWMS must be completed |

|illness that will temporarily disable you | | | |

|The hazard has the potential to cause a minor injury that |Low Risk |3 |A SWMS is not required – however – action must be taken to minimise the risk as far|

|will not disable you | | |as possible |

Please identify the risk involved and place the rating number in the “Rating” Column on page 1. The numbers show you how important it is to do something.

Environmental risks are to be listed on page 1 but a rating is not required for these risks.

|Provide a description of what training is given to people involved with the work | |

|List the names and qualifications of those responsible for training them |Supervisor – Line supervisor training, manual handling training | |

|Identify the plant and equipment that will most likely be used on site eg. ladders, scaffolds,|List the details of the inspection and maintenance checks that will be or|Signatures of staff who have read and understand the work |

|grinders, electrical leads, welding machines, fire extinguishers, manual handling aids ( |have been carried out on the plant and equipment ( |activities described in the Safe Work Method Statement ( |

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|List the names of person(s) responsible for supervising/inspecting work ( |

|Person(s) responsible for site supervision of the work, inspecting and approving work areas, compliance with SWMS, protective measures, plant, equipment and power tools |

|Name:___________________________________________ Position:___________________________________________ Signature: ______________________________________________ |

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