Date: Safe Work Method Statement SWMS NO:

Project Name: TGW Address:

Company Name:
Activity/Trade:
Office Contact No:
Supervisor Name:

Contact No:

Details: Equipment, Tools & tackles Spec:

Mandatory PPE’s:
1. Safety shoes,
2. Hard hat,
3. Reflective jacket,
4. Hand gloves,
5. Nose mask.

E - Extreme Risk: The hazard has the potential to kill or permanently disable a person H - High Risk: The hazard has the potential to cause a LTI ≥ 7 days
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (i.e.: Nil LTI)
Document Name: Page No.
SWMS: 01 1 of 8
 Date: Safe Work Method Statement SWMS NO:

Recovery/covid Measure
Procedure (in steps) Possible Hazards Risk Control Measures Risk Person
Ratin (Describe what action or procedure will be contr who will
(Break the job down (Identify the g taken to eliminate or minimize the risk of olled ensure
into steps. Each step hazards associated (See injury or damage. Use the Hierarchy of risk this
should accomplish with each step. below Controls below as ssa guide. score happens
some major tasks and Examine each to ) 1. Eliminate the Hazard2. Substitute the .
be in logical find possibilities material or equipment.
sequence.) that could lead to 3. Isolate the hazard4. Implement
an accident or Engineering control.
potential harm 5. Implement Administrative control [Link]
arising.)
 Equipment (Sanitizers, PPE,
Face Mask etc.,) which is
required to avoid the spread of
COVID-19 will be facilitated
before initiating the work.
 All the staff and workers will be
tested for COVID-19 with
thermal scanner,
 Mandate Medical certificate of
fitness.
 . If there is any symptoms
identified, the person will be
sent to hospital after informing
to the Client & management.

E - Extreme Risk: The hazard has the potential to kill or permanently disable a person H - High Risk: The hazard has the potential to cause a LTI ≥ 7 days
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (i.e.: Nil LTI)
Document Name: Page No.
SWMS: 01 2 of 8
 Date: Safe Work Method Statement SWMS NO:

Recovery/covid Measure
Procedure (in steps) Possible Hazards Risk Control Measures Risk Person
Ratin (Describe what action or procedure will be contr who will
(Break the job down (Identify the g taken to eliminate or minimize the risk of olled ensure
into steps. Each step hazards associated (See injury or damage. Use the Hierarchy of risk this
should accomplish with each step. below Controls below as ssa guide. score happens
some major tasks and Examine each to ) 1. Eliminate the Hazard2. Substitute the .
be in logical find possibilities material or equipment.
sequence.) that could lead to 3. Isolate the hazard4. Implement
an accident or Engineering control.
potential harm 5. Implement Administrative control [Link]
arising.)
   Manpower entry/exit record will
be maintained including their
body temperature and health
condition.
 All the staff and manpower will
be allowed into the site with
proper PPE along with self-
declaration.
 Any other measures shall be
applicable as per the notice
issued by Government
authorities from time to time.
 . Safety Induction should be
given to all workers along with
daily briefing on the covid-19
precautions to the all workers,
staff and other
 Job related Safety training shall
be provided.
 TBT shall be given by
supervisor/engineer before
start of activity with social
distance as per the G.O
 Gate pass & required PPE's.
Safety helmet, safety shoes,
reflective jacket, hand gloves,
safety goggle and nose mask
E - Extreme Risk: The hazard has the potential to kill or permanently disable a person etc. shall
H - High Risk: The hazard has the potential to cause a LTI ≥be provided.
7 days
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (i.e.: Nil LTI)
Document Name: Page No.
SWMS: 01 3 of 8
 Date: Safe Work Method Statement SWMS NO:

Recovery/covid Measure
Procedure (in steps) Possible Hazards Risk Control Measures Risk Person
Ratin (Describe what action or procedure will be contr who will
(Break the job down (Identify the g taken to eliminate or minimize the risk of olled ensure
into steps. Each step hazards associated (See injury or damage. Use the Hierarchy of risk this
should accomplish with each step. below Controls below as ssa guide. score happens
some major tasks and Examine each to ) 1. Eliminate the Hazard2. Substitute the .
be in logical find possibilities material or equipment.
sequence.) that could lead to 3. Isolate the hazard4. Implement
an accident or Engineering control.
potential harm 5. Implement Administrative control [Link]
arising.)
  Initiate first aid for injury.
 Conduct toolbox talk.
 Conduct safety audit

 

  

 

  

E - Extreme Risk: The hazard has the potential to kill or permanently disable a person H - High Risk: The hazard has the potential to cause a LTI ≥ 7 days
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (i.e.: Nil LTI)
Document Name: Page No.
SWMS: 01 4 of 8
 Date: Safe Work Method Statement SWMS NO:

Recovery/covid Measure
Procedure (in steps) Possible Hazards Risk Control Measures Risk Person
Ratin (Describe what action or procedure will be contr who will
(Break the job down (Identify the g taken to eliminate or minimize the risk of olled ensure
into steps. Each step hazards associated (See injury or damage. Use the Hierarchy of risk this
should accomplish with each step. below Controls below as ssa guide. score happens
some major tasks and Examine each to ) 1. Eliminate the Hazard2. Substitute the .
be in logical find possibilities material or equipment.
sequence.) that could lead to 3. Isolate the hazard4. Implement
an accident or Engineering control.
potential harm 5. Implement Administrative control [Link]
arising.)

E - Extreme Risk: The hazard has the potential to kill or permanently disable a person H - High Risk: The hazard has the potential to cause a LTI ≥ 7 days
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (i.e.: Nil LTI)
Document Name: Page No.
SWMS: 01 5 of 8
 Safe Work Method Statement

Personnel Summary

SUPERVISOR’S DETAILS
Supervisors Name & Qualifications: Name:
Experience:
Qualifications:
Supervisor’s Responsibilities:

DESCRIPTION OF TRAINING THAT HAS BEEN GIVEN TO PEOPLE INVOLVED WITH THE WORK

H&S GENERAL INDUCTION:

WORK ACTIVITY TRAINING:

SITE INDUCTION:

OTHER:(List other training undertaken by workers):

TICKETS, PERMITS or LICENCES REQUIRED undertaking this work (i.e. Certificates of Competency, Height work permit etc.):

N.B. -
LEGISLATION, CODES OF PRACTICE and GUIDELINES applicable to this work

Additional Codes and Standards applicable to this trade:

Document Name: Version Correct as at: Page No.

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 Date: Safe Work Method Statement SWMS NO:

Equipment & Material Summary

PLANT and EQUIPMENT used and MAINTENANCE FREQUENCY:

Serial Plant/Equipment Contractor Government Plant Hazards Maintenance/service records and logbooks sighted
Registration No. identified and by Principle Contractor prior to equipment being
controlled within used on site?
(Where applicable)
WMS?
Yes No Sign Date
1
2
3

ELECTRICAL EQUIPMENT USED DURING THE WORKS (Attach Electrical Equipment Register if applicable):
Item Tag/Item Testers Name & Signature License Number Test Date Result Test Date Result
Number
____ /____ /____ ____ /____ /____
____ /____ /____ ____ /____ /____
HAZARDOUS SUBSTANCES or DANGEROUS GOODS USED IN THE WORKS and anticipated volumes (Attach MSDS if applicable):
MSDS
Date on Purpose Location & Volume Controls
Date Left Site Product Name MSDS Date Attached
Site (ie. Application on site) Used on Site (& PPE to be worn)
(Y/N)
/ / / / / /

/ / / / / /

/ / / / / /
N.B. - All workers must be trained in the safe use of all chemicals and provided with the PPE required when using and storing these chemicals. Disposal is to be as
per the waste disposal methods in the MSDS. Spillage and leaks are to be cleaned up as per the spill/leak procedures identified in the MSDS.

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 Date: Safe Work Method Statement SWMS NO:

We agree that we have been consulted in the hazards and control measures and agree to complete the work in accordance with our Work Method Statement
(WMS).
We have been provided with training in all tasks outlined in our WMS and in the Codes of Practice applicable to our work.

Employee / Worker Signature Date Employee / Worker Signature Date

1. / / 8. / /
2. / / 9. / /
3. / / 10. / /
4. / / 11. / /
5. / / 12. / /
6. / / 13. / /

Reviewed by: Signature: Date:

(Principal Contractor’s Representative)

Any changes, additions or deletions made to this WMS are to be covered with the above personnel and the Principal Contractor’s representative at a Toolbox
meeting (Record date and time of Toolbox meeting below):

Date: Time:
Comments:

A copy of the Toolbox Meeting must be attached to this SWMS.

Document Name: Version Correct as at: Page No.

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