Safe Work Method Statement Template
A Safe Work Method Statement (SWMS) or equivalent must be completed by the contractor prior to the commencement of any high-risk work.
Name of Contractor
responsible for compliance
with SWMS:
Date:
Company name:
Workplace location:
Completion of
Confined Space
Entry Permit?
High risk job description
Yes
N/A
(n/a should only be selected
when not working in a confined space)
Personal Protective Equipment (PPE) required to complete the job
Gloves
Face mask
What are the tasks involved?
Describe the steps required to perform the
task in the sequence they are carried out.
Eye protection
Welding mask
Appropriate
footwear
What are the hazards and risks?
Against each step list the potential hazards that
could cause injury/damage when the task step is
performed.
Hearing protection
Protective clothing
How will hazards and risks be controlled?
List the control measure required to eliminate
or minimise the risk of injury arising from the
identified hazard, see Contractor Hazard
Identification and Control Table.
Central Office Use Only
Issue Date: June 2013
Last Reviewed: February 2016
Next Review Date: February 2018
No: DET ESWB-24-4-3
Authorised By: Manager, ESWB
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
Safe Work Method Statement Template
Sign off
Name
Signature
Date
I have provided site specific risk controls to manage the hazards identified above and will comply with the controls listed above.
Contractor:
I understand the risk controls listed above to be implemented to manage the identified hazards associated with the works to be undertaken.
Workplace
Manager and/or
Management OHS
Nominee:
Central Office Use Only
Issue Date: June 2013
Last Reviewed: February 2016
Next Review Date: February 2018
No: DET ESWB-24-4-3
Authorised By: Manager, ESWB
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
Safe Work Method Statement Template
Steps for filling out SWMS
1. Contractor to determine the tasks, and associated hazards, risks and controls.
2. In the What are the tasks involved? column, list the work tasks in sequence to how they will be carried out.
3. In the What are the hazards and risks? column, list the hazards and risks for each work task.
4. In the How will the hazards and risks be controlled? column, select the hazard or risk and then work through the control levels 1 4 from top to
bottom, as seen below. Choose a control measure (and how it is to be used) that is as close to level 1 as is reasonably practicable.
Control levels
1. Eliminate any risk to health or safety.
2. Reduce the risk to health or safety by any one or any combination of the following:
Substituting a new activity, procedure, plant, process or substance
Engineering controls, such as mechanical or electrical devices.
3. Use administrative controls, such as changing the way the work is done.
4. Provide appropriate personal protective equipment.
5. All contractors should be briefed on the SWMS before commencing work. Ensure all contractors know that work is to immediately stop if the SWMS
is not being followed.
6. Observe work being carried out. If controls are not adequate, stop the work, review the SWMS, adjust as required and re-brief the team.
7. Retain this SWMS for the duration of the high-risk work.
Central Office Use Only
Issue Date: June 2013
Last Reviewed: February 2016
Next Review Date: February 2018
No: DET ESWB-24-4-3
Authorised By: Manager, ESWB
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
