SWMS Template
نموذج تعبئة - Version 16
SWMS Template · FORM-30013
- Activity
- —
- Business contact
- —
- Phone #
- —
- Responsible person (for monitoring SWMS and work)
- —
- Signature
- —
- Date
- —
- Contact phone #
- —
- Principal contractor (PC)
- [Principal contractor]
- PC address
- —
- PC phone #
- [PC phone]
- Date SWMS provided to PC
- —
- Job address
- [Site address]
- Is the work associated with a construction project?
- —
High-risk construction work (HRCW)
Personal protective equipment (PPE)
Planning/preparation
Hold points
Training/licence
Worker duties and responsibilities
Monitor/review
Site-specific notes
Act, regulations, codes of practice references
None listed.
Job task, hazards and control measures
Work activityHazardIRControlsRRResponsible
- Work activity
Emergency response
Calling 000, site emergency and evacuation procedures, first aid and an incident report.
Overall risk rating after controls
Permits
Plant and equipment
Hazardous substances
Supervisory arrangements
Site management plan
SWMS sign-off
This SWMS developed in consultation and cooperation with workers and relevant organisation representatives. I have read the above SWMS, and I understand its contents. I confirm that I have the skills and training, including relevant certification, to conduct the task as described. I agree to comply with safety requirements within this SWMS, including risk control measures, safe work instructions and PPE described.
| Worker’s name | Job role / positione.g. supervisor, worker, trainee | Licences, competencies & qualificationsType / descriptionClassNumber | Date | Signature |
|---|---|---|---|---|
| - | - | - | - | - |
| - | - | - | - | - |
| - | - | - | - | - |
Construction Card | ||||
Construction Card | ||||
Construction Card | ||||
Construction Card | ||||
Construction Card | ||||
Construction Card | ||||
Construction Card | ||||
Construction Card | ||||
Construction Card |
Hierarchy of controls
Risk matrix
Step 1: Determine likelihood
Step 2: Determine consequence
Step 3: Determine the risk score
| Consequence → | |||||
|---|---|---|---|---|---|
| Likelihood ↑ | InsignificantNo effect, or so minor that the effect is acceptable | MinorMinor first aid treatment, minimal business disruption, minimal environmental effect | ModerateSerious injuries, medium business interruption, medium environmental impact | MajorExtensive injuries or fatality, significant business interruption, environmental harm, prosecution | CatastrophicMultiple permanent disabilities or fatalities, business failure, substantial environmental harm, prosecution or imprisonment |
| Almost certainExpected in most circumstances | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute | 4 A4 Acute |
| LikelyWill probably occur in most circumstances | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute | 4 A4 Acute |
| PossibleCould possibly occur at some time | 1 L1 Low | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute |
| UnlikelyUnlikely but possible | 1 L1 Low | 1 L1 Low | 2 M2 Moderate | 3 H3 High | 4 A4 Acute |
| RareHighly unlikely to occur | 1 L1 Low | 1 L1 Low | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High |
- 1 L1 LowRecord and monitor. Proceed with work, and review the risks regularly.
- 2 M2 ModerateMaintain control measures. Be cautious when working, and monitor and review regularly.
- 3 H3 HighReview before commencing work. Introduce new controls or maintain high-level controls to lower the risk level, and monitor the controls frequently.
- 4 A4 AcuteDo not proceed until the risk level is reduced. Immediately introduce high-level controls, and re-assess before proceeding.
Step 4: Record risk
خطوة عمل أخرى: Emergency response
لكل منها مخاطرها وتقييمات خطورتها وإجراءات التحكم فيها، إضافة إلى توقيع طاقمك.
SWMS Template · FORM-30013
