SWMS Template
Form - Version 15
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 injury | MinorFirst aid | ModerateMedical treatment, time off work | MajorSerious injury, hospital | CatastrophicDeath or permanent disability |
| Almost certainExpected to happen | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute | 4 A4 Acute |
| LikelyWill probably happen | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute | 4 A4 Acute |
| PossibleMight happen now and then | 1 L1 Low | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute |
| UnlikelyCould happen at some time | 1 L1 Low | 1 L1 Low | 2 M2 Moderate | 3 H3 High | 4 A4 Acute |
| RareOnly in exceptional circumstances | 1 L1 Low | 1 L1 Low | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High |
- 1 L1 LowManage with routine procedures.
- 2 M2 ModerateGo ahead with care: supervise and check the controls.
- 3 H3 HighReduce the risk before work starts; a supervisor checks the controls.
- 4 A4 AcuteStop: work must not start until the risk is reduced.
Step 4: Record risk
One more job step: Emergency response
Each with its hazards, risk ratings and controls, plus your crew's sign-on.
SWMS Template · FORM-30013