SAFE WORK METHOD STATEMENT (SWMS) -

Supervisor:

Ph:

Email:

Company/Business Name:

Person Responsible - SWMS Review:

Date SWMS Review:

Site location/address:

Principal Contractor:

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Personal Protective Equipment (PPE) Required:

NOTE: Work must be performed in accordance with this SWMS. Affected employees and their HSRs must be consulted in the preparation of the SWMS. This SWMS must be kept and be available for inspection until the high risk construction work to which this SWMS relates is completed. If the SWMS is revised, all versions should be kept. If a notifiable incident occurs in relation to the high risk construction work in this SWMS, the SWMS must be kept for at least 2 years from the date of the notifiable incident.

Emergency Procedures

First Aid Kit:

First Aid Officer:

Emergency Assembly Point:

Emergency Phone:

Nearest Hospital:

Hospital Phone:

Nearest Medical Centre:

Medical Centre Phone:

Signature Table:

Signature	Declaration	Date
	By signing, I acknowledge this constitutes a legal agreement confirming my understanding of the SWMS.
	By signing, I acknowledge this constitutes a legal agreement confirming my understanding of the SWMS.
	By signing, I acknowledge this constitutes a legal agreement confirming my understanding of the SWMS.

Exclude Signature Table

RISK MATRIX

Step 1: Assess Probability
	Criteria	Item
Certain	Expected in all cases.	The outcome is a typical occurrence.
Probable	Will likely happen under normal conditions.	The outcome has been observed before.
Occasional	Could happen under specific conditions.	The outcome is possible; I've encountered it before.
Remote	Unlikely but possible under rare circumstances.	The outcome is possible, though I haven't come across it before.
Highly Unlikely	Extremely rare.	The outcome is highly unlikely.

Step 2: Assess Severity
Effect Level	Instance at Each Level
Negligible	No impact or a trivial inconvenience.
Minimal	Minor injury requiring basic first aid, no operational delays.
Moderate	Injury requiring medical attention, moderate work disruption.
Severe	Major injury or long-term health effect, significant business impact.
Critical	Life-threatening, fatality, or extreme legal/regulatory consequences

Step 3: Determine Risk Score
Probability \ Severity	Negligible	Minimal	Moderate	Severe	Critical
Certain	2M	2M	3H	4E	4E
Probable	2M	2M	3H	4E	4E
Occasional	1L	2M	2M	3H	4E
Remote	1L	1L	2M	3H	4E
Highly Unlikely	1L	1L	2M	2M	3H

Step 4: Risk Handling Guide
Score	Action Required
4E (Extreme Risk)	STOP IMMEDIATELY - Work must not proceed until risk is significantly reduced.
3H (High Risk)	Act Immediately - Controls must be implemented before proceeding.
2M (Medium Risk)	Proceed with Caution - Ensure adequate control measures are in place.
1L (Low Risk)	Acceptable Risk - Proceed with standard precautions and periodic review.

Most Effective HIERARCHY OF CONTROLS Least Effective

Elimination

Substitution

Isolation

Engineering

Administrative

PPE