Safe Work Method Statement Worksheet

Use of Master Builders Generic Safe Work Method Statements

Disclaimer:
The Master Builders Association of Victoria expressly disclaim all and any liability to any person in respect of anything, and of
consequence of anything done or omitted to be done by any or such person in reliance, whether wholly or partially on this generic
safe work method statement.
Rules for the use of Master Builders generic SWMS
1. This generic SWMS is provided as a sample. It is not to be used by a builder or subcontractor for the purpose of managing
safety on their projects. It can be used as a template to enable builders and subcontractors to produce their own SWMS.
Master Builders have carbon copy pads available for sale to enable builders/subcontractors to produce their own SWMS.
2. Employers intending to use this SWMS as a template for their own SWMS must ensure they consult with their employees,
including their Health and Safety Representatives, prior to its introduction.
3. Builders and subcontractors must ensure that their SWMS is relevant to the project at hand. Generic SWMS should not be
used unless precautions have been taken to ensure that the document adequately addresses the hazards and risks relevant
to each particular project.
4. Builders and subcontractors intending to use this sample SWMS as a template for their own generic SWMS, without making
any changes to the detail, must ensure that they adhere to and implement all of the relevant risk controls.
5. The range of generic SWMS provided by Master Builders are not sufficiently broad enough to cover all hazards or risks
encountered by builders and subcontractors. It does not cover the full list of requirements for which SWMS are specifically
required under the OHS Construction Regulations. It is important that the builder or subcontractor undertake their own hazard
identification and risk control process relevant for each particular task.
It is highly recommended that persons who are responsible for preparing and reviewing SWMS undertake training so as to
understand the process of identifying and controlling risks in the workplace.

Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.

Safe Work Method Statement Worksheet

Company Name

Site Name

Safe Work Method Statement

No ______ Page

Contractor

Activity

Multi level formwork

of

Permit to Work Requirement

Yes

No

Tasks

Hazards and Risks

Risk control measures

Who is responsible?

List the tasks required to perform

the activity in the sequence they are
carried out.

What can harm you - Hazards?

What can happen - Risks?

List the control measures required to eliminate or reduce the risk of injury
and detail how the control measures will be put in place.

Write the name of the person

responsible (supervisor or
above) to implement the control
measures identified.

All workers to be inducted into and understand all the requirements of

this SWMS prior to commencing work.
All workers to have sufficient training, skills and competency to
complete the required tasks. All workers to be holders of a
Construction induction card
Schedule outdoor tasks to keep UV exposure to a minimum.
When working long periods in the sun the following should be worn:
full length clothing, such as overalls or long sleeve shirts and
pants
15+ sunscreen on exposed skin
wide brimmed hat or flap on hard hats0
AS rated sunglasses
Where practicable, reduce heat load using fans, shade cloth or other
suitable means.
Where practicable, schedule tasks to cooler parts of the day to
minimize risks of heat exposure.
Ensure workers wear the lightest clothing that still provides protection
and a wide brimmed hat or flap on hard hat.
Provide adequate supplies of drinking water.
Where workers are at risk, reduce the time spent on tasks and
provide adequate rest breaks in cooler areas.
Ensure that power is only obtained from a protected power supply
with RCD, over current protection and in compliance with AS 3012
and the Industry Standard for Electrical Installations on Construction
Sites.

All workers / Management

General planning and

general safety

Injuries due to lack of training,

inexperience or lack of supervision.

UV Exposure

Exposure to ultra violet light, glare

leading to skin cancer, sunburn, eye
damage.

Hot Weather

Dizziness, dehydration or other illness

due to hot weather.

Electrical Equipment

Electrocution from using power tools

and extension leads.

All workers

Builder / Management

Builder

Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.

Safe Work Method Statement Worksheet

Noise

Hearing damage from use of plant and

equipment such as excavators,
vibratory plate, vibrators, saws, nail
guns etc.

Access to Work Areas

Injuries from slips, trips and falls;

abrasions, strains and sprains due to
poor access or housekeeping.

Manual Handling

Sprains, strains or other

musculoskeletal injury from lifting and
carrying equipment (e.g., cement
mixer, Wacker plate, rotary trowel etc.)
and materials (e.g., sheets of ply,
frames, steel reo, bearers).

Use of Powered Mobile

Plant

Personnel being struck by powered

mobile plant.

Do not use electrical tools, plant extension leads and appliances

unless these have current test tags attached.
Extension leads to be kept elevated on insulated hangers or stands
to within 4 metres of the immediate area where power is to be used
and to be kept clear of access areas and walkways and clear of direct
contact with metal.
Where practicable, provide engineered solution for high noise level,
e.g. quieter or muffled equipment, temporary sound absorption
screen or barrier to protect other persons in the area.
Check that regular plant and equipment maintenance to minimize
noise has been carried out and that noise suppression mufflers etc.
are fitted to prior to use.
Identify noisy work areas.
Ensure appropriate hearing protection is worn.
Provide adequate access stairways, ladders and walkways for
concreters and their equipment.
Make sure that there is a complete form deck.
At least one metre of clear, uncluttered, unobstructed access to be
maintained to all work areas by making sure that waste, rubbish,
leads and hoses are kept clear of work areas.
Have equipment and materials delivered as close as possible to work
areas.
When possible, use a crane, winch or other mechanical lifting aid to
lift objects in and out of vehicles, or use a trolley and ramp if other
lifting aids are not practicable.
When possible, use aids such as forklifts, trolleys and wheel sets to
move equipment and materials to work areas.
When possible, use a crane, winch, materials hoist or other
mechanical lifting aid to get equipment and materials to upper levels.
When possible, use material sizes that are easily manageable by
workers (e.g., as short as possible formwork bearers, planks etc.).
Where the above are not practicable use team effort to lift or move
objects. This is to be applied only as a last resort measure and by
personnel trained in correct lifting techniques.
Ensure that all powered mobile plant is checked prior to use for
warning horn, reversing beepers, flashing lights, working mirrors to
enable a clear area of viewing.

All workers

Builder / Management /
All workers

Leading Hand

Leading Hand

Operator

Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.

Safe Work Method Statement Worksheet

Ensure that all maintenance of powered mobile plant is up to date.

Use of Cranes

Crushing injury from load failure due to

exceeding safe working load or lifting
gear snagging or failing.

Lighting

Insufficient lighting leads to injuries

from slips, trips, falls, walking into
objects, and other injuries.
Manual handling injuries.

Constructing Formwork
Lift formwork components
and fit into position

Erect formwork frames and

props

Formwork structure inadequate leading

to injuries due to formwork failure.

Injury from being struck by

unsupported falling frames or
damaged components.

Ensure that all operators of powered mobile plant are adequately

trained or have a certificate of competency for the operation of the
plant.
Separate pedestrians from the powered mobile plant operating area
by barricading pedestrian walkways and requiring the mobile plant
operators, their passengers and other operators to remain in their
cabins or within specified safety zones.
Ensure that all personnel within operating zones of powered mobile
plant wear reflective vests and hard hats.
Ensure that the crane is operated only by a crane operator holding a
certificate of competency of the right class for the type of crane.
All loads to be assessed and directed by a qualified dogman.
Slings to be regularly inspected, tested and tagged.
Ensure that sufficient lighting is available at the work face, especially
in basements and other enclosed areas. Principal contractor to
ensure access ways to be suitably defined and lit.
Control lifting as detailed above in General Planning and General
Safety Issues Manual Handling.
Deliver formwork as close as possible to the work area making sure
that materials are sorted out and placed optimally so as to minimize
double handling.
Ensure that formwork components that are to be lifted by hand are
small as practicable for ease of handling or that they are
manageable.
Avoid using long awkward to handle bearers.
Do not handle wet timber. Use only dry timber.
Ensure formwork structure is designed by a competent person and
that it is erected using the correct components and in compliance
with the formwork documentation and project documentation.
Carry out regular inspections for compliance.
Use correct frame erection sequence.
Support and brace frames as specified in site drawings. Do not leave
unsupported. Visually inspect all components for wear or damage
and ensure they are in good serviceable condition. Beams and ply to
be of suitable type and grade.

Crane operator

Principal Contractor /
Leading Hand
Leading Hand

Leading Hand

Leading Hand

Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.

Safe Work Method Statement Worksheet

Install bearers and joists

Falling off from formwork frames or

from planks.

Placing formwork ply deck

Falling off through bearers or from

unprotected edges during placement of
formwork ply.

Placing formwork ply deck

(Contd.)

Injury from wind uplifting formwork ply.

Falling from unprotected edges of

suspended slab decks or through
penetrations etc.

Installation of guard rails

Falling off unprotected voids and

unprotected edges.

Unauthorised access into

formwork areas

Falls from heights

Do not stand on formwork frames at any time. Stand on temporary

planking with a minimum of two planks or a safe working platform
such as a mobile scaffold where practicable.
Ensure that all work from which a fall of more than 2 metres is
possible is carried out from a working platform protected by perimeter
guardrails or equivalent fall protection.
Provide safe access ladder adequately secured against movement.
Do not walk on bearers. Initially work from temporary formwork ply or
planked platform placed from underneath and fitted with perimeter
guardrails (also placed from underneath or other safe platform).
Ensure that all work from which a fall of more than 2 metres is
possible is carried out from a working platform protected by perimeter
guardrails or equivalent fall protection.
Provide adequate access stairs or ladder to prevent falls.
Ensure loose formwork ply is secured during windy conditions and
that bulk ply is not left unsecured during down periods and after
hours.
Formwork ply to be nailed down immediately upon positioning.
Ensure that all formwork from which a fall of more than 2 metres is
possible is carried out from a working platform protected by perimeter
guardrails of adequate strength with midrails. Install guardrails as
necessary or other adequate fall protection such as external scaffold
or a catch platform.
Prohibit access within two metres of edges without fall protection.
Install access prohibition barrier with Danger No Access signs
within 2 metres of unprotected edges.
Ensure that all holes and penetrations are covered over or fitted with
guardrails.
Where practicable install guardrails from a protected work platform
such as a scaffold or elevating work platform.
Use a travel restraint/safety harness system, making sure that
workers are suitably trained prior to use and verify prior to use that
the restraint has adequate anchoring in accordance with
manufacturers instructions.
Clearly, define between complete and incomplete formwork areas
with appropriate hand rails and signage

Leading Hand

Leading Hand

Leading Hand

Principal Contractor /
Leading Hand

Principal Contractor /
Leading Hand

Leading Hand

Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.

Safe Work Method Statement Worksheet

Access to upper levels

Falling off while climbing frames due to

lack of stairs or ladder access or falling
off ladders or ladder landings.

Cutting and fitting timber

Injuries such as cuts, abrasions,

electric shock and flying objects from
using saws and nail guns.

Tripping hazards.

Install access stairs and/or additional access ladders and tie access
ladders securely to structure.
Ladders to project at least 900mm above upper landing.
Provide guardrails at landing point.
Install guard rails to landing zone working off stairs. Prohibit access
to upper levels pending installation of guardrails.
Ensure correct blades and working guards are fitted to all power
tools.
Wear protective goggles or face shields when using power tools and
nail guns.
Check to ensure compressor air hoses and clippings are secure.
Ensure that electrical equipment is used as detailed above in
General Planning and General Safety Issues Electrical
Equipment.
Control as detailed above in General Planning and General Safety
Issues Access to Work Areas; and:

Principal Contractor /
Leading Hand

Leading Hand

Leading Hand

Falling objects and collision with fixed

objects.

Injury from splinters and nails.

Hearing damage from noisy tools.

Walking on reinforcement
and formwork

Injury from tripping over during pour

and/or twisting ankle or knee.

Remove protruding nails or hammer flush with deck.

Keep access areas and decks free of oil and water. Use sand or
sawdust to minimize slipping where necessary.
Cover over all holes and penetrations as far as practicable.
Install kickboards or steel mesh at perimeters and other edges from
which objects may fall or barricade and signpost areas underneath
as No-Go areas.
Hard hats to be worn.
Ensure all timber and plywood is de-nailed prior to use. Timber
should be denailed immediately after being stripped.
Protective gloves to be worn when handling timber.
Control as detailed above in General Planning and General Safety
Issues Noise.
Make sure that steel reinforcement has enough ties or chairs so that
it does not sag or give way. Make sure that planks are provided to
cover deep beams and that penetrations are covered over so that
these do not form a trap. Do not walk backwards during delivery
and placement of concrete. Make sure boots are not caught between
steel.

Leading Hand

Leading Hand

Leading Hand
Leading Hand

Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.

Safe Work Method Statement Worksheet

Erect formwork frames on
upper levels (suspended
slabs)
Placing concrete on
suspended formwork

Formwork stripping

Structural collapse

Structural collapse from formwork

failure

Falls from heights

Structural collapse

Workers being struck by falling pieces

of ply, bearers, frames etc.

I have read and understood the content of this Safe Work Method
Statement
Workers name
Signature

Ensure the minimum concrete cure time has been reached before
placing loads on the deck. Ensure any issues of load limits and backpropping of lower floors have been addressed.
Before the concrete pour is allowed to commence, the formwork is to
be inspected and certified by a structural engineer.
The engineer should supply an inspection certificate to verify the
structural integrity of the support structure and formwork system.
Ensure that no worker is allowed to access the immediate area
beneath the section of formwork where the concrete is being poured.
If an observer is to be positioned at a lower level during the pouring
operation, they must be located in a position that will safe guard them
from injury if the formwork fails during concrete placement. Generally,
neither the observer nor any other worker should be permitted to
access the area below the pour once concrete placement has
commenced, even to rectify problems.
Ensure fall protection has been provided and being maintained. i.e.
scaffold, screens or hand rails and any voids are adequately covered
over.
Ensure there is a specification for a minimum concrete cure time
before dismantling. Do not allow formwork to be removed prior to the
concrete reaching its required strength.
When stripping the underside of a suspended floor slab, barricade
the area off from other workers. Make sure people dismantling the
formwork are working from properly constructed scaffolds or properly
planked shoring frames. Never allow "drop stripping" of form ply and
falsework.

Leading Hand

Leading Hand

Date
A
p
pr
ov
ed
B
y

Workers name

Signature

Remember: Each SWMS should be site specific. Include all workers in the development of the SWMS.
All workers should sign off to verify that they understand all the requirements of this Safe Work Method Statement.