Safe Work Method Statement

MASTER PLUMBERS ASSOCIATION OF NSW

Safe Work Method Statement (SWMS)

COMPANY DETAILS

COMPANY NAMEABN:

ADDRESS

PHONE:MOBILE:

FAX: This SWMS has been developed and authorised by:

Name:

Position:Date:

Signature:Phone:

Mobile:

Description of Work Activity: Excavation of 1.5mtr or Greater HIGH RISK ACTIVITY

Trades involved with undertaking this work activity:

This SWMS is submitted to (principal contractor):

Company:

Contact Name:Contact Name:

Site Address:Project Description:

This SWMS is reviewed by (principal contractor):

Name:Position:

Signature:Date:

Phone Number:Mobile Number:

Person responsible for supervising and implementing on this contractors behalf, the WHS controls associated with each step of this work activity:

Name:

Signature:Date:

Phone Number:Mobile Number:

Work activity (task):

Indicate by ticking the box beside the category for all high risk activities for the work activity (task).

High risk construction work involved in the work activity based on a site specific assessment

(1Risk of falls from greater than 2 metres

(2Work on a telecommunications tower

(3Demolition of load-bearing structure

(4Likely to involve disturbing asbestos

(5Temporary load-bearing support structures

(6Work in confined spaces

(7Work in or near shaft/trench with an excavated depth greater than 1.5m or a in tunnel

(8Work involving use of explosives

(9Work on or near pressurised gas pipes or mains

(10Work on or near chemical, fuel or refrigerant lines

(11Work on or near energised electrical installations or services

(12Work in an area with contaminated or flammable atmosphere

(13Work with tilt up or pre-cast concrete

(14Work on, in or adjacent to road, rail shipping or other major traffic corridor

(15Work in an area with movement of powered mobile plant

(16Work in or areas with artificial extremes of temperature

(17Work in or near a drowning risk

(18Diving work

Work Health Safety & Environmental Legislation Work Health & Safety Act 2011

Work Health & Safety Regulation 2011

Codes or Standards applicable to work task Australian Standard 3500 National Plumbing and Draining Australian Standard 5601 Gas Installations

NSW Plumbing Act 2011 and Regulations 2012 (replacing the NSW Code of Practice for Plumbing and Drainage Regulation) NSW Construction Work Code of Practice Confined spaces Hazardous manual tasks How to manage and control asbestos in the workplace How to manage work health and safety risks Managing the risk of falls at workplaces How to safely remove asbestos Labelling of workplace hazardous chemicals

HYPERLINK "http://www.workcover.nsw.gov.au/formspublications/publications/pages/managing-noise-preventing-hearing-loss-at-work-code-of-practice.aspx" Managing noise and preventing hearing loss at work

HYPERLINK "http://www.workcover.nsw.gov.au/formspublications/publications/pages/managing-work-environment-facilities-code-of-practice.aspx" Managing the work environment and facilities Preparation of safety data sheets for hazardous chemicals Work health and safety consultation, coordination and cooperation

COMPANY NAME

WHS MANAGEMENT SYSTEMDate:

List plant, equipment and tools to be usedList hazardous substances to be used or handledMSDS / SDS

available? (Tick)List PPE to be usedTickList hazards to considerTick

Hard HatFall from ladder

Safety FootwearFall from heights

Eye ProtectionFall from scaffold

Safety HarnessContact with electricity

Respiration EquipmentFalling objects

Hand ProtectionCollapse

Ear ProtectionSlip, trips and falls

OverallsManual Handling

Illuminating Safety VestExposure to noise

Wet Weather GearStruck by moving plant

Sun GlassesInhalation of dust or fumes

HatCuts

Sun ScreenOther (specify):

Other (specify):

Risk Scale Matrix

Review the risks involved and map them using the following scale and definitions.

RISK TABLEHow likely is it to be serious?NOTE: If a hazard is rated 1, 2 or 3, take action immediately.

What damage could itcause?Very likely(could happen anytime)

Likely(could happen sometimes)

Unlikely(could happen, but only rarely)

Very unlikely(could happen, but probably never will)

Death or permanent disability

1123

Long term illness or serious injury

1234

Medical attention and several days off work

2345

First aid needed

3456

How to complete the following form

List the step-by-step sequence of tasks required to carry out a work activity from start to finish.

List the potential hazards associated with each step, and the related WHS risks.

Using the risk table, rate the identified risks.

List what controls you will implement to reduce the risks to the lowest possible level.

Rate the level of risk once those controls have been implemented (must be 4-6 before you can start work).

List the names or positions of the persons responsible for ensuring that the controls are implemented.

A separate SWMS is required for each work activity.

Safe Work Method Statement

Activity: Excavation of 1.5mtr or Greater

STEPActivity steps

Break the activity down into steps. List the steps in this column.Hazards identification

Identify any potential hazards associated with each step and any related risks. Detail the hazards and risks in this column and enter the risk rating in the next column.

Initial risk rating (1-6)Controls to be implemented

Decide what controls to use to eliminate or minimise the risks. Detail the controls in this column, and enter the revised risk rating in the next column. Note: If the risk rating is still 1-3, do not begin workRevised risk rating (1-6)Person Responsible

1Establishment of SitePrepare to ExcavateContact with overhead or underground services resulting in electrocution/Electric Shock, Fire/Explosion

1Underground Essential Services to be located prior to commencement of work.

Dial-before-you-dig 1100 or www.dialbeforeyoudig.com.auUse location equipment to locate buried services

Work only within safe distances of power lines as published by the local supply authority.

Isolate any services (electricity, gas) before excavation commences.

No work is to be carried out on live services. If service is unable to be isolated contact the relevant supply authority.

Check stability of ground before positioning machinery (including vehicles).

5

2Working in ExcavationTrench Collapse2Trench is to be benched or shored where excavation is 1.5mtr or greater.

5

Contact with overhead or underground services (Electrocution/Electric Shock

Fire/Explosion)1

Work only within safe distances of power lines as published by the local supply authority.

Isolate any services (electricity, gas) before excavation commences.No work is to be carried out on live services. If service is unable to be isolated contact the relevant supply authority.

6

STEPActivity steps

Break the activity down into steps. List the steps in this column.Hazards identification

Identify any potential hazards associated with each step and any related risks. Detail the hazards and risks in this column and enter the risk rating in the next column.

Initial risk rating (1-6)Controls to be implemented

Decide what controls to use to eliminate or minimise the risks. Detail the controls in this column, and enter the revised risk rating in the next column. Note: If the risk rating is still 1-3, do not begin workRevised risk rating (1-6)Person Responsible

Working in Excavation

(continued)Working in vicinity of mobile powered plant

2Carry out all pre-inspection checklists and check log books.

Ensure operators of machinery are competent.

Exclusion zones to be set out and clearly identified.

Barricade work area.Hi-Visibility clothing to be worn.

Workers to avoid working in the swing zone of heavy machinery.6

Falls

Objects Falling

2Exclusion zones to be set out and clearly identified.

Barricade area.

Ensure tools and materials are secured.

Workers to wear hard hats.

6

Dust3Equipment used to minimise dust suppression or workers must wear dust mask or respirator.

5

Noise3Workers to wear ear muffs/ear plugs.

6

Fumes3Ensure adequate ventilation.

Workers must wear dust mask or respirator.

6

Untidy work areas

3Work areas and passage ways to remain clear at all times.

Rubbish and excavated material are to be removed on an ongoing basis.

6

Access/Egress from trench

2Ladders, steps or ramp access to be provided and maintained to ensure entry/exit into trench.6

Unauthorised Access2Any open excavation when not being worked on is to be covered and secured to prevent unauthorised access.6

STEPActivity steps

Break the activity down into steps. List the steps in this column.Hazards identification

Identify any potential hazards associated with each step and any related risks. Detail the hazards and risks in this column and enter the risk rating in the next column.

Initial risk rating (1-6)Controls to be implemented

Decide what controls to use to eliminate or minimise the risks. Detail the controls in this column, and enter the revised risk rating in the next column. Note: If the risk rating is still 1-3, do not begin workRevised risk rating (1-6)Person Responsible

3Reinstatement Slips/Trips/Falls

3Ground is to be fully reinstated after completion of excavation works.

All excess material to be disposed of correctly.

6

Special notes: (add issues identified which may need to be further discussed during the review stage)

Safe Work Method Statement (Part 2)

Personal Qualifications and Experience:Personnel, Duties and Responsibilities:Training Required to Complete Work:

Plumbing TradesmenWork under supervision of site foremanOngoing safety training by way of Tool Box Meetings

Plumbing ApprenticesWork under direct supervision of tradesmanOngoing safety training by way of Tool Box Meetings

Mobile equipment licensesAll workers operating equipment to have undergone formal training

Engineering Details/Certificates/WorkCover Approvals:

Plant/Equipment: Maintenance checks:

Read & Signed by All Employees on Site: Refer to attached register

ANY OTHER REQUIREMENTS ETC

NumberRequirementsAction

Declaration by contractors and workersYesNo

I have been consulted and have assisted in the development of this SWMS. FORMCHECKBOX

FORMCHECKBOX

I have been given the opportunity to comment o the content of this SWMS. FORMCHECKBOX

FORMCHECKBOX

I have read and understand how I am to carry out the activities listed in this SWMS. FORMCHECKBOX

FORMCHECKBOX

I have been supplied with the Personal Protective Equipment identified on this SWMS and I have been given training in the safe use of this equipment. FORMCHECKBOX

FORMCHECKBOX

I have read and understand the requirements set out in the Material Safety Data Sheets for the Hazardous Substances identified in this SWMS. FORMCHECKBOX

FORMCHECKBOX

NameSignatureDate

The SWMS template has been developed through consultation with our workers and has been read, understood and signed by all workers undertaking the works:

Print Names:Signatures:Dates:

Review No010203040506070809

Initial:

Date:

Issue: 2 Revision: 1 Date of Revision: 7 - 2014 Master Plumbers Association NSW

Page 2 of 12Document Name: MPA NSW Members Safety and Consultation System Section 3 SWMS Template Form