DATE: 24/06/2014
WHS&E - Site Safe Work
Method and Management
System Policy /Statement
(WHSE) Site Safety Management Plan
1 of 49
Date: 24/06/2014
(WHSE) Site Safety Management Plan
Project Name
Organisation Name
[INSERT COMPANY NAME HERE]
Address
Phone
Fax
Email
ACN/ABN
ACN:
ABN:
(WHSE) Site Safety Management Plan
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Date: 24/06/2014
Contents
( Indicates Forms can be filled in on-line at BuildLearn.com.au)
The table of contents is empty because none of the paragraph styles selected in the Document Inspector
are used in the document.
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WHSE 001 – Document Control
[INSERT COMPANY NAME HERE]:

Maintains an up to date version of this (WHSE) Site Safety Management Plan (SSMP).

Retains all obsolete pages of the Site Safety Management Plan for a minimum of seven (7) years to
demonstrate a record of WHSE management practices.

Provides a copy of the current version of the Site Safety Management Plan (SSMP) to Site
Contractors and Sub-contractors during the tendering process.

Reviews the Site Safety Management Plan on a periodic basis.

Ensures all amendments to the SSMP are recorded in the Register of Amendments.
Register of Amendments
Date
24/06/14
Page/Form No.
ALL
Version No.
Draft
Description of Amendments
New Document
Prepared by
Approved by
A.W.
BuildLearn
Distribution Register
Version No.
Date of Issue
Name of Recipient
Position / Organisation
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WHSE 002 – Project Details and
Introduction
Organisation Details
[INSERT COMPANY NAME HERE]
Business/ Trading Name
ACN/ABN
Contract Job Number
Director/Manager
Address
Phone
Fax
Mobile
Email
The following table sets out a brief description of the work to be carried out by [INSERT COMPANY NAME
HERE] during the course of the contract/agreed works on site.
Date
Description of Works
No of Contractors /subcontractors and employees
(incl. subcontractors)
The table below identifies the designated person on site responsible for the management of Work Health
Safety and Environment.
Name
Contact Details
[INSERT COMPANY NAME HERE] does / does not intend to subcontract all or part of the works.
Manager:
Date
Print Name:
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WHSE 003 – Work Health Safety and
Environment Policy
At [INSERT COMPANY NAME HERE], a commitment to Work Health Safety and the Environment is part of the
business.
This is achieved through:

Complying with the Work Health and Safety Act 2013 (SA), the Work Health and Safety Regulations
2013 (SA), Environmental Protection Act 1993 (SA) and supported by the various Codes of
Practice;

Setting up objectives and targets with the aim of eliminating work related incidents in relation to our
activities, products and services; and

Defining roles and responsibilities for Work Health Safety and the Environment.
Strategies will include:

Ensuring Work Health Safety and Environment management principles are included in all
organisational site planning activities;

Providing ongoing education and training opportunities through BuildLearn to all of our Contractors
and Sub-contractors;

Consulting with contractors and sub-contractors and other parties to improve decision-making on
Work Health Safety and Environment matters;

Ensuring incidents are logged, investigated and lessons are learnt within the organisation;

Distributing Work Health Safety and Environment information, including this policy, to all contractors
and sub-contractors contractors /sub-contractors and employees and interested parties during
tendering;

Providing resources to ensure Work Health Safety and Environment is a central part of the
organisation; and

Ensuring effective injury management and rehabilitation is provided to contractors /sub-contractors
and employees .
Director / Manager:
Print Name:
(WHSE) Site Safety Management Plan
Date
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WHSE 004 – Hazard Identification, Risk
Assessment and Control
[INSERT COMPANY NAME HERE] will not commence construction work at a site of work unless:

The contractors or sub-contractors have provided [INSERT COMPANY NAME HERE] have signed
the tender documents stating that they have read this document, understand its meaning,
implications and will abide by the relevant parts of this workplace (WHSE) Site Safety Management
Plan and the legislation;

[INSERT COMPANY NAME HERE] has undertaken an assessment of the risks associated with the
work activities and has provided to the contractor / sub-contractor with a BuildLearn on-line Safe
Work Method Statement (SWMS); and

[INSERT COMPANY NAME HERE] has provided induction training opportunities to all contractor /
sub-contractors and contractors /sub-contractors and employees through BuildLearn.com.au.

[INSERT COMPANY NAME HERE] maintains and updates the SWMS, and provides the updated
SWMS and SSMP to the contractors and sub-contractors as updates are required in a timely
fashion.

[INSERT COMPANY NAME HERE] has identified potential hazards of the proposed work activities,
assess the risks involved and developed control measures to eliminate, or minimise, the risks. The
risk management process is carried out in consultation with contractor / sub-contractor and
contractors /sub-contractors and employees .
Identify Hazards:
[INSERT COMPANY NAME HERE], breakdowns of specific work activities into job steps to assist in
identifying all potential hazards. These work activities are detailed in a SSMP on-line at BuildLearn.com.
The SSMP is a list of job steps and other work related practices.
For each of the work activities and associated job steps identified in the SSMP, [INSERT COMPANY NAME
HERE] has identified potential hazards and their risks.
To assist in identifying hazards and risks, [INSERT COMPANY NAME HERE] has considered the use of
resources such as codes and standards, industry publications (i.e. safety alerts; hazard profiles for specific
trade groups), workplace experience and consultation (i.e. Toolbox Meetings).
Assess Risks:
[INSERT COMPANY NAME HERE] has identified a risk class/ranking for potential workplace hazards by
referring to the categories ranging from high to low in a Risk Matrix.
The Risk Matrix is used to determine the level of danger or seriousness (i.e. the consequence) of the risk,
how likely it is that this risk will occur (i.e. likelihood/probability) and therefore how detailed control measures
will need to be to utilised to eliminate or minimise the risk.
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WHSE 005 – Hazard Categories
The following is a list of the hazards [INSERT COMPANY NAME HERE] has identified arising from the
tender documents for contracted/agreed work activities. These hazards are addressed within the Safe Work
Method Statement(s).
Work Health Safety
x
Access & egress
x
Confined/enclosed spaces
x
Coring/chasing
x
Dangerous Goods (Oxy/other)
x
Demolition/dismantling
x
Electricity (power tools/other)
x
Explosive/pneumatic power tools
x
Fatigue (shift work/hours of work)
x
Formwork erection/dismantling
Fire/explosion
Fumes/gas
x
Hazardous substances
x
Flying/falling objects/debris
x
Height & falls
x
Hazardous material
x
Hot/cold working environment
x
Hot work (cutting/welding/grinding)
x
Lighting
x
Manual handling (lifting or twisting)
x
Machine/equipment guarding
x
Moving plant/traffic
x
Materials handling (crane/forklift/other)
x
Plant & equipment operation
x
Noise (hearing)
x
Structural alterations/support
x
Public (pedestrians/other)
x
Services (underground/overhead)
Subsidence
x
Ultra Violet Light (sunlight)
Lasers
x
Trenching/excavation
Other:
x
Work near/over water
Other:
Young workers/unskilled labour
Other:
Biological/bacteria
Other:
Environment
x
Air quality (dust/emissions)
x
Bulk excavation/spoil
x
Concrete or paint wastes
x
Contaminated soil/water
x
Dewatering/pump out
x
Habitats (protected flora/fauna)
Heritage & Archaeology
x
Noise or vibration
x
Noisy work (neighbourhood)
x
Spills & response
x
Slurry or other discharges
x
Traffic & parking
x
Waste hazardous (paint sludge, synthetic min
fibre, asbestos/other
x
Dangerous Goods/Hazardous Substances
(use/storage/spills)
x
Stormwater/sediment control
Other:
x
Waste disposal
Other:
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WHSE 006 – Risk Matrix
[INSERT COMPANY NAME HERE] has identified a risk class/ranking for potential workplace hazards by
referring to the categories in the matrix below.
Step 1:
The organisation identifies the consequence for each potential risk by using the table below. Note:
If a combination of harm, loss or damage could occur the worst case consequence is selected.
Level
Description of Consequence
High (1)
(High level of harm)
Potential death, permanent disability or major structural failure/damage. Offsite environmental discharge/release not contained and significant long-term
environmental harm.
Medium (2)
(Medium level of harm)
Potential temporary disability or minor structural failure/damage.
On-site environmental discharge/release contained, minor remediation
required, short-term environmental harm.
Low (3)
(Low level of harm)
Incident that has the potential to cause persons to require first aid.
On-site environmental discharge/release immediately contained, minor level
clean up with no short-term environmental harm.
Step 2:
Using the following table, the organisation determines how likely it is that the risk will occur and
result in the consequence identified above.
Level
Likelihood / Probability
Likely
Could happen frequently
Moderate
Could happen occasionally
Unlikely
May occur only in exceptional circumstances.
Step 3:
Using the risk matrix below, the organisation identifies the risk class/ranking.
Likelihood / Probability
Consequence
Likely
Moderate
Unlikely
High (1)
1
1
2
Medium (2)
1
2
3
Low (3)
2
3
3
Class/Ranking
Description / Requirements
1
Will require detailed pre-planning.
Actions will be recorded on a Safe Work Method Statement
2
Will require operational planning.
Actions will be recorded on a Safe Work Method Statement
3
Will require localised control measures
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WHSE 007 – Safe Work Method
Statement (SWMS)
Organisation Details
Organisation Name:
ACN/ABN
Address:
[INSERT COMPANY NAME HERE] Contact Name::
James Wagner
ACN:
ABN:
60 Arthur Street, Payneham S.A.
5070
(08) 7230 0173 OR (08) 8298
4444
Contact Position: Manageing Director
Contract Phone
No:
Project Details:
Project:
All
Area:
All
This SWMS has been developed in consultation with:
Activity:
Residential Construction /
rennovation
BuildLearn.com.au
Reviewed By
James Wagner
Position
Manageing Director Date 24/6/14
Resources / Trades
Involved:
All Trades specific to construction of residential or commercial building
Equipment Used:
Refer On-Line SSMP
Maintenance checks:
Daily
Materials Used:
Various
Work Health Safety or Work Health & Safety ACT 2013
Environmental
(SA)
Legislation:
Codes or
Construction Regulations and
Standards
applicable to the applicable Codes Of Practices
works:
Likelihood / Probability
Level
Description of Consequence or Impact
Potential death, permanent disability or major
structural failure/damage. Off-site environmental
H (1)
(High level of harm) discharge/release not contained and significant
long-term environmental harm.
Potential temporary disability or minor structural
failure/damage.
M (2)
(Medium level of
On-site environmental discharge/release
harm)
contained, minor remediation required, short-term
environmental harm.
Incident that has the potential to cause persons to
require first aid.
L (3)
On-site environmental discharge/release
(Low level of harm)
immediately contained, minor level clean up with
no short-term environmental harm.
(WHSE) Site Safety Management Plan
Consequenc
e
M
L
U
Moderat
Likely
Unlikely
e
H (1)
(High)
1
1
2
M (2)
(Medium)
1
2
3
L (3)
(Low)
2
3
3
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1
Level
Likelihood / Probability
Likely
Could happen frequently
Moderate
Could happen occasionally
Unlikely
May occur only in exceptional circumstances
Item
Job steps
Hazards
Risk
Class/
Ranking
Arrive on site, survey and
Site
assess job to be done
levellin ensuring compliance with, Slips, trips, sprains L3
g
SafeWork SA guidelines &
WH&S ACT 2013 (SA)
Put on all PPE equipment
NIL
required for job
String Lines
Trips
L3
Secure area with bunting &
signage to ensure safety of
3rd parties and ensure area
Trips & cuts
L3
is fenced to minimise
injuries to create a safe
work environment
Trench
Slips, trips, sprains,
Foundations, storm water,
Examp
minor
L3
water, electrical
le only
cuts/abrasions
Foundation
steel
placement
Sunburn,
lifting new sheets/cutting Back injuries, cuts
and Manual Handling is
conducted in accordance
L3
with
SafeWork
SA Minor cuts, injuries
guidelines complying to the from trips, slips
safe
manual
handling resulting in
training in accordance with spains/strains
WHS regulations
Clean off site overburden,
Minor cuts, injuries
load equipment dispose of
from
L3
waste
lifting/shoveling
Name of
persons
responsible for
work
Controls
SafeWork
Guidelines/WH&S
(SA)
Act
SA
2013
Visual awareness
PPE/Fencing/SafeWorkSA/sign
age
Training/PPE/Manual
Handling/visual awareness
UV Protection
Manual
Handling
awareness/training,
Backbrace lifting, appropriate PPE
Training/PPE/Backbracesfor
lifting/ManualHandlingTrg
Appropriate PPE worn.
Environmental appropriate
cartage used
Found
ation
Qualifications and experience required to Personnel, Duties and Responsibilities
complete the task
(Supervisory staff and others)
Training Required to Complete
Work
E.G. Site Supervisor
PC – MS Suite Applications
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Engineering Details / Certificates / WorkCover Approvals:
E.G. Soil Sample – Engineer Name - outcomes
This SWMS has been developed through consultation with our contractors /sub-contractors and employees and has
been read, understood and signed by all contractors, sub-contractors and contractors /sub-contractors and employees
undertaking the work on site:
Print Names:
Signatures:
Dates:
Antonie Wissenburg for BuildLearn
Review No
01
02
24/06/2014
03
04
05
06
07
08
09
Initial:
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Date:
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WHSE 008 – Objectives and Targets
[INSERT COMPANY NAME HERE] has established the following objectives and targets to support and
maintain the effectiveness of the WHSE Site Safety Management Plan.
Planning
Objective:
Contractors /sub-contractors and employees are provided with regular and up-to-date information on
WHSE for the duration of the contracted/agreed works.
Target:
Review the content of the WHSE Site Safety Management Plan at maximum 3 month intervals (or more
frequent as required) to maintain the currency of information provided to contractors /sub-contractors and
employees and others.
Risk Management
Objective:
Contractors /sub-contractors and employees are familiar with hazards and risks associated with the
contracted/agreed works that are assessed as a medium to high risk.
Target:
Safe Work Method Statement(s) or the equivalent list as a minimum those hazards and risks associated
with the contracted/agreed works that are assessed as a medium to high risk.
Consultation
Objective:
Contractors /sub-contractors and employees are regularly consulted on matters that affect WHSE.
Target:
Toolbox/Pre-start or other agreed methods of consultation are undertaken on a regularly basis.
Training
Objective:
Contractors /sub-contractors and employees are provided with training by their respective employer’s to
enable work practices to be undertaken that are safe and minimise risk to themselves/environment.
Target:
All contractors /sub-contractors and employees involved with the contracted/agreed work have undertaken
as a minimum the levels of induction training, i.e. general industry (safety awareness) training, site specific
training and work activity training as noted in the Safe Work Method Statement(s) specific to the
contracted/agreed works.
Other
Objective:
Target:
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2013
WHSE 009 – Personal Protective
Equipment (PPE)
[INSERT COMPANY NAME HERE] maintains the following register of all PPE required by contractors /subcontractors and supplied to employees where such PPE is specified as a control measure in the Safe Work
Method Statement. Contractors /sub-contractors ensure that all items of PPE are manufactured, used and
maintained in accordance with the relevant Standard. Proof of Standard compliance may be checked on site
by the Site Supervisor if requested, e.g. labelling.
Each employee has been instructed and trained in the correct use of the PPE issued.
Signature of recipient
Employee name
Date of Issue/
replacement
(WHSE) Site Safety Management Plan
Item supplied
I have received the listed PPE with
appropriate instruction/training in
its correct use.
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WHSE 010 – Roles and Responsibilities
[INSERT COMPANY NAME HERE] provides the following key trained and competent personnel on site.
Heritage Building Group
Works Manager
Injury Management Coordinator
Site Supervisor
WHSE Coordinator
Contractor/sub-contractor/
Employees
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Roles and Responsibilities Defined
The roles and responsibilities of contractors /sub-contractors and employees within [INSERT COMPANY
NAME HERE] regarding WHSE are below.
Works Manager
[INSERT NAME/s] are responsible for WHSE at the workplace and duties include:
 Implementing the WHSE Management Plan;
 Using the Hierarchy of Controls in all design, fabrication and construct activities to minimise WHSE
risks;
 Communicating with the site supervisor to consult with contractor/sub-contractor to reduce risks;
 Being a part of the planning and design stages of trade activities;
 Deciding when training on WHSE is required;
 Leading by example and promoting sound WHSE practices at every opportunity;
 Ensuring safe equipment and plant is provided and maintained;
 Reviewing WHSE reports and inspections, and following up on recommendations;
 Coordinating incident investigations and reporting to the appropriate workplace / relevant authorities,
as required;
 Coordinating WHSE office meetings and programs;
 Monitoring compliance with the WHSE Site Safety Management Plan, including Safe Work Method
Statement; and
 Assisting injured and employees to return to their pre-injury duties as soon as practicable after a
work-related injury.
Signed by: ______________________ Date: ___ / ___ / ___
Works Supervisor
[INSERT NAME/s] is responsible for WHSE at the work site place and duties include:

Implementing the WHSE Management Plan;

Observing all WHSE rules and regulations;

Making sure that work activities are carried out in a safe and environmentally sound manner;

Planning to do all work safely including any interface with other work activities;

Providing advice and assistance on WHSE matters to contractors /sub-contractors and employees ;

Being part of the planning and design stages of trade activities;

Deciding when training on WHSE is required;

Actioning WHSE reports and carrying out workplace inspections;

Setting up WHSE toolbox meetings and programs;

Helping to prepare Safe Work Method Statements for the organisation’s work activities;

Investigating hazard reports and ensuring that they are completed and corrective actions
undertaken;

Carrying out project inductions, Toolbox and team meetings;

Being a part of incident investigations;

Leading by example and promoting sound WHSE practices at every opportunity;

Undertaking inspection of the contracted or planned works to ensure that WHSE control measures
are implemented and effective; and

Other WHSE duties as directed by the Administration Manager.
Signed by: ______________________ Date: ___ / ___ / ___
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Work Health Safety Environment Coordinator
[INSERT NAME/s] is responsible for WHSE at the workplace and duties include:

Communicating WHSE performance to the Works Manager;

Assisting the Site Supervisor to develop and implement the WHSE Plan; 

Providing advice on WHSE to all contractors /sub-contractors and employees ;

Being a part of planning and design in work activities;

Determining WHSE legal requirements for the work activity or trade;

Making sure WHSE work procedures are followed;

Coordinating injury management / return to work for injured contractors /sub-contractors and
employees ;

Reviewing WHSE reports and inspections;

Setting up and being a part of WHSE meetings and programs;

Insisting on sound WHSE practices at all times;

Setting up and conducting WHSE inductions for employees;

Conducting incident investigations;

Communicating with the Manager/Site Supervisor on WHSE matters;

Making sure records are kept under these guidelines;

Other WHSE duties as directed by the Manager Director.
Signed by: ______________________ Date: ___ / ___ / ___
Injury Management Coordinator
[INSERT NAME/s] is responsible for the management of employee injuries at the workplace and duties
include:

Assisting injured employees to return to their pre-injury duties as soon as practicable after a
work-related injury;

Ensuring that, where appropriate, the injured employee is given access to occupational
rehabilitation services; 

Liaising with any parties involved in the occupational rehabilitation of, or provision of medical
services, to the injured employee; 

Monitoring the progress of the injured employee’s capacity to work; 

Taking steps to prevent recurrence or aggravation of the relevant injury upon the injured
employee's return to work; and 

Providing assistance to meet all legal requirements regarding injury management and return to
work. 
Signed by: ______________________ Date: ___ / ___ / ___
Contractors /sub-contractors and employees
Are responsible for the following:

Working in a safe manner without risk to themselves, others or the environment;

Complying with the WHSE Site Safety Management Plan including all Safe Work Method
Statements;

Reporting all incidents to the Works Supervisor;

Reporting all injuries and illnesses to the designated First Aid Officer;
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
Reporting any WHSE hazards to the Site Supervisor;

Providing suggestion, through agreed consultation methods, on how to improve WHSE issues;

Seeking assistance if unsure of WHSE rules;

Reporting any faulty tools or plant to the Site Supervisor;

Complying with site rules;

Correctly using all Personal Protective Equipment; and

Complying with emergency and evacuation procedures.
Name:_____________________________ Signed by: ______________________Date: ___ / ___ / ___
Name:_____________________________ Signed by: ______________________Date: ___ / ___ / ___
Name:_____________________________ Signed by: ______________________Date: ___ / ___ / ___
Name:_____________________________ Signed by: ______________________Date: ___ / ___ / ___
Name:_____________________________ Signed by: ______________________Date: ___ / ___ / ___
Name:_____________________________ Signed by: ______________________Date: ___ / ___ / ___
Name:_____________________________ Signed by: ______________________Date: ___ / ___ / ___
Name:_____________________________ Signed by: ______________________Date: ___ / ___ / ___
Name:_____________________________ Signed by: ______________________Date: ___ / ___ / ___
Name:_____________________________ Signed by: ______________________Date: ___ / ___ / ___
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WHSE 011 – Training and Competency
Register
Having regard to the hazards and risks associated with the work activities, [INSERT COMPANY NAME
HERE] has assured that all contractors /sub-contractors and employees are trained and competent to
perform the tasks contracted for in a way that is safe and does not adversely impact on themselves, others
or the environment.
The following register contains details of the skills and competencies of the organisation’s contractors /subcontractors and employees.
Employee Name
Work on this project
James Wagner
Managing Director
[INSERT NAME/s]
Administrative Manager
[INSERT NAME/s]
Site Supervisor
Skills / Competencies /
Experience
(e.g. tickets / qualifications)
Card No. /
Reg. No.
Date of
Course
Duration
White card, Building
Contractor Licence,
Responsible Officer
White card, Tradesman,
Supervisors licence, First
Aid Cert
Concreter
Carpenter
Electrician
Plumber
Roofer
Foundation steel fixer
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WHSE 012 – Consultation
[INSERT COMPANY NAME HERE] promotes the active participation of all contractors /sub-contractors and
employees in WHSE decisions.
Contractors /sub-contractors and employees are consulted and given opportunity, encouragement and
training opportunities to be proactively involved in WHSE matters affecting the organisation and their work
activities.
Consultation occurs in reference to, but not limited to, the following subjects / topics:

Hazard identification and risk assessment processes;

Control measures for the management of hazards and risks;

Changes to the organisation's policies and procedures or work routines which may affect WHSE;

Make up of and representation on relevant committees; and
All workplace consultation is recorded and occurs on a regular monthly basis as per legislative requirements.
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WHSE 013 – Toolbox/Pre-Start Meetings
All Toolbox / Pre-start meetings undertaken on behalf of [INSERT COMPANY NAME HERE] are recorded
on this form and signed by participants.
All corrective actions noted on this form are implemented and signed by the nominated person. It is the
responsibility of the Site Supervisor to ensure that all corrective actions are completed and reviewed for
effectiveness.
Toolbox / Pre-start Talks
Workplace:
Subject of Talk:
Presented by:
Duration:
Date:
[INSERT NAME/s]
Print Name:
Signature:
Print Name:
Signature:
Points Raised / Comments:
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Corrective Action
Action Complete
Action by
Sign off
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WHSE 014 – Workplace Inspection
Checklist
[INSERT COMPANY NAME HERE] inspects the work activity(s) and work area, and provide a completed
Workplace Inspection Checklist each week to Administration Manager for the duration of the works.
Workplace Inspection
Workplace
All
Date
Inspected By
All Contractors /sub-contractors and
employees
Signature
Item
Access/Egress
Access paths clear
Access paths defined (signage
tape, other)
Prohibited areas display warning
signs and barricaded
Dust/Air Quality
Dust suppressed/watered down
Stock piles protected from wind
Plant & equipment maintained to
minimise emissions
Electrical
Electrical equipment tested &
tagged
Register of tagging current
Portable generator fitted RCD
Portable Residual Current Device
(RCD) tested/ tagged
First Aid/Emergency/Injury
First aid kit provided
Kit stocks refreshed
First Aid Officer available
Evacuation procedure in place
Emergency contacts displayed
Fire extinguisher/equipment
available
Manual Handling
Trolleys/aids in use
SWMS followed
Training/job rotation undertaken
Hazardous Substances/Dangerous
Goods
Item Correct
Action Priority
Yes
No
n/a
1
2
3
Yes
No
n/a
1
2
3
Yes
No
n/a
1
2
3
Yes
Yes
No
No
n/a
n/a
1
1
2
2
3
3
Yes
No
n/a
1
2
3
Yes
No
n/a
1
2
3
Yes
Yes
No
No
n/a
n/a
1
1
2
2
3
3
Yes
No
n/a
1
2
3
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
n/a
n/a
n/a
n/a
n/a
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
Yes
No
n/a
1
2
3
Yes
Yes
Yes
No
No
No
n/a
n/a
n/a
1
1
1
2
2
2
3
3
3
Register current
Yes
No
n/a
1
2
3
MSDS available
SWMS lists precautions for use
Storage area secure
Refuelling SWMS followed
Height work
Yes
Yes
Yes
Yes
No
n/a
No x n/a
No x n/a
No x n/a
1
1
1
1
2
2
2
2
3
3
3
3
(WHSE) Site Safety Management Plan
Action By
Close Out Close Out
By
Date
Managing
Director
Site Supervisor
Version _____
Page 25 of 59
Date: 24/06/2014
Item
Perimeter protection
Handrails in place
Penetrations covered
Fall restraint/arrest system in use
SWMS followed
Housekeeping
Materials stacked
Work area lit
Bins available & in use
Signage in place
Leads suspended
Walkway/stairs/work area clear
Noise
Plant & equipment maintained
Site hours observed
Noisy works identified
Hearing protection used (SWMS)
Personal Protective Equipment
Available and used when required
(SWMS)
Correctly used by contractors /subcontractors and employees
Plant & Equipment
Plant register current
Item Correct
Action Priority
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
n/a
n/a
n/a
n/a
n/a
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
n/a
n/a
n/a
n/a
n/a
n/a
1
1
1
1
1
1
2
2
2
2
2
2
3
3
3
3
3
3
Yes
Yes
Yes
Yes
No
No
No
No
n/a
n/a
n/a
n/a
1
1
1
1
2
2
2
2
3
3
3
3
Yes
No
n/a
1
2
3
Yes
No
n/a
1
2
3
Yes
No
n/a
1
2
3
Action By
All
All
All
All
Maintenance records provided
Yes
No
n/a
1
2
Daily log book completed
Operator ticketed/competency
verified
SWMS followed
Public Protection
Work area secure from public
Overhead protection provided
Stormwater/run off
Silt control fences in place
Stormwater inlets protected
Discharges contained, e.g. pump
out, slurry/other
Training
All contractors /sub-contractors and
employees have:
- General industry (safety
awareness) training
- Site specific induction training
- Work activity (SWMS) training
Vegetation
Fencing around drip line of retained
trees
No material/equipment stored
within drip line
Waste Management
Waste reduction plan in place
Waste contractor records available
Yes
No
n/a
1
2
Contractor /
Sub-contractor
3
to provide to
Site Supervisor
3
Yes
No
n/a
1
2
3
Yes
No
n/a
1
2
3
Yes
Yes
No
No
n/a
n/a
1
1
2
2
3
3
Yes
Yes
No
No
n/a
n/a
1
1
2
2
3
3 Site Supervisor
Yes
No
n/a
1
2
3
Yes
No
n/a
1
2
3
Yes
Yes
No
No
n/a
n/a
1
1
2
2
3
3
Yes
No
n/a
1
2
3 Site Supervisor
Yes
No
n/a
1
2
3
Yes
Yes
No
No
n/a
n/a
1
1
2
3
3
(WHSE) Site Safety Management Plan
2
Close Out Close Out
By
Date
All
All
Version _____
Page 26 of 59
Date: 24/06/2014
Item
Item Correct
Bins for litter/cigarette butts/other
provide
Hazardous wastes captured &
correct disposal, e.g. paint sludge/
contaminated soil/other
Action Priority
Yes
No
n/a
1
2
3
Yes
No
n/a
1
2
3
Yes
Yes
Yes
No
No
No
n/a
n/a
n/a
1
1
1
2
2
2
3
3
3
Action By
Close Out Close Out
By
Date
Engineer
Site Supervisor
Other
All items noted for correction have been rectified
Name
Signed
Date
Time
(WHSE) Site Safety Management Plan
Version _____
Page 27 of 59
Date: 24/06/2014
WHSE 015 – Plant and Equipment
[INSERT COMPANY NAME HERE] requires that contractors and sub-contractors carry out regular
inspections and maintenance on their plant and equipment.
[INSERT COMPANY NAME HERE] requires that contractors and sub-contractors carry out regular
inspections and maintenance on their plant and equipment in accordance with the manufacturer’s
recommendations.
Plant and equipment owners are responsible for and able to provide a inspection and maintenance history of
each item used on the work site is documented.
Certain items of plant and equipment will be ‘Item Registered’ and or ‘Design Registered’ by the Regulatory
Authority where required by Legislation, responsibility for this rests with the owner of the plant or equipment.
[INSERT COMPANY NAME HERE] ensures control measures are implemented and documented for all
plant and equipment, including its operation, deemed as high risk. The effect of all plant and equipment on
the workplace is considered and documented in the SafeWork SA Method Statement
Pre-start checks, schedule of maintenance and fault reports are notified to the plant/equipment owner and
documented in plant log books and made available to relevant parties on request.
Where plant and equipment is hired, the same requirements as above apply.
(WHSE) Site Safety Management Plan
Version _____
Page 28 of 59
Date: 24/06/2014
WHSE 016 – Plant and Equipment
Register
The following register contains details of all plant and equipment to be used by [INSERT COMPANY NAME
HERE] during the course of the work activities. Examples include lifting gear, firefighting equipment, mobile
plant, fall restraint equipment, company vehicles and other.
Plant Type
Authority
Registratio
Date last
Registratio
Required
Log
Serial No. /
n with
service or
Alteration Date
n Expiry
Maintenan
Book
Registratio Make / Model Authority
maintenance
Details Y / On
Date
ce
Availabl
n No.
Required?
record
N / NA
Site
(if
Frequency
e
Y/N
available
applicable)
(WHSE) Site Safety Management Plan
Version _____
Page 29 of 59
Date: 24/06/2014
WHSE 017 – Plant and Equipment PreStart Checklist
[INSERT COMPANY NAME HERE] completes the following checklist prior to initial plant operation at the
workplace.
Item
Description
A checklist should identify general hazards and associated risks
relating to the use of the plant & equipment e.g. entanglement,
Risk assessment
crushing, striking, electrical or other. The checklist should then
detail control measures to eliminate or minimise risk.
Check
Yes
No
Log Book
A current log book recording daily safety Pre-start checks. These Yes
are subject to random inspection.
N/A
No
Maintenance
Reports
Proof of ongoing maintenance, i.e. maintenance records. The
records should note the most recent inspection and who
conducted that inspection. It may also describe any repair work
carried out on the plant. Most importantly, there should be no
outstanding items noted for repairs.
Yes
No
Operator’s Manual
An operator’s manual relevant to the item of plant and which is to
Yes
be kept with the plant.
No
Operator
Certification
Copy of operator’s certification or licence to operate the plant.
Where no statutory certification is required, evidence of
competence by the operator in the use of the plant.
No
Yes N/A
Plant Provider
Name
Signature
Date
Plant Inspected
Plant Type / Make
Serial No.
Company
Inspection Verified By
Name
(WHSE) Site Safety Management Plan
Signature
Version _____
Date
Page 30 of 59
Date: 24/06/2014
WHSE 018 – Plant and Equipment
Regular Checklist
The following checklist is completed by [SERVICE PROVIDERS NAME] as a general and regular check on
plant operation at the workplace.
Plant and Equipment Checklist
Service Provider name
Plant type / make
Include vehicles owned by [INSERT COMPANY NAME HERE]
Plant No.
Serial No:
Description
Check
Risk assessment
Yes
No
n/a x
Operator’s manual
Yes
No
n/a
Maintenance reports
Yes
No
n/a
Log Book
Yes
No
n/a
Competency ticket/licence of operator
Yes
No
n/a
Fire extinguisher
Yes
No
n/a
Crack test reports
Yes
No
n/a
Chains tested and tagged
Yes
No
n/a
Regulatory Authority plant registration
Yes
No
n/a
Flashing light
Yes
No
n/a
Forward/reverse beeper
Yes
No
n/a
Tested and tagged electrically
Yes
No
n/a
Seat belt
Yes
No
n/a
Roll over Protection (ROPS)
Yes
No
n/a
Plant Provider
Name
Signature
Date
Inspection Verified By
Name
Signature
Date
In undertaking regular checks of plant and equiplent, [Service Provider] includes consideration of relevant
aspects as follows:
(WHSE) Site Safety Management Plan
Version _____
Page 31 of 59
Date: 24/06/2014
Scissor Lifts / Boom Lifts
Excavators / Backhoes / Bob Cats

Risk Assessment

Risk Assessment

SWMS

SWMS

Operators Manual

Operators Manual

Maintenance Reports

Maintenance Reports

Log Book

Log Book

Certification/Competency of Operator

Certification/Competency of Operator 

Safety Booklet

Fire Extinguisher

Company Name

Seat Belt

Flashing Light

Forward & Reverse Beeper
Fork Lifts / Manitou’s
Cranes

Risk Assessment

Risk Assessment

SWMS

SWMS

Operators Manual

Operators Manual

Maintenance Reports

Maintenance Reports

Log Book

Log Book

Certification/Competency of Operator 

Certification/Competency of Operator

Fire Extinguisher

Fire Extinguisher

Seat Belt

Crack Test Report

Flashing Light

Regulatory Authority Plant Registration

Forward & Reverse Beeper

Chains Tested and Tagged
Other…
Concrete Pumps

Risk Assessment

SWMS

Operators Manual

Maintenance Reports

Log Book

Certification/Competency of Operator 

Fire Extinguisher

Crack Test Report

Line thickness Testing

Regulatory Authority Plant Registration
(WHSE) Site Safety Management Plan
Version _____
Page 32 of 59
Date: 24/06/2014
WHSE 019 – Hazardous Substances/
Dangerous Goods
[INSERT COMPANY NAME HERE] maintains a current (within 5 years of the date of issue) MSDS for all
products and substances to be used on the work site.
Before a product or substance is used on the work site, [INSERT COMPANY NAME HERE] reviews the
Material Safety Data Sheet (MSDS) to determine if the product or substance is classified as hazardous.
All contractors /sub-contractors and employees involved in the use of products classified as hazardous, are
to provide information to [INSERT COMPANY NAME HERE] and have relevant training to allow safe use of
the hazardous substance for the completion of the required task.
As a minimum standard, all safety and environmental precautions for use listed on the MSDS are to be
followed when using the substance and are to be provided by contractors/sub-contractors and included in
the Safe Work Method Statement.
No products or substances, including chemicals or fibrous materials, are brought to the site workplace
without a current MSDS being provided to the Site Supervisor for inclusion into the Hazardous substances
register.
[INSERT COMPANY NAME HERE] considers the following when selecting chemicals and substances for
use on site:

Flammability and exclusivity;

Toxicity (short and long term);

Carcinogenic classification if relevant; 

Chemical action and instability;

Corrosive properties;

Safe use and engineering controls;

Environmental hazards; and

Storage requirements.
All storage and use of hazardous substances and dangerous goods is in accordance with the MSDS and
legislative requirements.
All hazardous substances and dangerous goods are stored in their original containers with the label intact at
all times.
Hazardous substances and dangerous goods of any quantity are not stored in amenities, containers (unless
properly constructed for the purpose), sheds or offices.
(WHSE) Site Safety Management Plan
Version _____
Page 33 of 59
Date: 24/06/2014
WHSE 020 – Hazardous
Substances/Dangerous Good Register
The following hazardous substances exist in the site work place. A copy of the MSDS has been forwarded to
the person responsible for First Aid.
Product Name
Application
Qty
Product
labelled
MSDS
Classified as Hazardous in the MSDS
e.g. Methylated
Spirits
Adhesive
removal
5 Ltr
Yes x No
Yes x No
Yes x No
e.g. Silicon
Adhesive
24
Tube
Yes x No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
(WHSE) Safety Management Plan
Version _____
If YES:
The risks and
control measures
associated with
the use of the
product/
substance and the
precautions for its
use are outlined in
the Safe Work
Method Statement
Page 34 of 59
Date: 24/06/2014
WHSE 021 – Electrical Equipment
[INSERT COMPANY NAME HERE] ensures that the use of electrical wiring, equipment, portable tools and
extension leads is in accordance with applicable codes and standards including AS3012, Electrical
Installations – Construction and Demolition Sites and AS3000, Wiring Rules.
[INSERT COMPANY NAME HERE] ensures that all electrical equipment brought on site is listed in the
Electrical Equipment Register. The register is completed prior to commencement of the works and
maintained for the duration of the works on site.
All electrical equipment including leads, portable power tools, junction boxes and earth leakage, or residual
current, devices are inspected and tested by a suitably qualified person and labelled with a tag of currency
before being used on site.
The responsibility for providing the evidentiary proof of test and tag remains with the owner of the plant or
equipment and will be provided to [INSERT COMPANY NAME HERE] upon request.
(WHSE) Site Safety Management Plan
Version _____
Page 35 of 59
Date: 24/06/2014
WHSE 022 – Electrical Equipment
Register
[INSERT COMPANY NAME HERE] records all electrical equipment brought on site in the Electrical
Equipment Register.
Note: Testing and Tagging frequency is as required by State or Territory Legislation, codes and relevant
standards.
Electrical Equipment
Workplace
Site Name / project number
Equipment
Description
Date of
Plant / Serial
Inspection/
No.
Test
Date
Results and/or
Electrician’s /
trip current
Date of next
qualified
License/
(less 30mA) for
Inspection/Test
person’s
Registration No.
Earth Leakage
Signature
Device
Cordless Drill
Charger
EXAMPLES


All leads


Generator


Elect Concrete
Mixer


Power Drills


Kettle


Microwave




Electrical item
Tools & leads or electrical
equipment
Frequency of inspection / test
(in accordance with relevant requirements)
6 months for protectively earthed, 12 months for double insulated
Sub-board earth leakage device
(WHSE) Site Safety Management Plan
Version _____
Page 36 of 59
Date: 24/06/2014
WHSE 023 – Hazard Reporting
[INSERT COMPANY NAME HERE] encourages all contractors /sub-contractors and employees to report
hazards immediately to the Site supervisor and MUST complete the Online associate BuildLearn forms.
Where the hazard cannot be corrected immediately, [INSERT COMPANY NAME HERE] records the details
of the hazard in the Hazard Register
[INSERT COMPANY NAME HERE] investigates all reported hazards and implements control measures to
eliminate and/or minimise the likelihood of an incident or injury.
[INSERT COMPANY NAME HERE] identifies a risk class/ranking for all hazards by referring to the
categories ranging from high to low in the Risk Matrix. The Risk Matrix is used to determine the level of
danger or seriousness (i.e. the consequence) of the risk, how likely it is that this risk will occur (i.e.
likelihood/probability) and therefore how detailed control measures will need to be to eliminate or minimise
the risk.
[INSERT COMPANY NAME HERE] regularly reviews and evaluates the effectiveness of control measures
until the hazard is addressed and/or all risks have been mitigated or reduced.
[INSERT COMPANY NAME HERE] will issue a copy of any completed Hazard Report form to the principal
contractor, as required.
(WHSE) Site Safety Management Plan
Version _____
Page 37 of 59
Date: 24/06/2014
WHSE 024 – Hazard Report
Where a hazard cannot be immediately corrected, [INSERT COMPANY NAME HERE] records the hazard
in the Hazard Report.
General
Date
Workplace
Submitted By
Signature
Submitted To
Signature
Details of Hazard
Location
Work Activity
Hazard identified
in relation to the
work activity
Details of Risk
Risk Class
High (1)
Medium (2)
Low (3)
Control Measures
Corrective Action
Required
By Whom
By Whom
When
Immediate
Within 24 hrs
Within 7 Days
Completion
Corrective Action
Completed By
Signature
Time
Date
Confirmed By
Signature
(WHSE) Site Safety Management Plan
Version _____
Page 38 of 59
Date: 24/06/2014
WHSE 025 – Injury and Incident
Investigation
Injuries:
All injuries are reported to the desiganted First Aid Officer in the workplace.
[INSERT COMPANY NAME HERE] records all injuries on the Register of Injuries.
Where the injury requires medical attention or off site treatment, [INSERT COMPANY NAME HERE]
completes an Incident Investigation Report Form through their online system.
In the event of medical attention copies of Incident Investigation Report are provided to SafeWork SA, within
24 Hours as required.
Reports can be found and completed on-line at www.BuildLearn.com.au
Incidents:
For all incidents involving near misses, property/plant damage or injury to the public or the environment,
[INSERT COMPANY NAME HERE] investigates and records the details in an Incident Investigation Report.
Copies of completed Incident Investigation Reports are provided to the [INSERT COMPANY NAME HERE]
and to SafeWork SA within 24 Hours as required.
Reports can be found and completed on-line at www.BuildLearn.com.au
Notifiable Incidents:
[INSERT COMPANY NAME HERE] reports all notifiable incidents to the relevant Authority (Safe Work SA).
Where such an incident has occurred, [INSERT COMPANY NAME HERE] considers whether the site
needs to be preserved for investigation by the relevant Authority.
Reports can be found and completed on-line at www.BuildLearn.com.au
Record Keeping:
[INSERT COMPANY NAME HERE] keeps records of incidents and injuies in accordance with Statutory
requirements, and online submitted forms are simutaneously safed to the systems Information System Hard
Drive (via www. BuildLearn.com.au)
(WHSE) Site Safety Management Plan
Version _____
Page 39 of 59
Date: 24/06/2014
WHSE 026 – Register of Injuries
[INSERT COMPANY NAME HERE] records all injuries in the following register Note complete Online form.
General
Workplace Location
Injured Persons Name
Home Address
Date of Birth
Gender
Male
Female
Occupation
Employers Name
Employers Address
Details of Injury
Date of Injury
Time of Injury
am
pm
Activity in which the person was
engaged at the time of injury
Exact location where injury
occurred
Nature of injury e.g. fracture,
burn, sprain, foreign body in eye.
Body location of injury
e.g. ear, eye, face, neck
Details of Treatment
Treatment provided
by First Aid Officer
Follow up
treatment required
Doctor/ Medical
Centre attended
Yes
No
Remarks:
Yes
No
If yes, an Incident Investigation Report must be completed with 24
hours
Date attended
Medical Certificate Received
Yes
No
Injury Management required
Yes
No
Treatment
i.e.
x-ray, prescription
Further consultation
required
Yes
No
If yes, notify the Return to Work Coordinator
Name of Witness
Address of Witness:
Name of Person Providing First Aid
Signature
(WHSE) Site Safety Management Plan
Date
Version _____
Page 40 of 59
Date: 24/06/2014
WHSE 027 – Incident Investigation
Report
[INSERT COMPANY NAME HERE] completes an Incident Investigation Report in the event of any injury
involving medical attention or off site treatment or in the event of any incidents involving a near miss,
property/plant damage or injury to the public or the environment.
The [INSERT COMPANY NAME HERE] will be informed immediately by the responsible person on site, in
the event of the above. Following discussions with the contractor/sub-contractor, a decision will be made as
to who will conduct the incident investigation and report the incident to SafeWork SA.
Reports can be found and completed on-line at www.BuildLearn.com.au
Class of Incident
Reported
Injury
Property/Plant Damage
Near Miss
Environmental
Other:
Yes
No
Details:
Further Action Required
Report to Authorities
Other:
Details of Incident
Date of Incident
Time of Incident
Witness Name
Witness Contact
am pm
Nature of Incident
Location of Incident
Description of Incident
Details of damage to
equipment / property?
Injured Person/s (if applicable)
Name
Address
Date of Birth
Occupation
Employer
Referred/transferred to
Recommended Preventive Action
Details
Completed By
(WHSE) Site Safety Management Plan
Version _____
Page 41 of 59
Date: 24/06/2014
Name
Position
Signature
Date
(WHSE) Site Safety Management Plan
Version _____
Page 42 of 59
Date: 24/06/2014
WHSE 028 – WHSE Site Safety
Management Plan Checklist
[INSERT COMPANY NAME HERE] reviews all WHSE policies and procedures on a Quarterly basis to
determine the effectiveness of the WHSE Site Safety Management Plan in addressing WHSE in the
workplace.
General
Project Name
All
Location
[INSERT COMPANY NAME HERE]
Auditor
Other Attendees
Activities Reviewed
Conforms
Changes and distribution of the WHSE Management Plan are recorded
Yes
No
Project details / Description of works / Organisation details are current
Yes
No
WHSE Policy signed and dated by Director/Manager
Yes
No
Hazards are identified and risks are assessed
Yes
No
Controls for high risk activities are documented (Safe Work Method Statement(s))
Yes
No
Training and Competency Register is current
Yes
No
Site Specific Induction on-line Training records are current
Yes
No
SWMS Training is current
Yes
No
Roles and responsibilities are allocated and signed
Yes
No
Consultation arrangements (nature, topics, intervals) are documented
Yes
No
Plant / Equipment Register is current
Yes
No
Hazardous Substances / Dangerous Goods Register is current
Yes
No
Personal Protective Equipment Register is current
Yes
No
Periodic Workplace Inspection Checklists are completed
Yes
No
Register of Injuries is current
Yes
No
Incident Investigation Reports are completed
Yes
No
Hazard Reports are completed
Yes
No
Electrical Equipment Register is current
Yes
No
Injury Management and Return-to-Work Program is displayed
Yes
No
Workers Compensation Information is current
Yes
No
Other:
Yes
No
Items Identified for Correction
(WHSE) Site Safety Management Plan
Version _____
Page 43 of 59
Date: 24/06/2014
Outstanding Issues and Recommendations
Follow up actions required
Yes
No
When
Completed By
Name
Position
Signature
Date
(WHSE) Site Safety Management Plan
Version _____
Page 44 of 59
Date: 24/06/2014
WHSE 029 – Injury Management and
Return-To-Work
Our Commitment:
[INSERT COMPANY NAME HERE] is committed to the return to work of injured contractors /subcontractors and employees .
As part of this commitment, we will:

Prevent injury and illness by providing a safe and healthy working environment;

Participate in the development of an injury management plan and ensure that injury management
commences as soon as possible after an employee is injured;

Support the injured employee and ensure that early return to work is a normal expectation;

Provide suitable duties for an injured employee as soon as possible;

Ensure that our injured employees (and anyone representing them) are aware of their rights and
responsibilities – including the right to choose their own doctor and rehabilitation provider, and the
responsibility to provide accurate information about the injury and its cause);

Ensure that our injured contractors /sub-contractors (and anyone representing them) are aware of
their rights and responsibilities – including the their responsibility to provide accurate information
about the injury and its cause) to [INSERT COMPANY NAME HERE] for investigation and reporting
purposes;

Consult with our employees and, where applicable, unions to ensure that the return-to-work program
operates as smoothly as possible;

Maintain the confidentiality of injured employee’s records.

Not dismiss an employee as a result of a work related injury within six months of becoming unfit for
employment.
To support the above, [INSERT COMPANY NAME HERE] has established the following procedures.
Notification of Injuries:

All injuries must be notified to the Site Supervisor as soon as possible.

All injuries will be recorded in the Register of Injuries.

Safe work SA will be notified where injuries or significant near miss incidents occure as per
legislative requirements;

Our Workers Compensation Scheme Agent will be notified of any injuries that may require
compensation within 48 hours.

Reports can be found and completed on-line at www.BuildLearn.com.au
Recovery:

All injured contractors /sub-contractors and employees will receive appropriate first aid or medical
treatment as soon as possible.

The injured employee must nominate a treating doctor who will be responsible for the medical
management of the injury and assist in planning return to work.

Note that the BuildLearn Sign has the QR reader code for the location of the nearest medical facility
(WHSE) Site Safety Management Plan
Version _____
Page 45 of 59
Date: 24/06/2014
Return To Work:

A suitable person will be arranged to explain the return to work process to the injured employee.

The injured employee will be offered the assistance of a WorkCover - accredited rehabilitation
provider if it becomes evident that they are not likely to resume their pre-injury duties, or cannot do
so without changes to the workplace or work practices.
Suitable Duties:

An individual return to work plan will be developed when the injured employee, according to medical
advice, is capable of returning to work.

The injured employee will be provided with suitable duties that are consistent with medical advice
and are meaningful, productive and appropriate to the injured employee’s physical and psychological
condition.

Depending on the individual circumstances of the injured employee, suitable duties may be at the
same workplace or a different workplace, the same job with different hours or modified duties, a
different job and may involve full-time or part-time hours.
Dispute Resolution:

If disagreements about the return to work program or suitable duties arise, the organization will work
with the injured employee and any union representing them to try to resolve the issue.

If all parties are unable to resolve the dispute, the organization will seek to involve the Scheme
Agent, an accredited rehabilitation provider, the treating doctor or an injury management consultant.
Contacts:
Serenity Home’s workplace contact for the return-to-work is:
Name
Organisation
[INSERT COMPANY NAME
HERE]
Contact Details
(08) 8298 4422
[INSERT COMPANY NAME HERE] ‘s preferred Work Cover-accredited rehabilitation providers are:
Name
Organisation
Contact Details
[INSERT COMPANY NAME HERE] workers’ compensation Scheme Agent is:
Name
(WHSE) Site Safety Management Plan
Organisation
Version _____
Contact Details
Page 46 of 59
Date: 24/06/2014
WHSE 030 – Emergency Plan
FOR ALL EMERGENCIES REQUIRING POLICE, AMBULANCE OR FIRE BRIGADE RING:
000
OR FROM DIGITAL PHONES RING
112
IF NO PHONES ARE AVAILABLE ATTEMPT CONTACT ON TWO-WAY RADIO.
Procedure:
1. If significant SPILL Use Environmental Emergency Procedure: Make Safe from Traffic. Stop traffic if
necessary. Be sure to facilitate access for emergency vehicles
2. Give immediate First Aid and extinguish any fire.
3. Assess the situation, call 000 or 112 and tell the operator:
Name of Organisation:
Name of Responsible person:
Name of First Aiders
Nature of emergency
Road Name:
Locality:
Kilometres N / S / E / W of nearest town (approx) OR
Nearest cross street
State number of people trapped or injured
State number people missing
If a spill: Quantity, Chemical, UN number and Hazchem
Code
Other problems e.g. Fire, Risk of Fire, Fallen power lines,
Flood, Weather
[INSERT COMPANY NAME HERE]
ANY
ANYWHERE
4. While waiting for Emergency Services. Continue first aid if appropriate.
5. When Emergency Services arrive, they will take control. Give them details of the incident & any further
actions you have taken and Assist as directed with traffic control etc.
6. Call (08) 8363 5922 number and inform them.

As soon as practicable report on the Incident using [INSERT COMPANY NAME HERE] Accident /
Incident Report form on-line at BuildLearn.com.au using the QR reader code on the BuildLearn Sign
located on the security fence of the work site Note: a second QR reader on sign for nearest Medical
Centre or Doctor for Attention.
Under your obligation to 'Duty of Care' requirements.

The PCBU (Principal Builders) - Site requirements include
A company sign
Security fencing
(WHSE) Site Safety Management Plan
Version _____
Page 47 of 59
Date: 24/06/2014
Warning signs
Security lock
Access and egress driveway, delivery and loading area
Essential services and amenities
Emergency planning
First aid provisions
Refuse area
Traffic management area
Storage location
Safety provisions - safety bin
Working drawings
Site entry instructions - BuildLearn QR code
Site Safety Management Plan

All Trades, stakeholders and visitors to site MUST:
Complete site entry form
Read Site Specific Site Safety Management Plan
Check tools are Tested / Tagged and Current
Consult/engage Site Supervisor and other stakeholder on site via a Toolbox meeting

Survey the site
Complete site entry form
Complete safe work method statement
Toolbox meeting

Soil sample
Complete site entry form
High risk construction method identified
Complete safe work method statement
Toolbox meeting

Deliver of amenities (toilet)
Complete site entry form
High risk construction method identified
Complete safe work method statement
Toolbox meeting

Temporary fencing
Complete Site Entry Form
Complete Site Specific Safe Work Method Statement
Read Site Specific Site Safety Management Plan
(WHSE) Site Safety Management Plan
Version _____
Page 48 of 59
Date: 24/06/2014
Toolbox meeting

Installation of cellar
Complete site entry form
High risk construction method identified
Complete safe work method statement
Toolbox meeting

Installation of swimming pool
Complete site entry form
High risk construction method identified
Complete safe work method statement
Toolbox meeting

Footing trenches over 1.5m deep
Complete site entry form
High risk construction method identified
Complete safe work method statement
Toolbox meeting

Delivery of rubble base
Complete site entry form
High risk construction method identified
Complete safe work method statement
Toolbox meeting

Spread of rubble base and compact
Complete site entry form
High risk construction method identified
Complete safe work method statement
Toolbox meeting

Excavate Trenches
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Underfloor Plumbing
Complete site entry form
High risk construction method identified (if digger is used)
Complete safe work method statement
(WHSE) Site Safety Management Plan
Version _____
Page 49 of 59
Date: 24/06/2014
Toolbox meeting

Engineering report
Complete site entry form
Complete safe work method statement
Toolbox meeting

Delivery of foundation steel reo
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Install Fortecon, steel reo to foundations, box up form work
Complete site entry form
Complete safe work method statement
Toolbox meeting

Install electrical sleeve and earth stake
Complete site entry form
Complete safe work method statement
Toolbox meeting

Engineering report
Complete site entry form
Complete safe work method statement
Toolbox meeting

Concrete pump and screed footing
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Install termite barrier
Complete site entry form
Complete safe work method statement
Toolbox meeting

Trench main sewer drain
Complete site entry form
High risk construction methods identified
Complete safe work method statement
(WHSE) Site Safety Management Plan
Version _____
Page 50 of 59
Date: 24/06/2014
Toolbox meeting

Delivery of structural steel
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Erection of structural steel
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Delivery of wall & roof frame timber
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Carpenter to erect wall frames
Complete site entry form
High risk construction Methods identified
Complete safe work method statement
Toolbox Meeting

Crane up roof trusses
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Carpenter erect roof frame
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Delivery & installation of fall protection
Complete site entry form
High risk construction methods identified
Complete safe work method statement
(WHSE) Site Safety Management Plan
Version _____
Page 51 of 59
Date: 24/06/2014
Toolbox meeting

Delivery of roofing materials
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Installation of roofing materials
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Delivery of bricks
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Removal of fall protection
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Delivery of brick sand
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Installation of brickwork
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Installation of stone veneer
Complete site entry form
High risk construction methods identified
Complete safe work method statement
(WHSE) Site Safety Management Plan
Version _____
Page 52 of 59
Date: 24/06/2014
Toolbox meeting

Installation of first fix plumbing
Complete site entry form
Complete safe work method statement
Toolbox meeting

Bobcat site clean
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Installation of first fix gas plumbing
Complete site entry form
Complete safe work method statement
Toolbox meeting

Installation of first fix electrical
Complete site entry form
Complete safe work method statement
Toolbox meeting

Installation of first fix A/C
Complete site entry form
Complete safe work method statement
Toolbox meeting

Installation of render
Complete site entry form
Complete safe work method statement
Toolbox meeting

Delivery of insulation
Complete site entry form
Complete safe work method statement
Toolbox meeting

Installation of insulation
Complete site entry form
Complete safe work method statement
Toolbox meeting
(WHSE) Site Safety Management Plan
Version _____
Page 53 of 59
Date: 24/06/2014

Delivery of brick sundries
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting

Delivery of Gyprock
Complete site entry form
Complete safe work method statement
Toolbox meeting

Installation of Gyprock
Complete site entry form
Complete safe work method statement
Toolbox meeting

Flushing of Gyprock
Complete site entry form
Complete safe work method statement
Toolbox meeting

Sanding of Gyprock
Complete site entry form
Complete safe work method statement
Toolbox meeting

Delivery of Bath & laundry trough cabinet
Complete site entry form
Complete safe work method statement
Toolbox meeting

Installation of Bath & laundry trough cabinet
Complete site entry form
Complete safe work method statement
Toolbox meeting

Cornicing of Gyprock
Complete site entry form
Complete safe work method statement
Toolbox meeting

Delivery of 2nd fix timber & eave material
Complete site entry form
Complete safe work method statement
(WHSE) Site Safety Management Plan
Version _____
Page 54 of 59
Date: 24/06/2014
Toolbox meeting

Window installation and glazing
Complete site entry form
Complete safe work method statement
Toolbox meeting

Waterproof wet areas
Complete site entry form
Complete safe work method statement
Toolbox meeting

Carpenter to fix 2nd timber & eave material
Complete site entry form
Complete safe work method statement
Toolbox meeting

Delivery of cabinets
Complete site entry form
Complete safe work method statement
Toolbox meeting

Installation of cabinets
Complete site entry form
Complete safe work method statement
Toolbox meeting

Delivery and installation of bench tops
Complete site entry form
Complete safe work method statement
Toolbox meeting

Delivery and installation of splashbacks
Complete site entry form
Complete safe work method statement
Toolbox meeting

Delivery of interior tiles
Complete site registration form
Complete safe work method statement
Toolbox meeting

Timber flooring and finish
Complete site registration form
Complete safe work method statement
(WHSE) Site Safety Management Plan
Version _____
Page 55 of 59
Date: 24/06/2014
Toolbox meeting

Install paint work
Complete site entry form
Complete safe work method statement
Toolbox meeting

Installation of 2nd fix electrical
Complete site entry form
Complete safe work method statement
Toolbox meeting

Delivery of all 2nd fix sanitary ware
Complete site entry form
Complete safe work method statement
Toolbox meeting

Installation of 2nd fix plumbing
Complete site entry form
Complete safe work method statement
Toolbox meeting

Installation of Interior tiles
Complete site entry form
Complete safe work method statement
Toolbox meeting

Installation of robes & shower screens
Complete site entry form
Complete safe work method statement
Toolbox meeting

Installation of garage doors
Complete site entry form
Complete safe work method statement
Toolbox meeting

Installation of Air Conditioning system
Complete site entry form
Complete safe work method statement
Toolbox meeting

Installation of carpets
Complete site entry form
Complete safe work method statement
(WHSE) Site Safety Management Plan
Version _____
Page 56 of 59
Date: 24/06/2014
Toolbox meeting

Cleaning of house
Complete site entry form
Complete safe work method statement
Toolbox meeting

Delivery & fitting of fly screens
Complete site entry form
Complete safe work method statement
Toolbox meeting

Delivery of appliances
Complete site entry form
Complete safe work method statement
Toolbox meeting

Delivery of Hot Water Service (HWS)
Complete site entry form
Complete safe work method statement
Toolbox meeting

Gas appliance install
Complete site entry form
Complete safe work method statement
Toolbox meeting

Kitchen electrical appliances to install
Complete site entry form
Complete safe work method statement
Toolbox meeting

Retaining walls
Complete site entry form
Complete safe work method statement
Toolbox meeting

Fencing
Complete site entry form
Complete safe work method statement
Toolbox meeting

Paving
Complete site entry form
Complete safe work method statement
(WHSE) Site Safety Management Plan
Version _____
Page 57 of 59
Date: 24/06/2014
Toolbox meeting

Cement paving or driveway
Complete site entry form
Complete safe work method statement
Toolbox meeting

Landscape
Complete site entry form
High risk construction method identified
Complete safe work method statement
Toolbox meeting

Site clean up
Complete site entry form
High risk construction method identified
Complete safe work method statement
Toolbox meeting

Handover
Complete site entry form
Complete safe work method statement
Toolbox meeting

Other building details

Details
Complete site entry form
High risk construction methods identified
Complete safe work method statement
Toolbox meeting
Landscaping
Complete site entry form
High risk construction methods identified
Complete safe work method statement

Toolbox meeting
Site Safety Rules
Contractors / Subcontractors to make their workers aware of the contents of the Site Safety Management
Plan and ensure they understand the site safety rules
No access to the site unless Building Site Supervisor is informed prior to attendance
If an area is barricaded do not enter the barricaded area unless authorized to do so
(WHSE) Site Safety Management Plan
Version _____
Page 58 of 59
Date: 24/06/2014
All contractors & subcontractors to have first aid kits available in their vehicles whenever working on
site
Work areas are to be kept clean and tidy at all times & rubbish to be placed in appropriate bins or
cages
All nails on waste timber to be removed or bent over
No alcohol or drugs (other than prescription drugs) to be consumed on this site
No worker is to enter the site while under the influence of alcohol or illicit drugs
Fighting, bullying, harassment or aggressive behaviour by anyone on this site will not be tolerated
All persons must leave site amenities in a clean, tidy and hygienic state after use - notify the Building Site
Supervisor should a problem arise
All site workers must immediately inform Building Site Supervisor when / if an unforseen risks or Hazard
arises so that applicable safety controls can be implement.

I have read, understood and will comply with the Site Safety Management Plan and Site Safety Rules
Yes
No
Site Address:
PROJECT ID #:
Contractor, Sub-contractor or their nominated Responsible Person
Name:
Email:
Signature:
Site Supervisor or nominated Responsible Officer for PCBU
Name:
Email:
Signature:
Person Conducting Business or Undertaking – Principal Builder, Manager
Name:
(WHSE) Site Safety Management Plan
Signature:
Version _____
Page 59 of 59