Form No. OH103
SAFE WORK METHOD STATEMENT
Revision: v1
Orange Hire 81 Links Rd
St Marys NSW 2760
ABN: 97 133 373 154
Activity Details
W ork Activity:
Installation of a-frame hoarding
Address of activity
Project/Client
Name:
Commencement
date
Duration of
works
Worker Details
Supervisor of the W ork*
Signature:
Qualifications:
Authorising Jaybro/Orange
Hire Person#
Signature:
Position:
Number of workers used
onsite
Primary contact
number
Sub-Contractor
Name
SWMS Preparation
Name
Date
SW MS prepared by:
Scott Montgomery
Reviewed 19/09/2016
W orker(s) who have had input into the
development of this SW MS
Luke Drady, Daniel Pridham
Date:11/03/2016
Date:
Associated SW MS (e.g. Subcontractors SW MS)
*- Responsible for providing site specific training; Implementing & monitoring implementation of this SWMS and conducting inspection
# - Responsible for ensuring SWMS are developed, consulted upon, distributed, returned, filed and all other WHS tasks completed including inspections
Note: template document
control only – see header
for SWMS review info
Template author date:
01/09/2016
Review of template:
30/08/2018
Template
version:V2
Copyright © 2016 Jaybro. All
Rights Reserved.
Authorised By – J.Joyce
Document Owner – Scott
Montgomery
Page 1 of 13
Form No. OH103
SAFE WORK METHOD STATEMENT
Orange Hire 81 Links Rd
St Marys NSW 2760
ABN: 97 133 373 154
Revision: v1
Personal Protective Equipment
Site Specific Requirements / Notes
Safety boots
Lace up
High Visible
clothing
Eye protection
Gloves
Mandatory
Mandatory
Mandatory
Mandatory
HRW & Other Licences Required
Dogman
Rigging basic
Rigging Int.
Rigging Adv
WP (>11m)
Traffic Control
MR/HR truck*
HC/MC truck*
LF/LO fork
*Dependant on
truck type
Other_______
Other _______
Crane License
C2
C6
C1
C0
CV (>10mT)
CN
Hard Hat
Hearing protection




Special PPE__________
Crew to be inducted into SWMS.
Crew to be advised on onsite risks and hazards
As needed for
tasks
Training Required
Construction Industry General Induction
Site Induction
 This SWMS
SDS
Confined Space
Manual Handling
Verification of Competency for plant
Trade Certificate
Permits/Approvals
Excavation
Working at Height
Hot works
Confined Space
Traffic Management
Other __________
___
Other ____________
Other ____________
High Risk Work Check
Note which high risk work activities are involved in this project
Risk of falls from greater than 2 meters
Work on, in or adjacent to road, rail
shipping or other major traffic corridor
Work in an area with movement of powered mobile plant
Work on a telecommunications tower
Work in or near shaft or trench with an excavated depth
greater than 1.5m or a in a tunnel
Temporary load-bearing support structures
Demolition of a load-bearing structure
Use of Explosives
Likely to involve disturbing asbestos
Work on or near pressurized gas pipes or
mains
Work on or near chemical, fuel or refrigerant lines
Work in confined spaces
Work on or near energized electrical installations or services
Work with tilt up or pre-cast concrete
Diving work
Work in or near a drowning risk
Work in areas with artificial extremes of temperature
Work in an area with contaminated or flammable atmosphere
Emergency Planning (tick or add as applicable and attach plan or details as required)
First Aid kit
9kg Fire Extinguisher
Radio
Page 2 of 13
Channel:
Form No. OH103
SAFE WORK METHOD STATEMENT
Revision: v1
Orange Hire 81 Links Rd
St Marys NSW 2760
ABN: 97 133 373 154
Protective Barriers (tick or add as applicable)
List warning signs, protective barriers and equipment to be used on this site:
PROTECTIVE BARRIERS:
SIGNS:
Other:
Bollards/Cones
Danger plant in use
Edge protection
Stop/Slow baton
Tape
Other ______________________
W arning lights, reversing alarms
__Traffic Control______________________
Substances to be brought on to site
Product
Note: Any Hazardous Substance must have a valid Safety Data Sheet
SDS
Attached
Product
Fuel
Plant and Equipment (tick or add as applicable)
Plant and Equipment to be used on this site?
Note: All servicing MUST be in accordance with manufacturers recommendations
List inspections and maintenance requirements and attach evidence to this SWMS
Hand tools
Visual inspection
Battery operated grinder
Visual inspection
Battery operated rattle gun
Visual inspection
Impact Drill
Visual inspection
Electrical leads
Visual inspection
Tagged and tested
Generator
Visual inspection
Daily checklist
Page 3 of 13
SDS
Attached
Form No. OH103
SAFE WORK METHOD STATEMENT
Orange Hire 81 Links Rd
St Marys NSW 2760
ABN: 97 133 373 154
Revision: v1
Risk Matrix
Step 2: Determine Consequence
What will be the expected outcome?
Level of
Example of each level:
Effect:
Step 1: Determine Likelihood
What is the possibility that the event will occur?
Likelihood
Criteria
Almost
certain
Expected in most circumstances.
Likely
Will probably occur in most circumstances
Minor
Moderate
Possible
Might occur at some time
Major
Unlikely
Could occur at some time
Catastrop
hic
Step 3: Determine the risk score
Consequences
Negligible
Discharge
Medical treatment; serious injuries, temporary
partial disability; lost time injury < 7 days
Moderate
Breach
Hospital admittance; extensive injuries; lost time
injury > 7 days; Permanent Total Disability injury;
death
Major Breach
of
Environmental
Statutes
Multiple Permanent Total Disability injuries; multiple
deaths
Shutdown of
Project due to
Environmental
Breach
Score
Moderate
Major
Catastrophic
Negligible
Spill/effect
Moderate Breach
of Environmental
law
Major Breach
of
Environmental
law
Shutdown of
Project due to
Environmental
Breach
Almost
certain
3 High
4 Severe
4 Severe
4 Severe
3
High
Likely
3 High
3 High
4 Severe
4 Severe
2
Moderate
Possible
2 Moderate
3 High
4 Severe
4 Severe
1
Low
Unlikely
1 Low
2 Moderate
3 High
4 Severe
Page 4 of 13
Minor clean up necessary
Spill kit deployed, drains and
gutters secured; Workzone
personnel and site contact notified
Fire brigade services required for
clean-up; Public diverted or
evacuated. Principal Contractor
notified.
Site shutdown and emergency
services required; evacuation of
personnel and public
Action
Minor
Environment
Likelihood
First Aid treatment only; no lost time injury
Example of each level:
Step 4: Record risk score on worksheet (Note – Risk scores are a subjective value and
should only be used for comparison and to engender discussion.)
Using the above steps, determine the risk score?
People
Level of
Effect:
4
Severe
DO NOT PROCCED. Requires immediate attention. Introduce
further high-level controls to lower the risk level. Re-assess
before proceeding.
Review before commencing work. Introduce new controls
and/or maintain high-level controls to lower the risk level.
Monitor frequently to ensure control measures are working.
Maintain control measures. Proceed with work. Monitor and
review regularly, and if any equipment/people/materials/work
processes or procedures change.
Record and monitor. Proceed with work. Review regularly,
and if any equipment/people/materials/work processes or
procedures change.
Form No. OH103
SAFE WORK METHOD STATEMENT
Revision: v1
ACTIVITY
Break the job into steps
What are you doing?
Hazards and Risks
What harm can occur to workers or others
UNTREATED
RISK RANKING
(4S, 3H, 2M or 1L)
Orange Hire 81 Links Rd
St Marys NSW 2760
ABN: 97 133 373 154
CONTROLS
What are you going to do to carry out the work safely?
(Apply the hierarchy of control)
RISIDUAL RISK
RANKING
(4S, 3H, 2M or
1L)
PERSON RESPONSIBLE
for implementation of the
controls
Step 1. Site access
Arrival onsite
Unaware of site safety rules,
hazards and instruction
3H





Pre Job Risk Assessment
3H


Performing duties near
roadways or mobile plant
Hit by moving vehicles/plant
3H


Page 5 of 13
All members of the crew will need to be:
o site inducted;
o trained in this SWMS;
o involved in the Work Site Inspection
for the work
Make sure you are aware of the site’s
emergency procedures.
If at any time you are unsure or have questions
– Speak Up & ask your Supervisor and/or site
manager for advice.
Assess weather conditions and adjust work
accordingly especially in the case of shadecloth
installation
Orange hire workers must verify location of
install via site map or supervisor instruction
You must inspect the site and complete the
Work Site Inspection form (last page of SWMS)
before commencing work activity.
Do not commence work until you are satisfied
the job is safe!
2M
Check constantly for changing hazards while
working
Monitor work position at all times. Ensure:
o High visibility clothing worn at all times
o Do not stand behind reversing vehicles
o Allow sufficient distance from plant
during operation (allow sufficient room
for equipment failure –such as plant
rollover)
o No work is conducted in established
“no go zones”
o Alertness at all times. Listen for:
 Reversing alarms/beepers
 Calls from Plant Operators
2M
1L
Supervisor and all
crew members
Supervisor and all
crew members
Supervisor
Form No. OH103
SAFE WORK METHOD STATEMENT
Revision: v1
Orange Hire 81 Links Rd
St Marys NSW 2760
ABN: 97 133 373 154




Safety/warning signs, Spotters,
traffic barriers etc. must be
obeyed as required
o Work positions should be in clear sight
of plant operators
o Follow traffic management plan where
required
Never assume you have right of way. Make
visual and verbal contact with plant operator as
required.
Avoid performing work on roadway directly
where possible
Use traffic cones and signage where available
Step 2. Installation of bracing
Erecting bracing
Hit by moving plant
3H



Manual handling
3H


Eye injuries
3H


Noise
Page 6 of 13
2M

All travel is to be taken through the designated
areas as directed by site personnel, maintain
no-go zones.
No work is to be undertaken on trafficked areas
PPE to be worn, gloves, steel capped boots
and high visibility garments
Adopt correct manual handling practices, bring
loads in close to the body, keep back straight
and lift with legs not the back.
Two person lift on this equipment
2M
Supervisor
2M
Supervisor
Eye protection must be worn at all times during
this work.
Ensure drill bit and grinding disc is secure
2M
Supervisor
Hearing protection must be worn while using
impact drill and grinder
1L
Supervisor
Form No. OH103
SAFE WORK METHOD STATEMENT
Revision: v1
Entanglement
3H


Moving parts


Slip, trips and falls
3H




Orange Hire 81 Links Rd
St Marys NSW 2760
ABN: 97 133 373 154
Check the drill bit is inserted in the chuck
correctly and running true
Ensure all covers are fitted, secure and
functional.
Do not operate if equipment that has missing or
damaged covers.
Secure/Remove jewelry, long hair and loose
clothing
Check for debris, reo, timber, straps and other
site rubbish – remove these from the
access/pathway before moving panels
Wear proper safety footwear
Maintain proper footing and take it slow over
uneven, broken or rough surfaces
Maintain good housekeeping practices to
eliminate hazards and keep access routes
clear
2M
Supervisor
2M
Supervisor
Adopt correct manual handling practices, bring
loads in close to the body, keep back straight
and lift with legs not the back.
Two person lift on this equipment is
recommended
Do not drop item into place
Communicate with team member on movement
of item
Clear path before lifting
All workers trained in this and any associated
SWMS
All lifting must be done in accordance to site
instruction.
Orange hire workers must verify competency of
Crane operator
Orange hire workers must move to a safe
location clear of moving plant and tag lines
Orange hire workers must not undertake
dogman activities unless qualified
All workers involved in activities are to obey the
2M
Supervisor
1L
Supervisor
2M
Supervisor
Step 3. Installing counterweights
Installation of counterweights
Manual handling
3H


Struck by falling item
Struck by moving plant (where
using plant to lift
counterweights)
2M
3H









Page 7 of 13
Form No. OH103
SAFE WORK METHOD STATEMENT
Revision: v1



Orange Hire 81 Links Rd
St Marys NSW 2760
ABN: 97 133 373 154
instructions of crane crew at all times
Make available all necessary equipment and
requirements to safely lift and transport barriers
Maintain clearance form all workers and do not
breach exclusion zones
Loads must not be suspended or travelled over
persons
Step 4. Installing hoarding panels
Affixing hoarding panels to
frame
Struck by falling item
3H


Ensure the panel is firmly held before fitting
Fix hoarding at all necessary points in
accordance with manufacturers guidance
1L
3H

Adopt correct manual handling practices, bring
loads in close to the body, keep back straight
and lift with legs not the back.
Second person to secure the panel while
affixing is highly recommended (consider wind
conditions)
Eye protection must be worn at all times during
this work.
Ensure drill bit is secure
Hearing protection must be worn while using
impact drill
Check the drill bit is inserted in the chuck
correctly and running true
Ensure all covers are fitted, secure and
functional.
Do not operate if equipment that has missing or
damaged covers.
Secure/Remove jewelry, long hair and loose
clothing
 Fencing must be installed by competent
installers inducted into Temporary
Fencing Installation manual
 The fitting of shadecloth, banner mesh or
signage will breach the installation
instructions. Discuss this with Orange Hire
2M
Vehicles or persons struck by
unsecured panels
Manual handling

3H

Noise
2M


Entanglement
3H

Eye injuries

Moving parts


Collapse of fencing
 Wind conditions
 Poor install
Page 8 of 13
3H
Supervisor
2M
1L
2M
2M
Supervisor
Form No. OH103
SAFE WORK METHOD STATEMENT
Revision: v1
Orange Hire 81 Links Rd
St Marys NSW 2760
ABN: 97 133 373 154
personnel
Installers must obtain installation sign off
from the site supervisor
 Installers must take photographs of the
completed works for supply to Orange Hire
Ensure the gate and components are firmly
held before during fitting.
Fix gates at all necessary points in accordance
with manufacturers guidance

Fixing traffic gates in place
(where applicable)
Fixing pedestrian gates in
place (where applicable)
Struck by falling item
3H


Vehicles or persons struck by
unsecured posts
Manual handling
3H



Struck by falling item
3H


Vehicles or persons struck by
unsecured posts
Manual handling
1L
Supervisor
Do not maintain awkward postures
Rotate tasks
Adopt correct manual handling practices, bring
loads in close to the body, keep back straight
and lift with legs not the back.
Ensure the gate and components are firmly
held before during fitting.
Fix gates at all necessary points in accordance
with manufacturers guidance
2M
Supervisor
1L
Supervisor
Do not maintain awkward postures
Rotate tasks
Adopt correct manual handling practices, bring
loads in close to the body, keep back straight
and lift with legs not the back
2M
Supervisor
3H



3H
As controls from Steps 2 – 4.
2M
4S

2M
Step 5. Disassembly and pick up
Hazards as per step 2-4
Work in an area with
movement of powered mobile
plant
Emergency situations
Emergency situations
Various

Page 9 of 13
Stop work then follow the site evacuation
instructions and notify emergency services if
required.
Determine evacuation assembly area during
toolbox talk
supervisor
Form No. OH103
SAFE WORK METHOD STATEMENT
Revision: v1
Orange Hire 81 Links Rd
St Marys NSW 2760
ABN: 97 133 373 154
Reasonable adjustment to this SW MS
Performing the tasks in a way that does not reflect the above SWMS.
Reasons:

There is a site specific omission from the SWMS

You have to perform an extra task

Performing the task as set out above may create a hazard
Task step:
Hazards:
Rating

Control of hazard
Rating
after
control
Responsible
persons
Task step:
Hazards:
Rating

Control of hazard
Rating
after
control
Responsible
persons
Page 10 of 13
Form No. OH103
SAFE WORK METHOD STATEMENT
Orange Hire 81 Links Rd
St Marys NSW 2760
ABN: 97 133 373 154
Revision: v1
State Legislation (tick or add as applicable)
Tick
Legislation
Tick
Codes of Practices/Guidance
Tick
Other
How to Manage Work Health & Safety
Risks
Hazardous Manual Tasks
Traffic Control at Work Sites – within each state
Managing the risk of falls at workplaces
Temporary Fencing Installation manual

OHS Act 2004 - Vic

OHS Regulation - Vic


Workplace Injury Rehabilitation and
Compensation Act 2013 - VIC
Environment Protection Act 1970 - VIC

OHS Act 1984 -WA

OHS Regulation 1996 - WA


Workers Compensation & Injury Act
1981 - WA
WHS ACT 2011 – NSW
Labelling of Workplace Hazardous
Chemicals
Managing Noise &Preventing Hearing
Loss at Work
Managing the Work Environment &
Facilities
Work Health & Safety Consultation,
Cooperation & Coordination
First Aid in the Workplace

WHS Regulation 2011 - NSW
Construction Work
AS 2741-2002 1-2002 Shackles
Managing Risks of Hazardous
Chemicals
Managing Risks of Plant in the
Workplace
Cranes
Australian Standard AS2550—Cranes, hoists and winches—Safe
use
AS 4497.2-1997 Round slings - Synthetic fibre - Care and use

Workplace Injury Management and
Workers Compensation Act 1998 - NSW
 Workers Compensation Regulation 2010
- NSW
 Protection of the Environment
Operations Act 1997 - NSW
 Work Health and Safety Act 2011 - QLD
 Work Health and Safety Regulation 2011 QLD
 Workers’ Compensation and
Rehabilitation Act 2003 - QLD
 Workers’ Compensation and
Rehabilitation Regulation 2014 - QLD
 Environmental Protection Act 1994

Page 11 of 13
Jaybro’s Procedures & Policies
Other relevant legislation

Road Transport Act 2013 and Heavy Vehicle (Mass,
Dimension and Loading) National Regulation 2013
Australian and other Standards
AS/NZS 2161.1 Occupational Protective glove
AS/NZS1337:1:2010 – Personal Eye and face protection
AS/NZS 4801:2001 Occupational health and safety management
systems
AS/NZS 2210 (1980) Type 1 Safety Footwear
AS 4687-2007 Temporary fencing and hoardings
AS NZS 1170.2-2011 Structural design actions - Wind actions
Form No. OH103
SAFE WORK METHOD STATEMENT
Orange Hire 81 Links Rd
St Marys NSW 2760
ABN: 97 133 373 154
Revision: v1
Commitment Sign off
I, the undersigned, understand that;
1.
2.
3.
The SW MS has been explained to me
Its contents are clearly understood by me
My qualifications are current to undertake this activity – tick or note
qualification
4.
5.
6.
I have had the opportunity to have input into the preparation or adjustment of the SW MS
I will comply with the SW MS otherwise work will stop immediately
I understand the importance of and how to report incidents and near misses
Skills Matching + Consultation & Review Sign Off












Other

Other

Dogging

Rigging

Forklift
DATE
First Aid
Page 12 of 13
SIGNATURE
Crane license
NAME
Site induction
All workers have been consulted, had an induction in and read and
understand the requirements contained in this SWMS. Signed by
ALL workers including non Orang Hire workers involved - Name and
Signature:
White Card
Training / Skill / Competency Required to Complete the Work Safely
Work Site Inspection
Jaybro Group workers, contractors or sub-contractors must complete the below safety checklist with all other colleagues,
offsiders and assistants to identify any hazards and state how they will control them.
1
Yes
Stop, look and think
Action
Required
Do all workers understand what they need to do?
Have SWMS been consulted, explained and Signed?
Check
with the
team
Permits obtained? (e.g. hot work/ground penetration etc.)
Are suitable and working tools/equipment available?
Is all PPE correct and fitted?
Are all workers trained and competent to perform this task?
Identify hazards – complete section 3 for controls of each
hazard
2
What could
happen?
Manual handling (e.g. heavy lifting, awkward posture, impact
or exertion)
Slips, trips and falls (e.g. from ladders, truck beds, platforms,
elevated areas; debris, hoses, cables, uneven ground, wet
areas etc.)
Mechanical (e.g. moving parts, moving plant, ejected objects)
Electrical (e.g. overhead wires, faulty tools, live power)
Discuss
if there
are any
of the
following
hazards
Chemical (e.g. inhalation, contact with acids, solvents,
asbestos)
Pressure (e.g. contact with high pressure liquid or air)
Noise (e.g. loud noises, hearing emergency alarms or
instructions)
Biological (e.g. exposure to potential disease carrying
material)
Radiation (e.g. exposure to sunlight, UV or x-rays)
Psychological (e.g. stress, violence, fatigue)
Heat and Cold (e.g. working in hot or cold environments)
3
Controls for the above hazards
Hazard identified
4
Risk
rating
(low,
medium,
high)
Safe to proceed with work
Page 13 of 13
How will you control the risk
☐ Yes
☐ No