Ohs Form 005 Safe Work Method Statement (SWMS) : This SWMS Has Been Developed and Authorised by

OHS FORM 005 SAFE WORK METHOD STATEMENT (SWMS) also known as Job Safety Analysis (JSA)
This SWMS has been developed and authorised by:
Name:
Company Name:
Position:
Date:
ABN:
Signature:
Phone:
Mobile:
DESCRIPTION OF WORK ACTIVITY:
Concrete Placement (General)
Trades involved with undertaking this Work Activity:

This SWMS is submitted to: (principle contractor)
COMPANY:
CONTACT NAME:
PHONE NUMBER:
SITE ADDRESS:
PROJECT DESCRIPTION:
This SWMS was review by: (principle contractor)

NAME:
POSITION:
SIGNATURE:
DATE:
PHONE NUMBER:
MOBILE NUMBER:
Person responsible for OHS on the contractors behalf:

NAME:
POSITION:
SIGNATURE:
DATE:
PHONE NUMBER:
MOBILE NUMBER:
Safe Work Method Statement (SWMS)
Page 1 of 1
List plant, equipment and

tools to be used
eg. Electric generator
List Hazardous Substances

to be used or handled
MSDS
available?
(Tick)
eg. Unleaded petrol
Hard Hat
Safety Boots
High-visy clothing
Gloves
Hearing Protection
Safety Glasses
30+ Sunscreen
Dust Masks
Other (specify):
Health Risks and Likelihood of Damage
How LIKELY is it to be that bad?

Note: If a hazard is rated 1, 2 or 3, action must be taken immediately.
What
damage
could it
cause?
Death or
permanent
disability
Long term
illness or
serious
injury
Medical
attention or
several
days off
work
First Aid
needed
VERY
LIKELY
VERY
UNLIKELY
LIKELY
UNLIKELY
Could happen
anytime
Could
happen
sometimes
Could
happen, but
only rarely
Could happen, but

probably never will
List PPE to be worn
(Tick) List Hazards to consider
(Tick)
Fall from ladder

Fall from heights
Fall from scaffold
Contact with electricity
Falling objects
Collapse
Slips, trips and falls
Manual handling
Exposure to noise
Struck by moving plant
Inhalation of dust or fumes
Cuts
Other (specify):
How to complete the following form

1. List the step-by-step sequence of tasks required to carry out
the work activity from start to finish.
2. Listing of potential hazards associated with each step, and the
related OHS risks.
3. Using the risk table, rating the identified risks.
4. List what controls you will implement to reduce the risks to the
lowest possible level.
5. Rate the level of risk once those controls have been
implemented (must be 4-6 before you can start work).
6. List the names or positions of the persons responsible for
ensuring the controls are implemented.
Page 2 of 2
1.
2.
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.
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 work.
Entry to Site
Entry to unsafe area
Report to site office for site induction.

Risk assessment of site conditions.
Unloading Equipment
Movement of site
personnel, vehicles, plant
& equipment
Fall from vehicle
Manual handling injuries,
cuts, splinters & abrasions
3.
Controls Implemented
Setting out / up
equipment
Revised Risk
Rating (1-6)
Beak the job down into steps.

List the steps in this column.
Hazard Identification
Initial Risk
Rating (1-6)
STEP
Job Step
Person
Responsible
Training of all employees

Training employees in manual handling and team
lifting
Wear gloves (PPE)
Being struck by equipment

Crush hands
Training employees in manual handling

The use of P.P.E equipment such as gloves
Team lifting
Slips, trips & falls
Unload equipment on a level clear area
Trips & falls
Ensure site is clear of any debris, obstructions.

Define & barricade work area & fall areas
4.
Drilling piers
Hit by auger or bobcat

excavator
Only suitably trained personnel to work with plant

Plant & equipment to be maintained, operator
must be licensed
Fall in holes
The training and use of P.P.E equipment such as

high visible vests, hard hats
Personnel to be trained on relevant works.
Site Induction
Page 3 of 3
5.
Placing Concrete in piers

Run over by concrete

pump or trucks
the next column.
Revised Risk
Rating (1-6)

Initial Risk
Rating (1-6)
STEP
Job Step
Person
Responsible
Truck drivers to be made aware of site entry,

driver to be aware of the whereabouts of the
offsider
Reverse siren to be in working order on concrete
pumps & trucks.
Relevant personnel to be in sight of driver at all
times
Pump operators to supply maintenance checklist &
log books
6.
Installing pegs for edge

boards
Back injury from using

sledgehammer.
All relevant personnel to be trained in the use and

shown the correct procedure in using a
sledgehammer.
Missing target when using

sledgehammer.
Use P.P.E equipment
Cuts, splinters and

abrasions
Training in manual handling and correct use of

sledgehammer
Arm & shoulder injuries

Training in manual handling
Keep hands and limbs out of rage
Workers to keep others in sight
Page 4 of 4
7.
8.
Installation of formwork
Benching / fill slab

Back and shoulder injuries

Injury from nail gun
Hit by materials
Hit by machines / plant
Back and shoulder injury
the next column.
Revised Risk
Rating (1-6)

Initial Risk
Rating (1-6)
STEP
Job Step
Person
Responsible
Training in manual handling

Keep hands and limbs out of range.
Workers to keep others in sight
Training in the use of shovels and wheelbarrows.
P.P.E equipment eye protection.
Eye injury from dust

Sunburn
9.
10.
11.
12.
Laying of plastic
Carrying steel
Cutting and placing steel
Set up of electrical leads
Slips and Trips

Back and shoulder
injuries.
Sun protection P.P.E equipment such as

sunscreen hats and shirts.
Clear waste materials from work area.
Care taken when walking on plastic.
Training provided in cutting and placing steel.
Cuts and abrasions.

Back and shoulder
injuries.
Training provided in cutting and placing steel.
Cuts and abrasions from

trips & slipping on steel.
Care taken when stepping over formwork onto

steel or plastic.
Cuts from cut ends of

steel.
Wear gloves (PPE)
Tripping over leads
Training in the set up of electrical leads.
Page 5 of 5
13.
Grinder use

the next column.
Pieces of metal
penetrating eyes
P.P.E. equipment use wear ear and eye

protection
Electrocution
Training in correct use of grinder
Revised Risk
Rating (1-6)

Initial Risk
Rating (1-6)
STEP
Job Step
Person
Responsible
Electrical test & tagging. Register of all equipment

14.
15.
16.
Use of Oxy Acetylene
Tying Steel
Installing bar chains
Burns
Wear Gloves
Sparks hitting eyes
High visibility vests to be removed prior to using

Oxy Acetylene as the vests are highly flammable.
Wear safety glasses (PPE)
Explosion and Fire
All Oxy Acetylene equipment to have flash back

arrestors and have fire extinguishers
accompanying them.
Cuts and abrasions
Wear gloves
Penetrating wounds
Bar caps to be installed on all exposed vertical

bars.
Back Injury
Bend knees as placing chairs under reo bar

All relevant personnel to be trained in manual
handling
Clear all waste materials
Page 6 of 6
17.
Set up of concrete pump

Placing Concrete

the next column.
Concrete pump (boom

line) not stable and tipping
over
Truck drivers / operators to be made aware of site

entry, driver to be aware of the whereabouts of the
offsider and site personnel.
Machine failure
Reverse siren to be in working order on concrete

pump
Set up of concrete pump

(continued)
18.
Revised Risk
Rating (1-6)

Initial Risk
Rating (1-6)
STEP
Job Step
Person
Responsible
Pump operators to supply maintenance checklist

and log books
Concrete pump to be set up in accordance with
the Code of Practice. (concrete pumps are to be
registered with WorkCover)
Hit by concrete
No persons to be standing in front of concrete

hose
Back injury from shovelling
Relevant personnel shown correct posture for

shovelling
Concrete burns
Avoid contact to skin, wash skin and clothing after.
Sun burn, skin cancer, eye
damage
Sun protection P.P.E equipment such as sun

cream, hats, shirts , sunglasses to be worn
Page 7 of 7
19.

Run over by concrete

pump or truck
the next column.
Revised Risk
Rating (1-6)

Initial Risk
Rating (1-6)
STEP
Job Step
Person
Responsible
Truck drivers to be made aware of site entry.

Relevant personnel to be in sight of drivers at all
times.
Personnel to be trained in the use of hazardous
substances e.g. cement.
20.
THESE ARE STANDARD SWMS, THEY MUST BE MODIFIED TO SUIT YOUR WORKERS, YOUR EQUIPMENT AND
YOUR SITE.
Page 8 of 8
CHECKLIST OF ITEMS THAT MAY BE REQUIRED FOR THIS WORK ACTIVITY
QUALIFICATIONS
TRAINING
Codes of Practice
CODES OF PRACTICE OR AS/NZS

STANDARDS TO BE COMPLIED WITH
OHS Consultation
OHS Induction Training for Construction
Amenities for Construction Work
Australian Standard
AS 1012
Page 9 of 9
Declaration by contractors & workers:

1. I have been consulted and assited in the development of this SWMS.
2. I have been given the opportunity to comment on the content of this SWMS.
3. I have read and understand how I am to carry out the activities listed in this SWMS.
4. 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.
5. I have read and understand the requirements set out in the mateial safety data sheets for the hazardous substances identified in this SWMS.
NAME:
SIGNATURE:
DATE:
Page 10 of 10

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Ohs Form 005 Safe Work Method Statement (SWMS) : This SWMS Has Been Developed and Authorised by

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Copyright:

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OHS FORM 005 SAFE WORK METHOD STATEMENT (SWMS) also known as Job Safety Analysis (JSA)

This SWMS has been developed and authorised by:

DESCRIPTION OF WORK ACTIVITY:

Concrete Placement (General)

Trades involved with undertaking this Work Activity:

This SWMS was review by: (principle contractor)

Person responsible for OHS on the contractors behalf:

Safe Work Method Statement (SWMS)

List plant, equipment and

List Hazardous Substances

eg. Unleaded petrol

Health Risks and Likelihood of Damage

How LIKELY is it to be that bad?

Could happen, but

Safe Work Method Statement (SWMS)

List PPE to be worn

(Tick) List Hazards to consider

Fall from ladder

How to complete the following form

Identify any potential hazards

Decide what controls to use to eliminate or minimise the risks.

Entry to unsafe area

Report to site office for site induction.

Beak the job down into steps.

Training of all employees

Being struck by equipment

Training employees in manual handling

Slips, trips & falls

Unload equipment on a level clear area

Trips & falls

Ensure site is clear of any debris, obstructions.

Hit by auger or bobcat

Only suitably trained personnel to work with plant

Safe Work Method Statement (SWMS)

The training and use of P.P.E equipment such as

Placing Concrete in piers

Identify any potential hazards

Run over by concrete

Beak the job down into steps.

Truck drivers to be made aware of site entry,

Installing pegs for edge

Back injury from using

All relevant personnel to be trained in the use and

Missing target when using

Use P.P.E equipment

Cuts, splinters and

Training in manual handling and correct use of

Arm & shoulder injuries

Safe Work Method Statement (SWMS)

Benching / fill slab

Identify any potential hazards

Back and shoulder injuries

Beak the job down into steps.

Training in manual handling

Eye injury from dust

Cutting and placing steel

Set up of electrical leads

Safe Work Method Statement (SWMS)

Slips and Trips

Sun protection P.P.E equipment such as

Cuts and abrasions.

Training provided in cutting and placing steel.

Cuts and abrasions from