OHS FORM 01: ORGANISATION DETAILS - Australia Web viewA mutual appointment needs to be arranged to...

Housing Industry Site Safety ‘Subby’ Pack (HISSP)

Submission Checklist

# Items # 1-14 must be completed for all Contractor/Supplier submissions

Tick WhenCompleted

1. Contractor Questionnaire – Please complete fully, date & sign

2. WHS FORM 01: Complete fully, date & sign

3. WHS FORM 02: Date & sign

4. WHS FORM 03: Date & sign x 2 sections

5. WHS FORM 04: Please return completed example.

6. WHS FORM 05: Please complete – All workers must sign declaration

7. WHS FORM 06: Please return completed example, signed by attending employees

8. WHS FORM 07: Complete for all employees

9. WHS FORM 08: List all plant & equipment used

10. WHS FORM 09: List all electrical equipment or copy of recent tagging register

11. WHS FORM 10: List all hazardous substances used

12. Subcontractor Statement completedAdditional documents required

13. Copies of all Insurance Certificates of Currency

14. Copies of all workers Workcover General Induction ‘White’ Cards

Additional documents required if applicable15. Copy of current Contractor Licence

When all above is completed make two (2) copies of the completed Site Safety Pack: Forward a copy to McDonald Jones Homes (MDJH), principal contractor, for review. Please keep

your original on file. Keep the 2nd Site Safety Pack with you when you go to site each day. Update the information in the WHS Forms if anything changes i.e. SWMS, registers etc

Please note:This pack must be reviewed, updated and submitted annually including any updated certificates of currency on renewal. You will receive a letter of notification when these documents are due. Failure to supply in a timely manner may cause delays in processing payments and issuing purchasing / work orders to you.

February 2012

Housing Industry Site Safety ‘Subby’ Pack (HISSP)

Within this pack you will find all the documents and requirements you will need to provide to McDonald Jones Homes prior to being able to commence work on site.

Once you have submitted all the relevant documents, you will need to make an appointment with WHS Department to be Company Inducted by the WHS Manager, Contractor Administrator or Site Supervisor.

A mutual appointment needs to be arranged to undertake a MDJH Company Induction either at MDJH offices or at an acceptable place of work. This process should take no more than 30 – 40 minutes. These appointments can also be made either early in the day 6 - 7am or late afternoon to assist minimal disruption to your workflow.

Prior to the Induction the Subby Pack will need to be returned to McDonald Jones Homes for WHS Administrator to review.

If all documents are correct and current then on completion of Induction you will be issued with a McDonald Jones Homes Induction Card.

Any missing documents will need to be provided within 1 week; failure to do so will result in not being able to commence work on site or may seriously disrupt your future payments if you are an existing contractor.

Enclosed:

1. MDJH Your Checklist of WHS Requirements Example of internal SWMS Checklist

2. Sub – Contractor Questionnaire3. Housing Industry Site Safety Pack (HISSP)4. Subcontractors Statement Declaration Form

If you require any further assistance – please contact WHS Administrator on 4918 2241.

Your Checklist of WHS Compliance RequirementsForms Safety Plan (HISSP) contains completed documentation as below? Yes No

1. Sub-contractors Questionnaire - Ensure completed correctly?2. Organisation Details – Form1 completed, signed & dated?

Supply current copies of all Certificates of Currency o Public Liability o Workers Compensationo Sickness & Accident (if applicable)

Copy of Licenses (Trade Licenses if applicable issued by DFT)3. Occupational Health & Safety Policy – Signed & dated?4. Roles & Responsibilities – Signed & dated?5. Site-Specific Risk Assessment (SSRA)

Provide a completed example of your SSRA to be submitted with your relevant invoices

6. Safe Work Method Statement (SWMS) Completed correctly Signed by all employers Copies of all Construction Induction cards

See example of MDJH SWMS checklist page 37. Record of Tool Box Talk - Provide a completed example?8. Employee Training Register – Training Identified?9. Plant & Equipment Register – Example date/s details provided?10. Electrical Equipment Register

Provide recent tagging inspection dates11. Hazardous Substance Register (MSDS)

Ensure products used are listed in SWMS and If possible provide MSDS of product/s used

12. Housing Industry Site Safety Pack - Ensure completed correctly as above checklist?

13. Subcontractors Statement Declaration Form - Ensure completed correctly?

Please note: Contractors must have a copy of the above documentation available on site (i.e. in your ute or truck) for inspection by Construction Management and WorkCover Inspectors.

All the above can be found in the Housing Industry Site Safety Pack which can be found at the following link; http://www.workcover.nsw.gov.au/Documents/Publications/Industry/Construction/housing_industry_site_safety_pack_5723.pdf

This document is the preferred document for McDonald Jones Homes, however is you have a document that covers all the above, McDonald Jones Homes will review and advise.

If you require further assistance – please contact WHS Administrator on 4918 2241.

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http://www.workcover.nsw.gov.au/Documents/Publications/Industry/Construction/housing_industry_site_safety_pack_5723.pdf

http://www.workcover.nsw.gov.au/Documents/Publications/Industry/Construction/housing_industry_site_safety_pack_5723.pdf

WHS FORM 01: ORGANISATION DETAILSBusiness or trading name(Please attach copy of business registration) ACN/ABN Number of

employeesScope of works

Insurances(Attach copies of Certificates of currency)

Company Policy Number

Limit per claim

Limit year Expiry date

Workers compensationPublic Liability

Professional indemnitySickness & accidentContract license numberName of director or managerBusiness address

Telephone Mobile

Facsimile Email

Person for managing WHS on site

Contact details

We do/do not intend to subcontract all or part of the works.If engaged, the sub-subcontractors intended to be used on this site are:Business Contact

detailsWe shall ensure that the above subcontractors provide an SWMS for their specialised work & shall review & amend the SWMS as appropriateSigned (Director or Manager)

Date

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DISCLAIMERThe authors of the Housing Industry Site Safety Pack (the Site Safety Pack) expressly disclaim any and all

liability and responsibility to any person in respect of anything, or the consequence of anything, done or omitted

by any person in reliance, whether wholly or partially, upon the whole or any part of this document.

DUTY OF CAREAs a contractor you have a duty of care to review work areas and activities to ensure your safety and that of

others. The Site Safety Pack is not intended to be a substitute for specific legal advice, but to provide guidance to

enable you to manage your occupational health and safety (WHS) in a systematic manner. You may need to

develop additional information, taking into account the circumstances specific to site conditions, trade interface,

client requirements and individual company policies and procedures.

All WHS documents should be regularly reviewed and updated to reflect changes to legislation, codes of practice,

Australian Standards and organisational policies and procedures.

ACKNOWLEDGEMENTThe Site Safety Pack has been developed by the following residential construction industry partners:

Housing Industry Association (HIA)

Housing Industry Consultative Committee (HICC) representatives:

o ATF Hire Group

o Australand

o Clarendon Residential Group

o Masterton Homes

o Mirvac Homes

o Master Builders Association (MBA)

o WorkCover NSW.

INTRODUCTIONWe have developed the Site Safety Pack to assist small businesses (0-10 employees) working in the residential

construction sector.

The Site Safety Pack provides a framework for you to meet your main WHS legal responsibilities. By following

this guidance you will be better placed to ensure a safe construction site.

Authorities, clients and principal contractors may require evidence of your WHS system. If you use the Site

Safety Pack as directed, you will be able to produce the necessary documents.

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CONTENTS PAGE/WHS FORM

How to Complete this Document 1

Your Checklist of WHS Compliance Requirements 3

Example of MDJH SWMS Checklist 4

WHS Form 01: Organisation details 5

Disclaimer, Duty of Care & Acknowledgment 6

Introduction 6

Contents

MDJH Contractor Questionnaire 8

WHS Form 02: Occupational Health & Safety Policy 10

WHS Form 03: Roles and Responsibilities 11

Consultation and Communication 12

Risk Management 13

Safe Work Method Statement – Hazard Identification, Risk Assessment and Control 14

Training 15

Plant and Equipment 16

Electrical 16

Hazardous Substances 16

Hazard Reporting 17

Injury and Incident Investigation 17

WHS Form 04: Site Specific Risk Assessment (SSRA) 18

WHS Form 05: Safe Work Method Statement (SWMS) 20

WHS Form 06: Record of Tool Box Talk 30

WHS Form 07: Employee Training Register 32

WHS Form 08: Plant & Equipment Register 33

WHS Form 09: Electrical Equipment Register 34

WHS Form 10: Hazardous Substance Register and Risk Assessment 35

WHS Form 11: Incident and Injury Report 36

Subcontractors Statement of Declaration & Notes

Page 7 of 40

Contractor Questionnaire (Required to be completed & sent to MDJH Annually)

1. Full Trading Name:

2. Address:

3. Phone Number:

4. ABN Number……………………………………………………………………

Company Trust ACN Number.…………………………………………………………………..

Sole Trader Partnership Please note: Accident and Illness insurance is compulsory for Sole Traders and all working partners of Partnerships (Please attach certificate of currency)

5. Nature of Services Provided:

Do you supply your own tools and materials? Yes No

6. If yes to Q6, brief description of tools and materials:

7. Is the supply of labour involved with the operation of machinery or the delivery of goods? For example Bobcat, Backhoe, Tipper bins? Yes No

8. Have you been engaged by McDonald Jones Homes for less than 90 days in the past year? (Any part day counts as a whole)? Yes

No

9. Do you contract with principals other than McDonald Jones Homes? Yes No

10. .Do you employ people other than directors, partners? Yes No – go to

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question 13

11. How many people employees?

12. Are staffs employed full-time or part-time? Full-time / Part-time

Controlled Document Version 3 Issue Date: February 2012

Contractor Questionnaire Page 1 of 2 Issued by: LM/Contractor Administrator

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13. Do you sub-contract any of the services you provide to McDonald Jones Homes? Yes – go to question 14 No – go to question 15

14. Please list names and contact details of all subcontractors.

15. Have all your employees/subcontractors who work on McDonald Jones Homes Construction Sites been issued with a McDonald Jones Company Induction card?

Yes No

Is your business registered for payroll tax? Yes No

If Yes, please provide the state in which you are registered and the number:

State ……………………………………..Registration Number………………………………………………………

Do you have a Contractor’s License issued by the department of Fair Trading? Yes No

If yes, please attach a copy. Please note: a must be provided before you commence work on any of our work sites.

Print Name: Signature:

Position:

Date:

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Controlled Document Version 3 Issue Date: February 2012

Contractor Questionnaire Page 1 of 2 Issued by: LM/Contractor Administrator

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WHS FORM 02: OCCUPATIONAL HEALTH AND SAFETY POLICY We believe that the well-being of people employed at work, or people affected by our work, is

a priority and must be considered during all work performed on our behalf.

People are our most important asset and occupational health and safety (WHS) is everyone’s

responsibility. The safety of the public is given equal priority to that of our employees.

The objectives of this policy are to, as far as reasonably practicable: -

achieve a safe and incident free workplace consider WHS in project planning and work activities involve employees and subcontractors in the decision-making process through regular

communication and consultation encourage employees and subcontractors to identify and control risks in the workplace monitor and review the elimination or control of potential risks enhance employees’ WHS knowledge through a program of education and training.

The success of our WHS management depends on:

the commitment of all persons to achieving the policy objectives planning work activities with due consideration given to WHS undertaking the risk management process in an effective manner promoting communication between employees and subcontractors.

We are committed to fulfilling the objectives of this policy and expect the same of all

employees and subcontractors working on our behalf.

_______________________ _____________ Date: ____/____/____Name and position (print) Signature

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WHS FORM 03: ROLES AND RESPONSIBILITIESThe owner/director/manager (delete as appropriate), _____________________________________ has

overall responsibility for the safe conduct of all work activities carried out on behalf of the business.

The roles and responsibilities of employees are listed below.

OWNER / DIRECTOR / MANAGER’S RESPONSIBILITIESThe owner/director/manager is responsible for WHS on the project. Duties include:

implementing the WHS procedures observing all legal WHS requirements ensuring that all works are conducted in a manner without risk to employees’ WHS planning to do all work safely participating in the planning and design stages of trade activities identifying WHS training required for an activity ensuring workers undertake identified WHS training communicating and consulting with employees investigating hazard reports and ensuring that corrective actions are undertaken assisting in rehabilitation and return to work initiatives.

Signed by: Date:

SUPERVISOR OR LEADING HANDThe supervisor or leading hand is responsible for operational safety on the project. Duties include:

making decisions about WHS that may affect work activities and/or others ensuring legal WHS requirements are met in the workplace actioning safety reports and carrying out workplace inspections facilitating the preparation of SWMS (including those for trades) ensuring safe work practices at all times conducting project inductions, toolbox talks and daily team briefings participating in accident or incident investigations leading by example and promoting WHS at every opportunity supervising and ensuring compliance with safe work procedures.

Signed by: Date:

EMPLOYEESEvery individual employee is responsible for:

conducting their allocated tasks in a safe manner and in accordance with their training and experience

giving due consideration to the safety of all others co-operating in matters of WHS leaving their work site in a safe condition complying with the SWMS and is encouraged to participate in the development of all SWMS complying with the site safety rules (including those set down by the principal contractor) in the

site induction.

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CONSULTATION AND COMMUNICATION

Promote active participation of all employees in WHS decisions.

Consult with employees and give them the opportunity, encouragement and training to be involved in WHS matters affecting the organisation and their own work.

Matters for consultation may include: hazard and risk identification control measures for managing hazards and risks the development of safe work method statements or risk assessments site induction changes to site conditions emergency procedures, covering:

o emergency contact details (including emergency services)o the location of a first aid kito emergency assembly points.

Record consultation and communication using: the record of toolbox talk (see WHS form 06) a site diary any documents clearly recording WHS meeting minutes.

Consultation records should include at least the following information: date location or workplace names and signatures of people present and consulted items or issues raised corrective actions to be undertaken and the people responsible for implementing those actions.

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RISK MANAGEMENT

Hazards versus risksHazards are different to risks.

A hazard has the potential to cause harm. This can include substances, plant, work processes and/or

other aspects of the work environment.

A risk is the likelihood that death, injury or illness might result because of a hazard.

Risk management cycleWHS laws require anyone in control of a workplace or a workplace activity to identify any potential

hazards, assess the risks associated with those hazards and (if necessary) implement control

measures to eliminate or minimise the risks.

All persons must have an understanding of the five-step risk assessment process. Incorporate the five

steps into all work activities. If any persons are concerned with the control measures used in a

workplace activity, they should bring this to the attention of their direct manager.

Step 1: Identify hazardHazards should be assessed by any person undertaking a work activity. When assessing what is a

hazard, consider: the work environment such as height or confined spaces, substances such as

chemicals, plant and equipment, energy such as electricity, gas or induced heat, manual handling,

noise, etc. Assess all identified hazards on their own merit.

Step 2: Assess riskOnce a hazard has been identified, determine how serious the risk is. Do this by assessing the

likelihood of an event happening and the consequence should the event occur.

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Table 1: Assessing the riskRISK High Medium Low

Potential death, permanent disability or major structural failure/damage.

Hospitalisation or medical treatment, potential temporary disability or minor structural failure/damage.

Hazard that has the potential to cause persons to require first aid.

ACTION REQUIRED Cease work immediately.

Review task/situation/ condition.

Additional risk controls and must be documented and implemented.

Ensure all parties are aware of risk control.

Implement suitable controls as soon as practical.

Task/situation/condition to be reviewed and reinforce control measures where applicable.

Review task and reinforce control measures where applicable.

Table 2: Hierarchy of controlsEliminateRemove the risk, process or task.

SubstituteReplace the risk with a less hazardous material, process or plant.

IsolateSeparate the people from the hazard or the hazard from the people.

EngineeringStructural or design change to the working environment, equipment or work process.

AdministrativeReduce exposure to the hazard through procedural instructions, training, signage or permits.

Use personal protective equipmentLast line of defence, worn by workers. Selected PPE must be fitted correctly and maintained used in accordance with manufacturer’s instructions.

ExamplesRemoval of trip hazard, removal of asbestos, working at heights.

ExamplesFibreglass insulation for non-fibrous insulation, lead based paint for lead free paint.

ExamplesFencing, barricades or removing people from the work area.

ExamplesEdge protection, lock out devices, guards on rotating parts.

ExamplesSWMS, signage, permit, training, tagging, inspection.

ExamplesSafety glasses, gloves, hardhat, harness.

Best Worst

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Step 3: Decide on control measuresDevelop and decide on a suitable control measure that will ensure that the hazard is either eliminated (where possible) or reduced to its lowest possible level using the hierarchy of controls, (Table 2).

Step 4: Implement control measures

Implement control measures in line with the hierarchy of controls.

Step 5: Monitor and reviewTake steps to monitor and review the effectiveness of implemented control measures by: consulting with employees identifying any new hazards and undertaking further risk assessments Analysing accident and incident reports.

SAFE WORK METHOD STATEMENT – HAZARD IDENTIFICATION, RISK ASSESSMENT AND CONTROL

Identify any potential hazards of the proposed work, assess the risks involved and develop controls to

eliminate or minimise the risk. Carry out the risk management process in consultation with your

employees.

Do not commence construction work unless:

the principal contractor has provided the relevant parts of their workplace WHS management

plan or equivalent (only applies where the project work costs exceed $250,000)

you have undertaken an assessment of the risks associated with the work to be carried out and

provided to the principal contractor a written safe work method statement (SWMS)

you have conducted a site-specific risk assessment (see WHS form 04) before undertaking work

on site, if site conditions change (e.g. weather, additional trades) and if the scope of work

changes.

Maintain an SWMS for each task undertaken on the project and provide the principal contractor with

any changes made to the SWMS.

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TRAININGEnsure that all employees undertake a minimum of three levels of induction training prior to

commencing work:

general industry (safety awareness) training

site-specific induction training

work activity training (as noted in the SWMS).

Give all employees appropriate instruction and training so they can carry out their work activities safely,

including:

site safety rules

the handling of hazardous substances in line with the material safety data sheets (MSDS)

fire fighting equipment

manual handling techniques

the safe use of power tools

working at heights (including the safe use of ladders)

PPE.

Record all employee training on one or more of the following forms:

employee training register (see WHS form 07)

safe work method statement training declaration (see WHS form 05)

record of tool box talk (see WHS form 06).

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PLANT AND EQUIPMENTEnsure that employees are familiar with hazards and risks associated with the use of plant and

equipment, and the requirements for regular inspection and maintenance.

Carry out regular inspection and maintenance of all plant and equipment used.

Ensure that plant and equipment is inspected and maintained in accordance with the relevant

standards and manufacturer’s recommendations. Document the inspection and maintenance history of

each item and make it available with the relevant plant or equipment.

Document and implement control measures for all plant and equipment. Assess the effects of all plant

and equipment on the workplace and document the risks in the SWMS.

Ensure that pre-start checks, schedules of maintenance and fault reports are notified to the supervisor,

documented in plant log books and made available to relevant parties on request.

Where plant and equipment is hired, the same requirements as above still apply.

Record inspections on one or more of the following forms:

plant and equipment register (see WHS form 08)

site-specific risk assessment – also known as pre-start inspection (see WHS form 04).

ELECTRICAL

Test and tag all electrical plant and equipment before use. List the equipment and plant on the SWMS.

Inspect, test and tag all portable electrical equipment on at least a three-monthly basis.

Ensure that all residual current devices (RCD’s) are calibrated and tested by a qualified electrician

every three months, and trip tested by a competent person monthly or prior to each use.

Record inspections of all electrical equipment on the electrical equipment register (see WHS form 09),

or an equivalent record, and make them readily available.

HAZARDOUS SUBSTANCES

Use the hazardous substance register and risk assessment (see WHS form 10 in) to record all

products classified as hazardous. Include the product name, its application, an assessment of the risks

associated with the product use and the control measures that will be implemented and included in the

SWMS.

Upon request, make available for inspection on site a current MSDS (within five years of the date of

issue) for hazardous products and substances that are to be used for the work activity.

Provide all employees involved with hazardous products and substances with information and

instruction on their use and handling.

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HAZARD REPORTING

Ensure that all hazards are reported to the supervisor and the principal contractor immediately.

Record the details of any additional hazards in a site diary or in the site-specific risk assessment (see WHS form 04).

INJURY AND INCIDENT INVESTIGATION

Ensure that all incidents and injuries are reported to the supervisor and are recorded on the incident

and injury report (see WHS form 11).

Investigate all incidents, record them on the incident and injury report and provide a copy to the

principal contractor upon request.

Notify the authorities if an incident or injury results in a person being killed or could be defined as a

‘serious incident’. Authorities also require that the place of work is ‘not to be disturbed’ except by

actions relating to emergency rescue.

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WHS FORM 04: SITE-SPECIFIC RISK ASSESSMENTSCOPE OF WORKS: Supervisor:

PRINCIPAL CONTRACTOR: DATE: TIME:SITE ADDRESS:

PERSON COMPLETING: (Print) SIGNATURE:# Contractor Work Activity - Site-Specific Risk Assessment (SSRA) Yes No N/A1 Ensure you complete a written Site-Specific Risk Assessment SSRA (This Document Accurately)

2 Have all employees completed WHS training (general, company induction and work-specific tasks)?

3 Have all employees read and understood the SWMS and is it accessible on site?

4 Have all employees been instructed on safe working practices (e.g. manual handling)?

5 Do you have the correct type of first aid kit, and is it stocked and accessible for use?

6 Have all employees been trained in the safe use of power tools?

7 Specify PPErequired.

Hard hat Safety boots Eye protection Hearing protection Gloves Hi-visibility vest Hat Sunscreen Sun protective clothing

8 Hazardous substance register on site & all relevant persons trained in substances safely?

9 Is appropriate fire-fighting equipment on site for flammable substances or hot works?

10 Have all employees reviewed site safety plan & the site safety signage before commencing work?

11 All the electrical equipment tested and tagged, and is the electrical tagging register on site?

12 Are all electric outlets (generator, meter box, etc) protected by an RCD unit?

13 Have all tools and equipment been serviced and are they in good working order?

14 Have all plant and tools been inspected and are they fit for purpose?

15 Is there guarding on all machinery, covering all moving parts?

16 Site security fencing intact (no gaps or missing fencing panels) gates secured?

17 Is the work area clear of rubbish and debris, and is an area provided for debris?

18 Are materials delivered and stored in a safe and responsible manner in your work area?

19 Are amenities on site clean and accessible for use?

20 Are all fall zones protected?

21 Have all safety systems (e.g. scaffolding and guard railing) been inspected and are they safe to use?

22 Has the stairwell and open penetrations protection system been installed?

23 Is there a safe path of travel to all work areas and have all trip hazards been identified?

24 Have all trenches and excavations been backfilled, covered or barricaded? HAVE YOU ELIMINATED ALL POTENTIAL RISKS FROM ANY OTHER HAZARDS IDENTIFIED ON SITE THAT MAY AFFECT YOUR WORK TASK? If you answer No? You must complete the risk assessment table below and consult with all employees and subcontractors before commencing any work. If you cannot remove or control the hazard, please contact your construction supervisor for advice before starting any work.

Hazard identified Controls implemented By whom

RiskLow Medium High

Hazard that has the potential to cause Hospitalisation or medical treatment, potential temporary disability Potential death, permanent disability or

Hierarchy of controls (Best) (Worst)

Eliminate the risk all together.

Substitute the risk.

Isolate people from the risk.

Engineer out the risk.

Apply administrative controls.

Use personal protective equipment (PPE).

WHS FORM 04: SITE-SPECIFIC RISK ASSESSMENT

SCOPE OF WORKS

PRINCIPAL CONTRACTOR DATE TIME

SITE ADDRESS

PERSON COMPLETING THIS ASSESSMENT SIGNATURE

Site-specific work activity – risk assessment Yes No N/A

Contractor assessment

1 Have all employees completed WHS training (general, site induction and work-specific tasks)?

2 Have all employees been instructed on safe working practices (eg manual handling)?

3 Have all employees read and understood the SWMS and is it accessible on site?

4 Do you have the correct type of first aid kit, and is it stocked and accessible for use?

5 Have all employees been trained in the safe use of power tools?

6 Specify the PPErequired.

Hard hat Safety boots Eye protection Hearing protection

Hi-visibility vest Hat Sunscreen Sun protective clothing

7 Is the hazardous substance register on site and are all relevant persons trained in using and handling the substances safely?

8 Do you have the appropriate fire-fighting equipment on site for flammable substances or hot works?

9 Have all employees reviewed the site safety signage before commencing work?

Equipment assessment

10 Has all the electrical equipment been tested and tagged, and is the electrical tagging register on site?

11 Are all electric outlets (generator, meter box, etc) protected by an RCD unit?

12 Have all tools and equipment been serviced and are they in good working order?

13 Have all plant and tools been inspected and are they fit for purpose?

14 Have all ladders used on site been inspected and are they fit for purpose?

15 Is there guarding on all machinery, covering all moving parts?

Site assessment

16 Is the site security fencing intact (with no gaps or missing fencing panels) and are gates chained and padlocked?

17 Is the work area clear of rubbish and debris, and is an area provided

18 Are materials delivered and stored in a safe and responsible manner in your work area?

19 Are the public and other workers protected during work activities?

20 Are amenities on site clean and accessible for use?

21 Are all fall zones protected?

22 Have all safety systems (eg edge protection, scaffolding and guard railing) been inspected and are they safe to use?

23 Has the stairwell and open penetrations protection system been

24 Is there a safe path of travel to all work areas and have all trip hazards been identified?

25 Have all trenches and excavations been backfilled, covered or HAVE YOU ELIMINATED ALL POTENTIAL RISKS FROM ANY OTHER HAZARDS IDENTIFIED ON SITE THAT MAY AFFECT YOUR WORK TASK?

If you answer No to any of the items above – you must complete the risk assessment table below and consult with all employees and subcontractors before commencing any work. If you cannot remove or

control the hazard, please contact your construction supervisor for advice before starting any work.

Identify below any hazard (plant or substance or process) that could be a risk to WHS, and list the controls taken.

Hazard identified Risk(1-6)

Controls implemented Risk(4-6)

By whom

Risk rating score 1-6

POSSIBLE RISK Very likely Likely Unlikely Very unlikelyDeath or permanent disability 1 1 2 3Long term illness or serious 1 2 3 4Medical attention or days off 2 3 4 5First aid needed 3 4 5 6

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Insert:1. Company Logo or Business Card2. ABN Number

This SWMS has been developed and authorised by:

Name:

Position: Date:

Signature:Phone:

Mobile:

SAFE WORK METHOD STATEMENT (SWMS) (Job Safety Analysis Worksheet – Scope of Works)

DESCRIPTION OF WORK SPECIFIC TO THE ACTIVITY / TASK BEING UNDERTAKEN:

Trades involved with undertaking this Work Activity / Task:

This Safe Work Method Statement is submitted to: (Principal / Head Contractor)COMPANY:

CONTACT NAME: PHONE NUMBER:

SITE ADDRESS: PROJECT DETAIL:

This Safe Work Method Statement was reviewed by: (Principal / Head Contractor)

NAME: POSITION:

SIGNATURE: DATE:

PHONE NUMBER: MOBILE NUMBER:

Responsible person who will implement, review supervise, oversee, approve & inspect workplace, plant, tools, protective measures & equipment on Contractors behalf).

NAME: POSITION:

SIGNATURE: DATE:

PHONE NUMBER: MOBILE NUMBER:

Equipment To be used Insert other equipment Personal Protective Equipment to be used. has PPE been supplied Y/N Common Hazard

Extension Ladder Cement Mixer Hard Hat Fall from ladderStep Ladder Safety Boots Fall from heightsScaffold (Mobile) Safety Vest Fall from scaffoldExternal Scaffold Gloves Contact with electricityFire extinguisher Hearing Protection DermatitisTrestles Safety Glasses Slip, trips and fallsElectrical Leads Barrier Cream Manual handingPower Tool Safety Lines Inhalation of dust or fumesGenerator Safety Harness Exposure to noiseRCD power board Dust Masks Contact with moving plantHand Tools Other: CutsNail Gun Other:WheelbarrowShovel

How to complete the following form List the step-by-step sequence of tasks required to carry out a work activity from start to finish. List the potential hazards associated with each step, and the related WHS risks. List what controls you will implement to reduce the risks to the lowest possible level. List the names or positions of the persons responsible for ensuring that the controls are implemented. A separate SWMS is required for each work activity.

Assessing the Risk

RISKHigh Medium Low

Potential death, permanent disability or major structural failure/damage.

Hospitalisation or medical treatment, potential temporary disability or minor structural failure/damage.

Hazard that has the potential to cause persons to require first aid.

ACTION REQUIRED

Cease work immediatelyReview task / situation/ condition Additional risk controls and must be documented & implementedEnsure all parties are aware of risk control

Implement suitable controls as soon as practical. Task / situation/ condition to be reviewed and reinforce control measures where applicable.

Review task and reinforce control measures where applicable.

Hierarchy of ControlsEliminate the risk

altogether Substitute the risk Isolate people from the risk Engineer out the risk Apply Administrative Controls

Use Personal Protective Equipment (PPE)

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STEP

Job Step

Break the job down into steps, Outline each task

to do the job

Hazards IdentificationIdentify any potential hazards associated with each job step. Access any risks that

could lead to an incident or lead to an adverse environmental impact and rate

each risk accordingly.

Controls ImplementedUsing the previous two columns as a guide, decide

what actions are necessary to eliminate or minimise the hazards that could lead to an accident, injury or occupational illness or environmental impact.

Person Responsible

1.

2.

3.

4.

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STEP

Job Step


to do the job






Person Responsible

5.

6.

7.

8.

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STEP

Job Step


to do the job






Person Responsible

9.

10.

11.

12.

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STEP

Job Step


to do the job






Person Responsible

13.

14.

15.

16.

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STEP

Job Step


to do the job






Person Responsible

17.

18.

19.

20.

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ITEMS REQUIRED FOR THIS WORK ACTIVITY

TRAINING and QUALIFICATIONS

Examples: Workcover Construction Induction HR Licence Backhoe Licence Trade Licence

Please attach relevant copies of the above

WorkCover General Induction to Construction

NSW WHS LEGISLATION

WHS ACT WHS Regulation National Standard for Construction Work

Examples of these which may be relevant to your work activity please add or delete as necessary i.e.CODES OF PRACTICE

Manual Handling Moving Plant and Equipment Hazardous Substances Electrical Practices for Construction Works Working At Heights Work Near Overhead Power Lines Manual Handling Excavation

and Guides: Safe work at Heights Falling Objects Masonry Wall

AUSTRALIAN STANDARDS: (relevant) Guide Lines for Scaffolding AS4576 & AS1576:1-3 Domestic Guard Rail AS4994:1-3 & AS1576:1-3 Electrical Wiring Rules AS3000 / AS3018 Ladders AS1892.5 Respiratory Protection Devices AS1715 & 1716 Eye Protection AS1336 &1337

NSW WHS Act 2011

NSW WHS Regulation 2011

National Standard for Construction Work

Electrical Practices for Construction Works Manual Handling

AS/NZ (list)?

COMMUNICATION AND CONSULTATIONConsult with employees and give them the opportunity, encouragement and training to be involved in WHS matters i.e.

hazard and risk identification, control measures for managing hazards and risks development of SWMS and SSRA’s.

Record monthly consultation and communication using:

Toolbox Form 6 and provide an example

Keep these on file for due diligence

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Declaration by Contractors & Workers:1. I have been consulted and assited in the development of this Safe Work Method Statement (SWMS).2. I have been given the opportunity to make comment on the content of this SWMS I have read and understood how I am to carry out the tasks listed in this

SWMS. 3. I have been supplied with the appropirate Personal Protective Equipment that has been identified on this SWMS and I have been given training in the safe use

of this equipment.4. I have read and understood the requirements set out in the Mateial Safety Data Sheets for the Hazardous Substances which have been identified in this

SWMS for this particular work activity.

PLEASE LIST ALL MATERIAL SAFETY DATA SHEETS USED ON SITE.

All Contractors/Workers/Employees to signNAME SIGNATURE DATE

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WHS FORM 06: COMMUNICATION & CONSULTATION: - RECORD OF TOOL BOX TALKCompany Name: Date: Name of presenter:

Subject: Delivery & Installation of (Insert product or work activity) Time:

Persons present

Name (Print) Signature Name Signature

Issues raised: Example of potential subject matter (add & delete as appropriate) Y N Comments arising:

(Place any action outcomes in table below)

1. New / Existing client I.e. MDJH2. Overview of SWMS & Sign Declaration

3. Site Specific Risk Assessment (SSRA) Overview (Must be completed prior to undertaking the work activity task & attached to invoice)

4. Safety of Vehicle Load & Off Loading 5. Basic Traffic Management (Parking)

6. Overhead Electrical (If Applicable)

7. Underground Services (DBYD) – Pits (If Applicable)8. Working at Heights (If Applicable)

9. Safe Delivery i.e. (Stacked / Stored Level) 10. EPA – Mud on the road & noise etc11. Complete documentation (If Applicable)

12. Site Security – Ensure site left secure

13. Any issues on site with delivery please contact operations to address prior to leaving site.

14. Any other issues?

Action/s Person responsible

Action completed

Name Signature Date

Comments:1

23456

Actions Required: -On Completion scan a copy for communication & consultation files & Keep for 5years.

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WHS FORM 07: EMPLOYEE TRAINING REGISTER

Name: _______________________________________________________________ Date employment started: ________________________

Examples of training:

WHS general induction for construction work basic scaffold mobile crane licence skid steer or front end loader licence

excavator licence forklift licence vehicle loading crane licence use of hazardous substances

trade or contractor licence work activity training tools and equipment.

Please write clearly.

Type of training or certification Certificate or card number(if applicable)

Instructor’s name Date of training Expiry or renewal date (if applicable)

WHS FORM 08: PLANT AND EQUIPMENT REGISTER (IF APPLICABLE- Insert N/A if not)Include details of all plant and equipment to be used during the work activities.Examples include lifting gear, fire-fighting equipment, mobile plant and fall restraint equipment.

Company name:

Address:

Plant or equipment type Serial no or registration no Make and modelDate last serviced or

maintained(record required)

Required maintenance frequency(as per manufacturer’s instructions)

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WHS FORM 09: ELECTRICAL EQUIPMENT REGISTER (IF APPLICABLE- Insert N/A if not)Inspect, test and tag all electrical equipment, including extension leads.

Company name:Address:

Electrical company (if required):Address:

Equipment description Manufacturer Serial

numberDate of

inspection and test

Result Action to be taken

Signature of person

undertaking the

Certificate number (if

appropriate)

Date for next inspection and

test

Electrical item Frequency of inspection and test

Tools and leads Every three months

RCD unit (sub-board earth leakage device) Trip-test on a monthly basisCalibrate every three months

WHS FORM 10: HAZARDOUS SUBSTANCE REGISTER AND RISK ASSESSMENT (If Applicable- INSERT N/A IF NOT)

Product name ApplicationProduct

labelled?(Yes/No)

MSDS date of issue no older than five years?

(Yes/No)

Risk rating(1–6)

Controls to be implementedNote: Incorporate these controls into the

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WHS FORM 11: INCIDENT AND INJURY REPORTDetails of incident (e.g. property, plant or environmental damage)

Date of incident Time of incident am pm

Nature of incident

Location of incident

Description of incident

Details of damage to equipment or property

Name of person who received the report

Telephone

Reported to authorities?

Yes Provide details (when and whom):

Details of injury (e.g. to a worker or visitor) and treatment

Date of incident Time of incident am pm

Name of injured person Date of birth

Address Telephone

Occupation Employer

Activity in which the person was engaged at the time of injuryExact site location where injury occurred

Nature of injury – e.g. fracture, burn, sprain, foreign body in eye

Body location of injury (indicate location of injury on the diagram)

Treatment given on site Name of treating person

Referral for further treatment?

Yes Name of doctor or hospital:

No

Medical certificate received?

YesAttach copies

NoInjury management required?

Yes Notify return to work

coordinator

Name of return to work coordinator

Reported to authorities Yes Provide details (when and whom):

No Witness to incident (each witness may need to provide an account of what happened)

Witness name Witness contact

Witness name Witness contact

INVESTIGATION

Cause of incident or injury

Preventative actions (include what needs to be done, who will do it and when it will be done)

Completed by

Name Position

Signature Date

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