ABN: 12 345 678 910 ACN: 123 456 789

Address: Your Company Address PH: Your Company Phone E: Your Company Email Web: Your Company Website

SAFE WORK METHOD STATEMENT (SWMS)

PROJECT DETAILS:

Project: Area:

Job Address:

Job Description:

WORK ACTIVITY: WORKING AT HEIGHTS

Consult relevant workers during development, approval and communication of this SWMS SWMS Approved by: Page 1 of 12

Name: (Include names of workers Signature: Job Title: Date: Name:

who were consulted in relation to
this SWMS) Signature:

Date:

Overall Risk Rating After 4 Acute 3 High

Personnel responsible for monitoring and managing activity:
Controls 2 Moderate 1 Low
COMMUNICATE THIS SWMS TO ALL PERSONS INVOLVED IN TASK PRIOR TO WORK COMMENCING

• ____________will conduct regular inspections and observations to ensure SWMS is being complied with.
• Hold Daily Tool Box Talks to identify, control and communicate additional site hazards.
• Cease work immediately if incident or near miss occurs. Amend the SWMS in consultation with relevant persons.
• ______________ will approve and communicate amendment to all affected workers before work resumes.
• As required by WHS legislation, make the SWMS available for inspection or review.
• As required by WHS legislation, keep record of SWMS (until job is complete or for 2 years if involved in a notifiable incident).

DOCUMENT NO: ACTIVITY: REVIEW NO: DATE:

Authorised by: © Blue Safe Online 2018 All rights reserved Page 1
Signature: Date:
 IMPORTANT NOTES:
Check local government standards, codes of practice, regulations and legislation for any training requirements before use.

Apprentices and Trainee Personnel are usually permitted to operate certain machinery and equipment provided they are guided and supervised by an experienced
and qualified person, while also recording the hours of use in an approved logbook.

WorkCover National Certificates of Competency are nationally recognised and these specific certificates do not have to be changed over to work interstate.

1. These procedures apply for situations when according to a risk assessment, a person may be injured as a result of a fall from a lesser height than that specified,
or where a man may fall more than the height or distance specified by the Regulatory Authority.
2. Refer to workplace practices manual or specific safe work procedures for further information on topics.
HIGH RISK CONSTRUCTION WORK INVOLVED IN THIS ACTIVITY (Check any that are applicable to this site)
A risk of a person falling more than 2 metres (or 3
☒ ☐ Work on a telecommunications tower ☐ Demolition of a load-bearing structure
m in SA, or housing const. in Qld)
Temporary load-bearing support for structural
☐ Likely to involve disturbing asbestos ☐ ☐ Work in or near a confined space
alterations or repairs
Work in or near a shaft or trench with an excavated
☐ ☐ Work involving the use of explosives ☐ Work on or near pressurised gas mains or piping
depth over 1.5m; or in a tunnel
Work on or near energised electrical installations or Work in an area that may have a contaminated or
☐ Work on or near chemical, fuel or refrigerant lines ☐ ☐
services flammable atmosphere
Work on, in or adjacent to a road, railway, shipping
☐ Tilt-up or precast concrete elements lane or other traffic corridor used by traffic other than ☐ Work in an area with movement of powered mobile plant
☐
pedestrians
Work in areas with artificial extremes of Work in or near water or other liquid that involves a
☐ ☐ ☐ Diving work
temperature risk of drowning
EMERGENCY EVACUATION PROCEDURE:
1. Rescue or assist any person in immediate danger if safe to do so. 4. Evacuate the work site with directions given by site manager.
2. Sound the Alarm. 5. Move to the evacuation assembly area.
3. Secure any activity or hazardous material if practical and safe to do so.
PLANT AND EQUIPMENT USED FOR THE WORK: COMPETENCIES, QUALIFICATIONS AND PERMITS REQUIRED:

Ladders, Scaffold, Elevated work platform, Scissor lifts, Fall Restraint system Work at Heights Permit

DOCUMENT NO: ACTIVITY: REVIEW NO: DATE:

Authorised by: © Blue Safe Online 2018 All rights reserved Page 2
Signature: Date:
 RISK ASSESSMENT
References: How to Manage Work Health and Safety Risks Code of Practice 2011, AS/NZS 31000 -2009 Risk Management Principles and guidelines

Step 1 Determine Likelihood – What is the possibility that the effect will occur? Step 2 Determine Consequence – Expected Consequences
Likelihood Definition Level of Consequence Examples
Almost Expected to happen in most A common and very possible result Insignificant/Acceptable No consequence – so minor that the
certain circumstances. consequence is manageable
Likely Will probably occur in most Known to have occurred and has Minor First aid treatment only; manageable and
circumstances. happened before contained.
Possible Might occur at some time Could occur and is likely it has Moderate Medical treatment; manageable with 3rd
happened before party assistance.
Unlikely Could occur at some time Not likely to occur Major Serious injuries; Down time and loss of
productivity
Rare May occur only in Very unlikely
Catastrophic Death; Very serious consequences
exceptional circumstances
Step 3 Determine the risk score Step 4 Record risk score (Note – Risk scores are only estimated and should not be
CONSEQUENCE solely relied upon)
Score Action
LIKELIHOOD Insignificant Minor Moderate Major Catastrophic
4 URGENT – Act on and lower the risks immediately.
A: Acute Demands immediate attention.
Almost 3 High 3 High 4 Acute 4 Acute 4 Acute
3
certain Decisions required urgently by Management.
H: High
Likely 2 Medium 3 High 3 High 4 Acute 4 Acute 2
M: Moderate Follow instructions given by management.
Possible 1 Low 2 Medium 3 High 4 Acute 4 Acute
1 Manageable. Review regularly, and if any conditions
Unlikely 1 Low 1 Low 2 Medium 3 High 4 Acute L: Low of work change.

Rare 1 Low 1 Low 2 Medium 3 High 3 High

DOCUMENT NO: ACTIVITY: REVIEW NO: DATE:

Authorised by: © Blue Safe Online 2018 All rights reserved Page 3
Signature: Date:
 Potential Hazards/Risks of Control Measures - Steps To Follow Responsible
Task Steps RB RA
Each Step Safety Checks & PPE Officer

NOTE: RB = Risk Rating before controls implemented - RA = Risk Rating after controls are implemented.
1. General precautions Falling objects To prevent objects falling off working surfaces, provide edge
protection.
Electrical hazards
To prevent access to areas where objects may fall, barricades
may be used.

Before commencing working, make sure that electric wires and

de-energized, insulated with matting, and identified with “tiger
tails”.

On sites where falling objects may occur, wearing head

protection is recommended.

Always maintain a safe distance from electric catenary wires.

2. Ladders Falls For access only, use extension or single ladders, except where
the work to be carried out is of the nature that the equipment or
material used does not cause loss of balance, or restrict the
movement; the trunk remains cantered on the ladder, and
equipment can be used with one hand.

Use only industrial ladders and have 3 points of contact

always.

Stand the ladder on a firm, stable surface, and secure it against

movement.

3. Scaffolding Improper erection A person holding a Certificate of Competency as a Scaffolder

only should erect a scaffolding, from which an object or a
Instability person could fall 4 meters or more.

DOCUMENT NO: ACTIVITY: REVIEW NO: DATE:

Authorised by: © Blue Safe Online 2018 All rights reserved Page 4
Signature: Date:
 Potential Hazards/Risks of Control Measures - Steps To Follow Responsible
Task Steps RB RA
Each Step Safety Checks & PPE Officer

NOTE: RB = Risk Rating before controls implemented - RA = Risk Rating after controls are implemented.
Overloading Scaffoldings that are not prefabricated types must be erected
by a scaffolder.
Persons falling
Erect scaffolds only on stable, firm base.

Before allowing any person to work from or climb on to a

completed scaffold, always check the stability.

Mobile scaffolds must have their wheels locked before any

person is allowed to climb on to the scaffolding.

Never exceed the safe working load of any component of the

scaffold.

All parts of the work platform and scaffold must have safe
means of access.

Unattended or incomplete scaffoldings should be prevented

against unauthorized access.

Levelling screws must be used to make sure that all uprights

are vertical.

All scaffolding must be marked SWL

Suitable access ladders must be used.

4. Work platforms Persons falling Work platform should be at least 450mm wide and be capable
of carrying the load that the type of work carried out may
Falling objects require, unless specifically allowed in codes or practice or
regulations.

DOCUMENT NO: ACTIVITY: REVIEW NO: DATE:

Authorised by: © Blue Safe Online 2018 All rights reserved Page 5
Signature: Date:
 Potential Hazards/Risks of Control Measures - Steps To Follow Responsible
Task Steps RB RA
Each Step Safety Checks & PPE Officer

NOTE: RB = Risk Rating before controls implemented - RA = Risk Rating after controls are implemented.
To prevent persons from falling from the outside edges of work
platforms, guardrails and mid-rails may be fitted.

If loose objects or other materials may be present on the

platforms, edge protection must be provided on work platforms.

Where permitted by the Authority for “light work” only, a single

plank of 225mm width may be used.

5. Edge Protection Persons falling To prevent persons falling, edge protection must be erected
around the perimeter of the work. This must comprise of a mid-
Falling objects rail and a guardrail designed to withstand any reasonable
force, which is expected to fall against it.

Edge protection should conform to the requirements stated by

the Authority.

Where objects can fall onto people in the adjoining areas such
as residences, streets, etc., catch platforms or hoardings must
be used, along with perimeter screening.

Guardrail must be minimum 900mm high with toe board and

mid-rail.

Only a competent person should erect an edge protection

system and this must be used according to the instructions of
the manufacturer.

6. Elevating work platforms Unsafe operation For operating a machine with a boom greater than 11 meters,
/ boom lifts the operator must hold a Class WP license.

DOCUMENT NO: ACTIVITY: REVIEW NO: DATE:

Authorised by: © Blue Safe Online 2018 All rights reserved Page 6
Signature: Date:
 Potential Hazards/Risks of Control Measures - Steps To Follow Responsible
Task Steps RB RA
Each Step Safety Checks & PPE Officer

NOTE: RB = Risk Rating before controls implemented - RA = Risk Rating after controls are implemented.
Overturning Machine must be operated on firm level surface, for stability,
use outriggers.
Overloading of platform
Make sure that the total load in the bucket of the EWP,
Persons falling including personnel, tools and equipment and materials does
not exceed the safe working load of the unit.
Falling objects
Approved parachute type safety harness must be worn by
Electric shock person in bucket. This will prevent them from falling on to any
part of the machine or truck, or to the ground.

To prevent tools from falling from EWP during use, lanyards,

etc. may be used.

Powered equipment such as chainsaws must be started

outside of bucket.

For electric work, use EWPs, which are approved for the
electric work.

Unless specifically authorized, do not go near electricity wires.

Make sure that a competent operator will be operating the

machine.

Do not operate machine with jerky or sudden movements.

Do not exceed the safe working load of the EWP.

Safety belts are not suitable.

DOCUMENT NO: ACTIVITY: REVIEW NO: DATE:

Authorised by: © Blue Safe Online 2018 All rights reserved Page 7
Signature: Date:
 Potential Hazards/Risks of Control Measures - Steps To Follow Responsible
Task Steps RB RA
Each Step Safety Checks & PPE Officer

NOTE: RB = Risk Rating before controls implemented - RA = Risk Rating after controls are implemented.
Always attach the harness to the bucket.

Never carry flammable liquids in bucket.

For safe approach distances, refer to SWP257 Electrical

safety.

7. Scissor lifts Overloading Make sure that the total load in the bucket of the unit, including
personnel, tools and equipment and materials does not exceed
Persons falling the safe working load of the unit.

Falling objects Make sure the unit cannot move when platform is extended, by
checking the operations of outriggers, stops, brakes, etc.
Electric shock
When working at heights, persons must not lean out over the
rails of the platform.

Always lower the platform, even when moving the unit for short
distances only.

To prevent tools from falling from the unit during use, lanyards,
etc. may be used.

Unless specifically authorized to access or carry out electrical

work, do not go near electricity wires.

Observe the safe clearing distances.

Do not exceed the safe working load of the scissor lift.

DOCUMENT NO: ACTIVITY: REVIEW NO: DATE:

Authorised by: © Blue Safe Online 2018 All rights reserved Page 8
Signature: Date:
 Potential Hazards/Risks of Control Measures - Steps To Follow Responsible
Task Steps RB RA
Each Step Safety Checks & PPE Officer

NOTE: RB = Risk Rating before controls implemented - RA = Risk Rating after controls are implemented.
If brakes and stops fail to prevent all movement of the unit, do
not use.

Always keep body inside platform.

Never travel with a raised platform.

For safe approach distances, refer to SWP257 Electrical

safety.

8. Fall Restraint system Persons falling A fall arrest system or a restraint should comprise of items
compatible with one another, and have negligible risk of
accidental release of connections.

Only a competent person must install all systems.

A restraint belt will be acceptable only when working on a slope

of 15ºor less, and the length of the restraint will arrest the
vertical free fall of the wearer.

If the slope or roof is greater than 15ºand the person can

maintain a secure footing, a fall arrest harness or a work
positioning harness must be worn.

All components must conform to the Australian Standard

relevant to those components.

Any person must be connected to a minimum one fall-arrest

system, if they are at a risk of falling.

DOCUMENT NO: ACTIVITY: REVIEW NO: DATE:

Authorised by: © Blue Safe Online 2018 All rights reserved Page 9
Signature: Date:
 Potential Hazards/Risks of Control Measures - Steps To Follow Responsible
Task Steps RB RA
Each Step Safety Checks & PPE Officer

NOTE: RB = Risk Rating before controls implemented - RA = Risk Rating after controls are implemented.
Prior to removal of temp barrier, fall restraint system will be set-
up to eliminate any fall potential. User to adjust lanyard
distance to eliminate potential fall. Protect static line from
snare edges

It is not recommended to use inertia reel.

9. Safety Harnesses and Person striking against Where there is a likelihood of a person falling more than 2m, a
Fall Arrest Devices fall arrest harness must be worn.
Suspension trauma
In the event of a fall, suitable equipment to rescue a person
Failure of components must be available within a short period for minimizing the risk of
suspension trauma.
Incorrect use and fitting
Call fire & rescue

Fall arrest harnesses must comply with the Australian

Standards AS 1891.1 Industrial fall-arrest systems and
devices-Safety belts and harnesses.

Before being allowed to use the harness, all persons must

receive instructions and training in the correct use of the
harness.

Under work position, make sure adequate fall clearance is

available.

All persons on site must be instructed in procedures for rescue.

Never use faulty or out-of-date equipment.

DOCUMENT NO: ACTIVITY: REVIEW NO: DATE:

Authorised by: © Blue Safe Online 2018 All rights reserved Page 10
Signature: Date:
 Potential Hazards/Risks of Control Measures - Steps To Follow Responsible
Task Steps RB RA
Each Step Safety Checks & PPE Officer

NOTE: RB = Risk Rating before controls implemented - RA = Risk Rating after controls are implemented.
For safety in use, harnesses must be properly fitted.

DOCUMENT NO: ACTIVITY: REVIEW NO: DATE:

Authorised by: © Blue Safe Online 2018 All rights reserved Page 11
Signature: Date:
 PERSONAL PROTECTIVE EQUIPMENT REQUIREMENTS
Foot Protection Hearing Protective Head Protection Eye Protection Hand Protection Sun Protection Safety Harness
Protection Clothing

☒ ☐ ☒ ☒ ☐ ☒ ☒ ☒
Other PPE Required:

PPE Notes:
The above PPE Requirements are the minimum requirements for all personnel involved in this task. Be sure to conduct a Risk Assessment for other factors that
may influence the work environment such as Temperatures – Hot/Cold, Working in the Sun, Night Work etc. Be sure that all PPE used is approved by Australian
Standards.

LEGISLATION, CODES OF PRACTICE AND STANDARDS

Acts and Regulations Work Health and Safety Act 2011; Work Health and Safety Regulation 2017
Codes of Practice First Aid in the Workplace Managing Electrical Risks in the Workplace,
How to Manage Work Health and Safety Risks Managing the Work Environment and Facilities,
Hazardous Manual Tasks Managing the Risk of Falls at Workplaces,
How to Prevent Falls at Workplaces Managing the Risk of Plant in the Workplace
Managing Risks of Hazardous Chemicals, Managing Noise and Preventing Hearing Loss in the Workplace
AS/NZS 1418.10-2011 Cranes, Hoists and Winches – Safe Use – Mobile Elevating Work Platforms
AS/NZS 1576 Scaffolding
AS/NZS 1892 Portable ladders

DOCUMENT NO: ACTIVITY: REVIEW NO: DATE:

Authorised by: © Blue Safe Online 2018 All rights reserved Page 12
Signature: Date:
 SIGN OFF
Workers and relevant Persons Conducting Business or Undertaking (PCBU) were consulted for developing this SWMS. I have read the above SWMS and I
understand its contents. I confirm that I have the necessary training and skills, including any relevant certifications to undertake the related tasks contained in this
SWMS. I agree to comply with any safety guidelines, requirements and recommendations as set forth by the responsible officer within this SWMS including safety
instructions and use of recommended Personal Protective Equipment.

Name Qualifications Signature Date Time Employer

DOCUMENT NO: ACTIVITY: REVIEW NO: DATE:

Authorised by: © Blue Safe Online 2018 All rights reserved Page 13
Signature: Date: