Safe Work Method Statement

Company: (Name, Contact Person & Phone)

Project/Site: Principal Contractor:
Job Task: Core Drilling - Floors & Walls SWMS No.:
Date Created: Revision Number: Review Date:

Workers Involved in Developing this SWMS

Print Name: Signature: Print Name: Signature:

Relevant Australian Standards /

Codes of Practice / Legislation
Material Safety Data Sheets
Required
Plant & Equipment Required
Licenses / Competencies Required
Hot Work Permit Yes Confined Space Permit Yes Crane Lift Plan / Permit Yes Other Permit Yes
Applicable Permit Number(s):
PPE
Required:

High Risk Work: Structural Collapse Confined Spaces Work in Tunnel Explosives
Fall from Heights > 2m Demolition of Structures Excavation >1.5m Mobile Plant Drowning
Asbestos Pressurised Gas Pipes/Mains Electrical Traffic Tilt-up/Precast Concrete
Telecommunication Contaminated/Flammable Extremes of Artificial Chemical/Fuel/Refrigerant
Towers Atmosphere Temperature Lines

Task/Location Specific Risks: Ground Conditions Noise Water Pollution Weather

Access & Egress Compressed Air Cultural / Heritage Area Soil Pollution Obstacles / Buildings
Overhead Obstructions Quick Cut Saw Snakes / Vermin Rotating Machinery
Underground Services Angle Grinder Dust Fatigue
Pedestrians / Workers Hot Work / Burns Significant Trees Exposure to UV
Unauthorised Persons Poor Lighting Flora & Fauna Ignitions Sources Other (refer to hazard prompt list)

© 2012 Master Builders Association of South Australia, Inc CORE DRILLING – FLOORS & WALLS Page 1 of 5
 Safe Work Method Statement

Step 1
Consequences
5 – Severe Potential to be fatal. Permanent disability. Destruction of property or plant.
4 – Major Serious injury. Long term disability. Major damage to plant, property or environment.
3 – Moderate Potential for injury resulting in medical attention. Damage to plant, property or environment.
2 – Minor Injury requiring First Aid treatment and / or short term discomfort.
1 – Negligible Cause a near miss, needs to be reported

Step 2
Potential (Likelihood)
A – Almost Certain This event is expected to occur in most circumstances
B – Likely The event will probably occur in most circumstances
C – Possible The event might occur at some time
D – Unlikely The event could occur at some time
E - Rare The event may occur only in exceptional circumstances

Step 3
Matrix Consequences
Potential 1 – Negligible 2 – Minor 3 – Moderate 4 – Major 5 – Severe
A – Almost Certain M (9) S (15) S (19) H (24) H (25)
B – Likely L (7) M (11) S (18) S (21) H (23)
C – Possible L (5) L (6) M (13) S (17) H (22)
D – Unlikely L (3) L (4) M (10) M (14) S (20)
E - Rare VL (1) L (2) M (8) M (12) S (16)

Legend
Risk Rating
Activity to be re-planned and/or re-designed. If this is not possible, an independent Hazard Assessment of the activity is to be completed by the Project
High Manager prior to completing the SWMS
Significant Activity Must be reviewed by Senior Site Management Representative and have identified risk controls built into the SWMS and work procedure
Medium Site Supervisor must review method of task.
Low Some action may be required, Supervisor to determine and monitor
Very Low Minimal risk, monitor where work changes

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 Safe Work Method Statement

Risk Residual Person Responsible for

Job Step Potential Hazard Rating
Control Risk Controls
Break the job into What can cause harm at each step Describe the control measures and how they will be
S (17) M (8) EXAMPLE
steps High risk work is to be kept to its own cell used
In conjunction with principle contractor and on
site electrician check for any existing services in
Electric shock from services wall or floor and sign verification form
H M [insert responsible person]
Explosion Ensure services are isolated and locked out
prior to commencing work by the worker
completing the task
Barricade drop area for core
Erect warning signs
Times established to undertake work outside of
Falling object (core) H work hours where possible M [insert responsible person]
Preparation Use two way communication system between
spotter and machine operator or third person to
act as runner
Consult principal contractor and site engineer
check that drilling site/s will not affect strength of
Weakening structure S structure. M [insert responsible person]
Engineer to sign verification that drilling will not
affect structural strength of building
Noise Wear ear muffs or plugs with safety helmet,
M L [insert responsible person]
Foreign body in eye glasses / goggles, gloves and boots
Operation All electrical equipment to be tested and tagged
as per AS 3760 & 3012
Electrocution H M [insert responsible person]
Provide RCD protection
Hang leads on insulated hooks or lead stands
Drill jamming M Only trained personnel to complete task L [insert responsible person]
Slips, trips, falls Follow manufacturer’s instructions for safe
useEnsure operators adequately trainedSet drill
into position and turn on compressor making
sure suction is achieved Use wet vac to remove
excess water
When drilling through wall bolt securely
Upon completion finish clean up and securely
cover penetration
Ensure work area clear of all trip hazards

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 Noise Wear ear muffs or plugs with safety helmet,
M L [insert responsible person]
Foreign body in eye glasses / goggles, gloves and boots

Ensure barricades and warning signs erected

Use spotter where necessary
Falling object (core) H Use two way communication system between M [insert responsible person]
spotter and machine operator or third person to
act as runner

Have you considered the site specific hazards? e.g. IN PREPARING A SAFE WORK METHOD STATEMENT YOU MUST:
- lay of the land 1. Consider any site specific potential hazards and include any identified risks in Safe Work Method Statement (SWMS)
- obstacles (buildings, workers, excavations, plant) 2. Assess the risk
- changes to site conditions 3. Insert controls using the hierarchy of controls for the hazards identified i.e. Elimination, Substitution (materials, equipment, and
- other contractors’ work in progress chemicals), Isolation, Engineering (guarding), Administration (training) or PPE
Have you considered weather conditions? Eg. 4. Review the residual risk to ensure controls are adequate to safely perform the work
- wind 5. Document the matters contained in items 1 – 4, above, in this SWMS
- rain 6. Complete the SWMS and Delete these notes to demonstrate that you have considered all relevant matters
- heat 7. Ensure that all workers involved in the job task have read, understood and signed off on the SWMS
- cold etc
8. Ensure that work is carried out in a safe manner in accordance with the SWMS
Have you considered job specific details?
- different material NB: If you are unsure of anything seek professional advice. Master Builders WHS department can assist members in developing and
- different equipment implementing safety plans, including SWMS.
Any other factor that may make affect the risks associated with
performing this task?

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 Safe Work Method Statement

WORKERS INVOLVED IN JOB TASK

We, the undersigned, confirm that we have been consulted regarding the above SMWS and that its content is clearly understood. We also confirm that our required qualification(s) etc.
to undertake this activity, is\are current and that we are competent to complete the work safely and without risk to our own health or the health and safety of others. We clearly
understand that the control(s) in this SWMS must be applied as documented, otherwise work is to cease immediately, and we will ensure that the work area is made safe, as far as
reasonably practicable.

Print Name: Company: Signature: Date:

I, the undersigned Supervisor, confirm that I have checked all qualifications provided and verify that they are applicable and current. I have also ensured that all
inductions have taken place and that all tools and equipment are properly maintained and safe to use. I have issued all relevant permits and have ensured to the
best of my ability that the work area is safe and that the work will not damage any property or injure any persons.

Supervisor Name Supervisor Signature Date________________

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