Company Details

Company Name: [Insert Company Name] ABN: [Insert ABN] Address: [Insert Address] Phone: [Insert Phone Number] Email: [Insert Email Address]

Project Details

Project / Site Name: [Insert Project Name] Site Address: [Insert Site Address] Client Name: [Insert Client Name] Date of Issue: [Insert Date]

Job Description

[Provide a brief description of the work to be performed. Be specific about the scope.]

Persons Responsible

Project Manager / Supervisor: [Insert Name] Contact Number: [Insert Number]

Hazards and Controls

Job Step	Potential Hazards	Risk Rating (H/M/L)	Control Measures	Person Responsible
[Step 1: e.g. Delivery of materials]	[e.g. Manual handling, traffic]	[e.g. M]	[e.g. Use trolley, designate loading zone, wear high vis vest]	[e.g. Site Supervisor]
[Step 2: e.g. Preparation of work area]	[e.g. Slips trips falls, dust]	[e.g. L]	[e.g. Keep area clean, use water suppression, wear safety boots]	[e.g. All Workers]
[Step 3: e.g. Installation]	[e.g. Use of power tools, noise]	[e.g. M]	[e.g. Use residual current devices, wear hearing protection, follow manufacturer instructions]	[e.g. Tradesperson]
[Step 4: e.g. Clean up]	[e.g. Waste disposal]	[e.g. L]	[e.g. Remove waste daily, stack materials safely]	[e.g. Labourer]

Safety Equipment and PPE

List all Personal Protective Equipment required for this job:

• Safety Helmet
• Safety Glasses / Goggles
• High Visibility Clothing
• Safety Boots
• Hearing Protection
• Gloves
• Dust Mask
• [Other]

Plant and Equipment

List all plant and equipment to be used on site:

• [Equipment 1 - e.g. Cordless Drill]
• [Equipment 2 - e.g. Circular Saw]
• [Equipment 3 - e.g. Ladder]

Note: All equipment must be inspected prior to use and tagged where required.

Pre-Start Checklist

• Workers briefed on this SWMS?
• Emergency contact numbers confirmed?
• First aid kit located and accessible?
• Site amenities (toilets, water) available?
• Permits and inductions completed?

Sign Off

I acknowledge that I have read and understood the contents of this Safe Work Method Statement. I agree to follow all stated control measures.

Worker Name	Worker Signature	Date
[Name]	[Sign]	[Date]
[Name]	[Sign]	[Date]
[Name]	[Sign]	[Date]

Supervisor Signature: __________________________ Date: ___________