Safe Work Method Statement Template
v3.1
Purpose. The controlled template for preparing a safe work method statement for high-risk construction work on any Keystone site.
1.About this template
This template must be used for every safe work method statement prepared by Keystone workers. Subcontractor SWMS can be on the subcontractor's own template but must contain the same information. Read the Safe Work Method Statement Procedure before you start.
2.Task description
Describe the task, the location, the plant and the materials in enough detail that a worker who has not seen the site understands what will be done. Identify which of the high-risk construction work categories apply.
3.Step, hazard, control
Break the task into steps in the order they will be done. For each step, list the hazards, rate the risk using the Keystone risk matrix, list the controls in hierarchy order and name the person responsible for each control. Re-rate the risk with the controls in place.
- Eliminate the hazard where possible
- Substitute a safer method or material
- Isolate with guards, barriers or exclusion zones
- Engineering controls such as edge protection or trench shields
- Administrative controls such as permits and supervision
- Personal protective equipment last
4.Licences, training and PPE
List the high-risk work licences, tickets, competencies and PPE required for the task. Confirm against the Licences and Training Matrix that each worker holds what is listed before they sign.
5.Emergency response
State what will happen if the controls fail, including rescue from height, trench collapse, electric shock or a gas leak, who will lead the response and where the emergency equipment is located.
6.Sign-off and review
The preparer, the reviewing supervisor and every worker doing the task must sign and date the SWMS. Record the version number and the reason for any revision. The SWMS must be reviewed if the task or conditions change or after an incident.