Procedure No. DEE EHU-24-2-1
Authorised By: Manager EHU
Title: Safe Work Method Statement
Issue Date: September 2010
Review Date: September 2012
Is a Permit to Work Required?
Personal Protective Equipment (PPE)
Requirements:
(please indicate by ticking or blacking-out
box)
None
Confined Space
Hot Work
Work at Height
(please list)
Page Number: 1 of 1
Tools, Equipment or Instruction Required
(consider such things as gas detection, ventilation fans, lighting,
scaffolding, etc)
Hazardous Materials
Potential Environmental Hazards
Fire/Emergency Equipment
Requirements
(List any hazardous materials to be used)
(please indicate by ticking box)
(consider fire extinguishers, rescue gear, etc)
Spills to ground
Noise pollution
Soil erosion
Spills to water
Hazard to flora or
fauna
STEP/TASK
No.
Air pollution (dust, fumes)
Job Step/Task
Potential Hazard
Current Control
Describe the steps required to
perform the task in the sequence they
are carried out
Against each step list the potential
hazards that could cause
injury/damage when the task step is
performed.
List the control measure required to
eliminate or minimise the risk of
injury arising from the identified
hazard
Action Plan
(additional Controls)
4. SWMS Signoff
Authorised By:
Signature:
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
Date:
Responsibility