(Insert Company Name)
LEAK TESTING AND PRESSURE TESTING
SWMS No R12
Page 1 of 5
Client / Principal Contractor Name: ______________________________________________________________________________ Date: ____/____/____
Project Name and Project No: ________________________________________________ Date work is to start: ____/____/____ ABN No: ______________
Workplace Location: ______________________________________________________________________________________________________________
Person/s involved in the development of this SWMS: ____________________ Consultation with workers on SWMS (including HSR if present)  Yes  N/A
Person responsible for SWMS compliance and review: ________________________ Contact phone: _________________ Review date: ____/____/____
Licenses, Permits, Competencies
Hazardous Substances
Significant Plant & Equipment
(must be written into the Sign-On page of this SWMS)
(attach SDS to SWMS)
(eg scissor lift, mobile scaffold, forklift)
Electrical License

Rescue & Resuscitation 
White Card

High Risk Work License 
Traffic Control

Work at Heights

Confined Space

High Voltage Work

Permit to Work _______________________________ 
Other _______________________________________ 
Consequence of
Injury or Impact on
Environment
RISK
ASSESSMENT
MATRIX
Likelihood of Causing Injury or Environmental Harm
Very likely
Could happen
frequently
Likely
Could happen
occasionally
Unlikely
Could happen
but only rarely
Very unlikely
Could happen,
but probably
never will
Kill or cause a catastrophic release to
the environment
1
1
2
3
Long term injury/illness or
environmental impact on neighbours
1
2
3
4
Medical treatment or environmental
impact on site
2
3
4
5
First aid treatment or enviro clean up
3
4
5
5
SWMS R12
PRIORITISATION OF RISK (Actions)
1 = Urgent – Stop Work Immediate Action Required
2 = Immediate – Take Action within 24 hours
3 = Medium Term – Take Action within 5 days
4 = Longer Term – Take Action within 30 days
Page 1 of 5
5 = Monitor Risk – Monitor the Risk
Issued:
(Insert Company Name)
LEAK TESTING AND PRESSURE TESTING
SWMS No R12
Page 2 of 5
POTENTIAL SAFETY HAZARDS/RISKS WITH THIS TASK (tick relevant)
LEGISLATION AND OTHER REFERENCES
THE HARMONISED WHS REGULATION IS DESIGNATED BY: C = CHAPTER, P = PART, D = DIVISION, COP = CODE OF PRACTICE, HRCW = HIGH RISK CONSTRUCTION WORK (C6, P3, D2)

Risk of Person Falling
physical barriers, fall arrest, fall
prevention, retrieval
C4/P4
COP
HRCW

Temperature Extremes including
Artificial
sun, UV, freezers, boilers
C3/P1
COP
HRCW

Energised Electrical Works
live work, electric shock, testing,
LOTO, UG services
C4/P7
COP
HRCW

Asbestos
likely exposure, register, PPE, airmonitoring

Precast and Tilt Up Concrete
lifting, moving, craning, placing,
propping
COP
HRCW

Demolition
elect shock, isolations, LOTO, load
bearing issues of structure
C4/P6
COP
HRCW

Confined Space
work in or near a confined space,
unsafe oxygen level, competency,
permit to work, spotter
C4/P3
COP
HRCW

Flammable Atmosphere, Major
Hazard Facility
flammable gas, vapour, fumes,
combustible dust, ignition sources,
licenses, permits
C3/P2/D8
C9
Schedules
15 - 18
HRCW

Powered Mobile Plant,
maintenance, competencies, traffic
movement plan
C5/P1/D7
HRCW

Working in or near Water/Liquid
risk of drowning, PFD, fall arrest

Live Traffic Corridors
working near/adjacent road, rail,
traffic control, licenses
C3/P1
HRCW


Excavation >1.5 m deep
engineers report, bench, batter, soil
report, retrieval

C8
COP
HRCW
C6/P3/D3
COP
HRCW

Pressurised Gas Distribution Mains
or Piping
hitting or puncturing & UG services
C7/P1/D9
HRCW

Refrigerant, Fuel or Chemical Lines
flammable gas, vapour, fumes
C3/P2/D8
HRCW

Emergency/First-Aid/Remote Work
first aid facilities, remote / isolated
work, emergency response plan
C3/P2
D3,4,6
COP

Hazardous Subs/Chemicals/Lead
SDS, registers, manifest, signage,
spills, contamination, health
monitoring, emergency planning
C7, C8
Schedules
7 - 14
COP
C3/P1
HRCW

Falling Objects
from above or on those below,
lanyards, screens, drop zone
C3/P2/D10
Work on Telecommunication
Towers
installing equipment, falls
C3/P1
HRCW

Alterations/Repairs/Temp Support
to Prevent Collapse
structural alterations, propping
C3/P1
HRCW

POTENTIAL ENVIRONMENTAL IMPACTS TO CONSIDER (tick relevant activities)
Air pollution (dust)

Contamination to ground

Noise pollution (ambient)

Soil erosion

Contamination to water

Hazards to flora & fauna

Noise/Hearing Loss
exposure, managing risk, PPE,
audiometric testing and monitoring
Other References:
C4, P1
COP
HEIRARCHY OF CONTROLS
Most effective
Eliminate
Substitute
Engineer
Administration
PPE
Least effective
SWMS R12
Page 2 of 5
Issued:
(Insert Company Name)
LEAK TESTING AND PRESSURE TESTING
SWMS No R12
S
T
E
P
What are the Steps / Tasks
Hazards at each
Step
Initial
Risk
Rating
Control Description
separate control/s are required for each
hazard identified
likelihood x
consequence
Page 3 of 5
Residual
Risk
Rating
Persons
Responsible
for Controls
likelihood x
consequence
1
Entry to site
Unknown site hazards
and conditions
2
Site Induction / Familiarisation of site conditions
5
Supervisor &
Workers
2
Never use oxygen to leak test, purge or
pressure test a machine. Nitrogen is
recommended for these purposes.
Fire/explosion
3
Implement fire safety and first aid procedures
according to the Safety Data Sheet (SDS)
First aid available
5
Supervisor &
Workers
3
Always use a gauge equipped regulator
on the nitrogen cylinder and verify that
the gauge has been recently checked
and calibrated.
Fire/explosion
3
Implement fire safety and first aid procedures
according to the Safety Data Sheet (SDS)
First aid available
5
Supervisor &
Workers
4
When using nitrogen and a refrigerant
trace for leak testing, always put the
refrigerant first then valve off and
remove the refrigerant cylinder before
connecting and adding the regulated
nitrogen.
Fire/explosion
1
Implement fire safety and first aid procedures
according to the Safety Data Sheet (SDS)
First aid available
5
Supervisor &
Workers
5
Never exceed the specified field leak
test pressures. Check the instructions.
Fire/explosion
2
Implement fire safety and first aid procedures
according to the Safety Data Sheet (MSDS)
First aid available
5
Supervisor &
Workers
6
Do not allow the full cylinder pressure to
enter a pressurising line. Ensure valve
is off and disconnect the nitrogen
cylinder when the recommended test
pressure is attained.
Fire/explosion
2
Implement fire safety and first aid procedures
according to the Safety Data Sheet (SDS)
First aid available
5
Supervisor &
Workers
7
Do not pressure test any vessel at its
design pressure (found on the
equipment nameplate);
Fire/explosion
2
Implement fire safety and first aid procedures
according to the Safety Data Sheet (SDS)
First aid available
5
Supervisor &
Workers
8
Do not confuse water (brine) side test
pressures with refrigerant side test
pressures.
5
Supervisor &
Workers
SWMS R12
Fire/explosion
3
Implement fire safety and first aid procedures
according to the Safety Data Sheet (SDS)
First aid available
Page 3 of 5
Issued:
(Insert Company Name)
LEAK TESTING AND PRESSURE TESTING
SWMS No R12
9
Do not enter any vessel or restricted or
closed space immediately after the use
of significant amounts of nitrogen
without procedure or testing oxygen
levels.
Asphyxiation
Site specific tasks
Site specific hazards
1
Page 4 of 5
Wear correct respirator PPE 6
5
Supervisor &
Workers
Site specific controls
P
P
E
other
1
2
3
4
5
6
7
8
9
10
11
12
13
(Mark all PPE required for this task – ensure available prior to commencing work)
SWMS R12
Page 4 of 5
Issued:
(Insert Company Name)
LEAK TESTING AND PRESSURE TESTING
SWMS No R12
Page 5 of 5
SWMS SIGN ON
We, the undersigned, confirm that we have been consulted regarding the above SWMS and that its content is clearly understood. We also confirm that our required
qualification/s to undertake this activity is current and that we are competent to complete the work safely and without risk to our own health or the health of others. We clearly
understand that the controls 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
should risks to other workers, visitors or the public remain.
Worker’s Name
Job Title
Principal Qualification/License/Ticket
Date
Worker’s Signature
I, the undersigned Supervisor confirm that I have checked all qualifications tendered and verify 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.
Person responsible for SWMS: ___________________________________________
SWMS R12
Page 5 of 5
Signature: _____________________________________________
Issued: