Housing Industry Site Safety ‘Subby’ Pack
(HISSP)
Submission Checklist
Items # 1-14 must be completed for all
Contractor/Supplier submissions
#
1.
Contractor Questionnaire – Please complete fully, date & sign
2.
WHS FORM 01: Complete fully, date & sign
3.
WHS FORM 02: Date & sign
4.
WHS FORM 03: Date & sign x 2 sections
5.
WHS FORM 04: Please return completed example.
6.
WHS FORM 05: Please complete – All workers must sign declaration
7.
WHS FORM 06: Please return completed example, signed by attending
employees
8.
WHS FORM 07: Complete for all employees
9.
WHS FORM 08: List all plant & equipment used
10.
WHS FORM 09: List all electrical equipment or copy of recent tagging register
11.
WHS FORM 10: List all hazardous substances used
12.
Subcontractor Statement completed
Tick When
Completed
Additional documents required
13.
Copies of all Insurance Certificates of Currency
14.
Copies of all workers Workcover General Induction ‘White’ Cards
Additional documents required if applicable
15.
Copy of current Contractor Licence
When all above is completed make two (2) copies of the completed Site Safety Pack:
 Forward a copy to McDonald Jones Homes (MDJH), principal contractor, for review. Please keep
your original on file.
 Keep the 2nd Site Safety Pack with you when you go to site each day.
 Update the information in the WHS Forms if anything changes i.e. SWMS, registers etc
Please note:
This pack must be reviewed, updated and submitted annually including any updated certificates
of currency on renewal. You will receive a letter of notification when these documents are due.
Failure to supply in a timely manner may cause delays in processing payments and issuing
purchasing / work orders to you.
February 2012
Housing Industry Site Safety ‘Subby’ Pack (HISSP)
Within this pack you will find all the documents and requirements you will need to
provide to McDonald Jones Homes prior to being able to commence work on site.
Once you have submitted all the relevant documents, you will need to make an
appointment with WHS Department to be Company Inducted by the WHS Manager,
Contractor Administrator or Site Supervisor.
A mutual appointment needs to be arranged to undertake a MDJH Company
Induction either at MDJH offices or at an acceptable place of work. This process
should take no more than 30 – 40 minutes. These appointments can also be made
either early in the day 6 - 7am or late afternoon to assist minimal disruption to your
workflow.
Prior to the Induction the Subby Pack will need to be returned to McDonald Jones
Homes for WHS Administrator to review.
If all documents are correct and current then on completion of Induction you will be
issued with a McDonald Jones Homes Induction Card.
Any missing documents will need to be provided within 1 week; failure to do so will
result in not being able to commence work on site or may seriously disrupt your future
payments if you are an existing contractor.
Enclosed:
1. MDJH Your Checklist of WHS Requirements
 Example of internal SWMS Checklist
2. Sub – Contractor Questionnaire
3. Housing Industry Site Safety Pack (HISSP)
4. Subcontractors Statement Declaration Form
If you require any further assistance – please contact WHS Administrator on 4918 2241.
Your Checklist of WHS Compliance Requirements
Forms
Safety Plan (HISSP) contains completed documentation as below?
1.
Sub-contractors Questionnaire - Ensure completed correctly?
2.
Organisation Details – Form1 completed, signed & dated?


o
Public Liability
o
Workers Compensation
o
Sickness & Accident (if applicable)
Copy of Licenses (Trade Licenses if applicable issued by DFT)
Occupational Health & Safety Policy – Signed & dated?
4.
Roles & Responsibilities – Signed & dated?
5.
Site-Specific Risk Assessment (SSRA)
6.
No
Supply current copies of all Certificates of Currency
3.

Yes
Provide a completed example of your SSRA to be submitted with your
relevant invoices
Safe Work Method Statement (SWMS)

Completed correctly

Signed by all employers

Copies of all Construction Induction cards
See example of MDJH SWMS checklist page 3
7.
Record of Tool Box Talk - Provide a completed example?
8.
Employee Training Register – Training Identified?
9.
Plant & Equipment Register – Example date/s details provided?
10.
Electrical Equipment Register

11.
Provide recent tagging inspection dates
Hazardous Substance Register (MSDS)

Ensure products used are listed in SWMS and

If possible provide MSDS of product/s used
12.
Housing Industry Site Safety Pack - Ensure completed correctly as above checklist?
13.
Subcontractors Statement Declaration Form - Ensure completed correctly?
Please note:
Contractors must have a copy of the above documentation available on site (i.e. in your ute or truck)
for inspection by Construction Management and WorkCover Inspectors.
All the above can be found in the Housing Industry Site Safety Pack which can be found at the
following link;
http://www.workcover.nsw.gov.au/Documents/Publications/Industry/Construction/housing_industry_sit
e_safety_pack_5723.pdf
This document is the preferred document for McDonald Jones Homes, however is you have a
document that covers all the above, McDonald Jones Homes will review and advise.
If you require further assistance – please contact WHS Administrator on 4918 2241.
Page 3 of 40
Page 4 of 40
WHS FORM 01: ORGANISATION DETAILS
Business or
trading name
(Please attach copy of
business registration)
ACN/ABN
Number of
employees
Scope of works
Insurances
(Attach copies of
Certificates of
currency)
Company Policy
Number
Limit per
claim
Limit year
Expiry date
Workers
compensation
Public Liability
Professional
indemnity
Sickness &
accident
Contract license
number
Name of director
or manager
Business address
Telephone
Mobile
Facsimile
Email
Person for
managing WHS
on site
Contact
details
We do/do not intend to subcontract all or part of the works.
If engaged, the sub-subcontractors intended to be used on this site are:
Business
Contact
details
We shall ensure that the above subcontractors provide an SWMS for their specialised work &
shall review & amend the SWMS as appropriate
Signed (Director
Date
or Manager)
Page 5 of 40
DISCLAIMER
The authors of the Housing Industry Site Safety Pack (the Site Safety Pack) expressly disclaim any and all
liability and responsibility to any person in respect of anything, or the consequence of anything, done or omitted
by any person in reliance, whether wholly or partially, upon the whole or any part of this document.
DUTY OF CARE
As a contractor you have a duty of care to review work areas and activities to ensure your safety and that of
others. The Site Safety Pack is not intended to be a substitute for specific legal advice, but to provide guidance to
enable you to manage your occupational health and safety (WHS) in a systematic manner. You may need to
develop additional information, taking into account the circumstances specific to site conditions, trade interface,
client requirements and individual company policies and procedures.
All WHS documents should be regularly reviewed and updated to reflect changes to legislation, codes of practice,
Australian Standards and organisational policies and procedures.
ACKNOWLEDGEMENT
The Site Safety Pack has been developed by the following residential construction industry partners:

Housing Industry Association (HIA)

Housing Industry Consultative Committee (HICC) representatives:
o
ATF Hire Group
o
Australand
o
Clarendon Residential Group
o
Masterton Homes
o
Mirvac Homes
o
Master Builders Association (MBA)
o
WorkCover NSW.
INTRODUCTION
We have developed the Site Safety Pack to assist small businesses (0-10 employees) working in the residential
construction sector.
The Site Safety Pack provides a framework for you to meet your main WHS legal responsibilities. By following
this guidance you will be better placed to ensure a safe construction site.
Authorities, clients and principal contractors may require evidence of your WHS system. If you use the Site
Safety Pack as directed, you will be able to produce the necessary documents.
Page 6 of 40
PAGE/WHS
FORM
CONTENTS
How to Complete this Document
1
Your Checklist of WHS Compliance Requirements
3
Example of MDJH SWMS Checklist
4
WHS Form 01: Organisation details
5
Disclaimer, Duty of Care & Acknowledgment
6
Introduction
6
Contents Page
7
MDJH Contractor Questionnaire
8
WHS Form 02: Occupational Health & Safety Policy
10
WHS Form 03: Roles and Responsibilities
11
Consultation and Communication
12
Risk Management
13
Safe Work Method Statement – Hazard Identification, Risk Assessment and Control
14
Training
15
Plant and Equipment
16
Electrical
16
Hazardous Substances
16
Hazard Reporting
17
Injury and Incident Investigation
17
WHS Form 04: Site Specific Risk Assessment (SSRA)
18
WHS Form 05: Safe Work Method Statement (SWMS)
20
WHS Form 06: Record of Tool Box Talk
30
WHS Form 07: Employee Training Register
32
WHS Form 08: Plant & Equipment Register
33
WHS Form 09: Electrical Equipment Register
34
WHS Form 10: Hazardous Substance Register and Risk Assessment
35
WHS Form 11: Incident and Injury Report
36
Subcontractors Statement of Declaration & Notes
Page 7 of 40
Contractor Questionnaire
(Required to be completed & sent to MDJH Annually)
1. Full Trading Name:
2. Address:
3. Phone Number:
4. ABN Number……………………………………………………………………
Company
Trust
ACN Number.…………………………………………………………………..
Sole Trader
Partnership
Please note: Accident and Illness insurance is compulsory for Sole
Traders and all working partners of Partnerships (Please attach certificate of currency)
5. Nature of Services Provided:
Do you supply your own tools and materials?
Yes
No
6. If yes to Q6, brief description of tools and materials:
7. Is the supply of labour involved with the operation of machinery or the delivery of goods?
For example Bobcat, Backhoe, Tipper bins?
Yes
No
8. Have you been engaged by McDonald Jones Homes for less than 90 days in the past year?
(Any part day counts as a whole)?
9. Do you contract with principals other than McDonald Jones Homes?
10. .Do you employ people other than directors, partners?
Yes
Yes
No
Yes
No
No – go to question 13
11. How many people employees?
12. Are staffs employed full-time or part-time?
Controlled Document
Contractor Questionnaire
Full-time / Part-time
Version 3
Issue Date: February 2012
Page 1 of 2
Issued by: LM/Contractor Administrator
Page 8 of 40
Page 9 of 40
13. Do you sub-contract any of the services you provide to McDonald Jones Homes?
Yes – go to question 14
No – go to question 15
14. Please list names and contact details of all subcontractors.
15. Have all your employees/subcontractors who work on McDonald Jones Homes Construction Sites
been issued with a McDonald Jones Company Induction card?
Yes
No
Is your business registered for payroll tax?
Yes
No
If Yes, please provide the state in which you are registered and the number:
State ……………………………………..Registration Number………………………………………………………
Do you have a Contractor’s License issued by the department of Fair Trading?
Yes
No
If yes, please attach a copy. Please note: a must be provided before you commence work on any of
our work sites.
Print Name:
Signature:
Position:
Date:
Controlled Document
Contractor Questionnaire
Version 3
Issue Date: February 2012
Page 1 of 2
Issued by: LM/Contractor Administrator
Page 10 of 40
WHS FORM 02: OCCUPATIONAL HEALTH AND SAFETY POLICY
We believe that the well-being of people employed at work, or people affected by our work, is
a priority and must be considered during all work performed on our behalf.
People are our most important asset and occupational health and safety (WHS) is everyone’s
responsibility. The safety of the public is given equal priority to that of our employees.
The objectives of this policy are to, as far as reasonably practicable: 
achieve a safe and incident free workplace

consider WHS in project planning and work activities

involve employees and subcontractors in the decision-making process through regular
communication and consultation

encourage employees and subcontractors to identify and control risks in the workplace

monitor and review the elimination or control of potential risks

enhance employees’ WHS knowledge through a program of education and training.
The success of our WHS management depends on:

the commitment of all persons to achieving the policy objectives

planning work activities with due consideration given to WHS

undertaking the risk management process in an effective manner

promoting communication between employees and subcontractors.
We are committed to fulfilling the objectives of this policy and expect the same of all
employees and subcontractors working on our behalf.
_______________________
Name and position (print)
_____________
Signature
Page 11 of 40
Date: ____/____/____
WHS FORM 03: ROLES AND RESPONSIBILITIES
The owner/director/manager (delete as appropriate), _____________________________________ has
overall responsibility for the safe conduct of all work activities carried out on behalf of the business.
The roles and responsibilities of employees are listed below.
OWNER / DIRECTOR / MANAGER’S RESPONSIBILITIES
The owner/director/manager is responsible for WHS on the project. Duties include:










implementing the WHS procedures
observing all legal WHS requirements
ensuring that all works are conducted in a manner without risk to employees’ WHS
planning to do all work safely
participating in the planning and design stages of trade activities
identifying WHS training required for an activity
ensuring workers undertake identified WHS training
communicating and consulting with employees
investigating hazard reports and ensuring that corrective actions are undertaken
assisting in rehabilitation and return to work initiatives.
Signed by:
Date:
SUPERVISOR OR LEADING HAND
The supervisor or leading hand is responsible for operational safety on the project. Duties include:
 making decisions about WHS that may affect work activities and/or others
 ensuring legal WHS requirements are met in the workplace
 actioning safety reports and carrying out workplace inspections
 facilitating the preparation of SWMS (including those for trades)
 ensuring safe work practices at all times
 conducting project inductions, toolbox talks and daily team briefings
 participating in accident or incident investigations
 leading by example and promoting WHS at every opportunity
 supervising and ensuring compliance with safe work procedures.
Signed by:
Date:
EMPLOYEES
Every individual employee is responsible for:
 conducting their allocated tasks in a safe manner and in accordance with their training and
experience
 giving due consideration to the safety of all others
 co-operating in matters of WHS
 leaving their work site in a safe condition
 complying with the SWMS and is encouraged to participate in the development of all SWMS
 complying with the site safety rules (including those set down by the principal contractor) in the
site induction.
Page 12 of 40
CONSULTATION AND COMMUNICATION
Promote active participation of all employees in WHS decisions.
Consult with employees and give them the opportunity, encouragement and training to be involved in
WHS matters affecting the organisation and their own work.
Matters for consultation may include:

hazard and risk identification

control measures for managing hazards and risks

the development of safe work method statements or risk assessments

site induction

changes to site conditions

emergency procedures, covering:
o
emergency contact details (including emergency services)
o
the location of a first aid kit
o
emergency assembly points.
Record consultation and communication using:

the record of toolbox talk (see WHS form 06)

a site diary

any documents clearly recording WHS meeting minutes.
Consultation records should include at least the following information:

date

location or workplace

names and signatures of people present and consulted

items or issues raised

corrective actions to be undertaken and the people responsible for implementing those actions.
Page 13 of 40
RISK MANAGEMENT
Hazards versus risks
Hazards are different to risks.
A hazard has the potential to cause harm. This can include substances, plant, work processes and/or
other aspects of the work environment.
A risk is the likelihood that death, injury or illness might result because of a hazard.
Risk management cycle
WHS laws require anyone in control of a workplace or a workplace activity to identify any potential
hazards, assess the risks associated with those hazards and (if necessary) implement control
measures to eliminate or minimise the risks.
All persons must have an understanding of the five-step risk assessment process. Incorporate the five
steps into all work activities. If any persons are concerned with the control measures used in a
workplace activity, they should bring this to the attention of their direct manager.
Step 1: Identify hazard
Hazards should be assessed by any person undertaking a work activity. When assessing what is a
hazard, consider: the work environment such as height or confined spaces, substances such as
chemicals, plant and equipment, energy such as electricity, gas or induced heat, manual handling,
noise, etc. Assess all identified hazards on their own merit.
Step 2: Assess risk
Once a hazard has been identified, determine how serious the risk is. Do this by assessing the
likelihood of an event happening and the consequence should the event occur.
Page 14 of 40
Table 1: Assessing the risk
RISK
ACTION REQUIRED
High
Medium
Low
Potential death,
permanent disability or
major structural
failure/damage.
Hospitalisation or medical
treatment, potential
temporary disability or
minor structural
failure/damage.
Hazard that has the
potential to cause
persons to require first
aid.
Cease work immediately.
Implement suitable
controls as soon as
practical.
Review task and reinforce
control measures where
applicable.
Review task/situation/
condition.
Additional risk controls
and must be documented
and implemented.
Task/situation/condition to
be reviewed and reinforce
control measures where
applicable.
Ensure all parties are
aware of risk control.
Table 2: Hierarchy of controls
Use personal
protective
equipment
Eliminate
Substitute
Isolate
Engineering
Administrative
Remove the
risk, process or
task.
Replace the risk
with a less
hazardous
material,
process or plant.
Separate the
people from the
hazard or the
hazard from the
people.
Structural or
design change
to the working
environment,
equipment or
work process.
Reduce
exposure to the
hazard through
procedural
instructions,
training, signage
or permits.
Examples
Examples
Examples
Examples
Examples
Examples
Removal of trip
hazard, removal
of asbestos,
working at
heights.
Fibreglass
insulation for
non-fibrous
insulation, lead
based paint for
lead free paint.
Fencing,
barricades or
removing people
from the work
area.
Edge protection,
lock out devices,
guards on
rotating parts.
SWMS,
signage, permit,
training, tagging,
inspection.
Safety glasses,
gloves, hardhat,
harness.
Best
Last line of
defence, worn
by workers.
Selected PPE
must be fitted
correctly and
maintained used
in accordance
with
manufacturer’s
instructions.
Worst
Page 15 of 40
Step 3: Decide on control measures
Develop and decide on a suitable control measure that will ensure that the hazard is either eliminated (where possible) or reduced
to its lowest possible level using the hierarchy of controls, (Table 2).
Step 4: Implement control measures
Implement control measures in line with the hierarchy of controls.
Step 5: Monitor and review
Take steps to monitor and review the effectiveness of implemented control measures by:

consulting with employees

identifying any new hazards and undertaking further risk assessments

Analysing accident and incident reports.
SAFE WORK METHOD STATEMENT –
HAZARD IDENTIFICATION, RISK ASSESSMENT AND CONTROL
Identify any potential hazards of the proposed work, assess the risks involved and develop controls to
eliminate or minimise the risk. Carry out the risk management process in consultation with your
employees.
Do not commence construction work unless:

the principal contractor has provided the relevant parts of their workplace WHS management
plan or equivalent (only applies where the project work costs exceed $250,000)

you have undertaken an assessment of the risks associated with the work to be carried out and
provided to the principal contractor a written safe work method statement (SWMS)

you have conducted a site-specific risk assessment (see WHS form 04) before undertaking work
on site, if site conditions change (e.g. weather, additional trades) and if the scope of work
changes.
Maintain an SWMS for each task undertaken on the project and provide the principal contractor with
any changes made to the SWMS.
Page 16 of 40
TRAINING
Ensure that all employees undertake a minimum of three levels of induction training prior to
commencing work:

general industry (safety awareness) training

site-specific induction training

work activity training (as noted in the SWMS).
Give all employees appropriate instruction and training so they can carry out their work activities safely,
including:

site safety rules

the handling of hazardous substances in line with the material safety data sheets (MSDS)

fire fighting equipment

manual handling techniques

the safe use of power tools

working at heights (including the safe use of ladders)

PPE.
Record all employee training on one or more of the following forms:

employee training register (see WHS form 07)

safe work method statement training declaration (see WHS form 05)

record of tool box talk (see WHS form 06).
Page 17 of 40
PLANT AND EQUIPMENT
Ensure that employees are familiar with hazards and risks associated with the use of plant and
equipment, and the requirements for regular inspection and maintenance.
Carry out regular inspection and maintenance of all plant and equipment used.
Ensure that plant and equipment is inspected and maintained in accordance with the relevant
standards and manufacturer’s recommendations. Document the inspection and maintenance history of
each item and make it available with the relevant plant or equipment.
Document and implement control measures for all plant and equipment. Assess the effects of all plant
and equipment on the workplace and document the risks in the SWMS.
Ensure that pre-start checks, schedules of maintenance and fault reports are notified to the supervisor,
documented in plant log books and made available to relevant parties on request.
Where plant and equipment is hired, the same requirements as above still apply.
Record inspections on one or more of the following forms:

plant and equipment register (see WHS form 08)

site-specific risk assessment – also known as pre-start inspection (see WHS form 04).
ELECTRICAL
Test and tag all electrical plant and equipment before use. List the equipment and plant on the SWMS.
Inspect, test and tag all portable electrical equipment on at least a three-monthly basis.
Ensure that all residual current devices (RCD’s) are calibrated and tested by a qualified electrician
every three months, and trip tested by a competent person monthly or prior to each use.
Record inspections of all electrical equipment on the electrical equipment register (see WHS form 09),
or an equivalent record, and make them readily available.
HAZARDOUS SUBSTANCES
Use the hazardous substance register and risk assessment (see WHS form 10 in) to record all
products classified as hazardous. Include the product name, its application, an assessment of the risks
associated with the product use and the control measures that will be implemented and included in the
SWMS.
Upon request, make available for inspection on site a current MSDS (within five years of the date of
issue) for hazardous products and substances that are to be used for the work activity.
Provide all employees involved with hazardous products and substances with information and
instruction on their use and handling.
Page 18 of 40
HAZARD REPORTING
Ensure that all hazards are reported to the supervisor and the principal contractor immediately.
Record the details of any additional hazards in a site diary or in the site-specific risk assessment (see
WHS form 04).
INJURY AND INCIDENT INVESTIGATION
Ensure that all incidents and injuries are reported to the supervisor and are recorded on the incident
and injury report (see WHS form 11).
Investigate all incidents, record them on the incident and injury report and provide a copy to the
principal contractor upon request.
Notify the authorities if an incident or injury results in a person being killed or could be defined as a
‘serious incident’. Authorities also require that the place of work is ‘not to be disturbed’ except by
actions relating to emergency rescue.
Page 19 of 40
WHS FORM 04: SITE-SPECIFIC RISK ASSESSMENT
SCOPE OF WORKS:
Supervisor:
PRINCIPAL CONTRACTOR:
DATE:
TIME:
SITE ADDRESS:
PERSON COMPLETING:
(Print)
SIGNATURE:
#
Contractor Work Activity - Site-Specific Risk Assessment (SSRA)
1
Ensure you complete a written Site-Specific Risk Assessment SSRA (This Document Accurately)
2
Have all employees completed WHS training (general, company induction and work-specific tasks)?
3
Have all employees read and understood the SWMS and is it accessible on site?
4
Have all employees been instructed on safe working practices (e.g. manual handling)?
5
Do you have the correct type of first aid kit, and is it stocked and accessible for use?
6
Have all employees been trained in the safe use of power tools?
7
 Hard hat
 Safety boots
 Hi-visibility vest  Hat
Specify PPE
required.
 Eye protection
 Sunscreen
8
Hazardous substance register on site & all relevant persons trained in substances safely?
9
Is appropriate fire-fighting equipment on site for flammable substances or hot works?
Yes
No
N/A
 Hearing protection
 Gloves
 Sun protective clothing
10
Have all employees reviewed site safety plan & the site safety signage before commencing work?
11
All the electrical equipment tested and tagged, and is the electrical tagging register on site?
12
Are all electric outlets (generator, meter box, etc) protected by an RCD unit?
13
Have all tools and equipment been serviced and are they in good working order?
14
Have all plant and tools been inspected and are they fit for purpose?
15
Is there guarding on all machinery, covering all moving parts?
16
Site security fencing intact (no gaps or missing fencing panels) gates secured?
17
Is the work area clear of rubbish and debris, and is an area provided for debris?
18
Are materials delivered and stored in a safe and responsible manner in your work area?
19
Are amenities on site clean and accessible for use?
20
Are all fall zones protected?
21
Have all safety systems (e.g. scaffolding and guard railing) been inspected and are they safe to use?
22
Has the stairwell and open penetrations protection system been installed?
23
Is there a safe path of travel to all work areas and have all trip hazards been identified?
24
Have all trenches and excavations been backfilled, covered or barricaded?
HAVE YOU ELIMINATED ALL POTENTIAL RISKS FROM ANY OTHER HAZARDS IDENTIFIED ON SITE THAT MAY AFFECT YOUR WORK TASK?
If you answer No? You must complete the risk assessment table below and consult with all employees and subcontractors before commencing
any work. If you cannot remove or control the hazard, please contact your construction supervisor for advice before starting any work.
Hazard identified
Risk
Controls implemented
By whom
Low
Medium
High
Hazard that has the potential to cause
persons to require first aid.
Hospitalisation or medical treatment, potential temporary disability
or minor structural failure/damage.
Potential death, permanent disability or
major structural failure/damage.
Hierarchy of controls (Best)
Eliminate the risk all
together.
(Worst)
Substitute the
risk.
Isolate people from the
risk.
Engineer out the
risk.
Apply administrative
controls.
Use personal protective
equipment (PPE).
WHS FORM 04: SITE-SPECIFIC RISK ASSESSMENT
SCOPE OF WORKS
PRINCIPAL CONTRACTOR
TIME
DATE
SITE ADDRESS
PERSON COMPLETING
THIS ASSESSMENT
SIGNATURE
Site-specific work activity – risk assessment
Yes
No
N/A
Contractor assessment
1
Have all employees completed WHS training (general, site induction and workspecific tasks)?



2
Have all employees been instructed on safe working practices (eg manual
handling)?



3
Have all employees read and understood the SWMS and is it accessible on site?



4
Do you have the correct type of first aid kit, and is it stocked and accessible for
use?



5
Have all employees been trained in the safe use of power tools?



6
Specify the
PPE
required.
 Hard hat
 Safety boots
 Eye protection
 Hearing protection
 Hi-visibility vest
 Hat
 Sunscreen
 Sun protective clothing
7
Is the hazardous substance register on site and are all relevant persons trained in
using and handling the substances safely?



8
Do you have the appropriate fire-fighting equipment on site for flammable
substances or hot works?



9
Have all employees reviewed the site safety signage before commencing work?



Equipment assessment
10
Has all the electrical equipment been tested and tagged, and is the electrical
tagging register on site?



11
Are all electric outlets (generator, meter box, etc) protected by an RCD unit?



12
Have all tools and equipment been serviced and are they in good working order?



13
Have all plant and tools been inspected and are they fit for purpose?



14
Have all ladders used on site been inspected and are they fit for purpose?



15
Is there guarding on all machinery, covering all moving parts?



Site assessment
16
Is the site security fencing intact (with no gaps or missing fencing panels) and are
gates chained and padlocked?



17
Is the work area clear of rubbish and debris, and is an area provided for debris?



18
Are materials delivered and stored in a safe and responsible manner in your work
area?



19
Are the public and other workers protected during work activities?



20
Are amenities on site clean and accessible for use?



21
Are all fall zones protected?



22
Have all safety systems (eg edge protection, scaffolding and guard railing) been
inspected and are they safe to use?



23
Has the stairwell and open penetrations protection system been installed?



24
Is there a safe path of travel to all work areas and have all trip hazards been
identified?



25
Have all trenches and excavations been backfilled, covered or barricaded?






HAVE YOU ELIMINATED ALL POTENTIAL RISKS FROM ANY OTHER HAZARDS
IDENTIFIED ON SITE THAT MAY AFFECT YOUR WORK TASK?
If you answer No to any of the items above – you must complete the risk assessment table below and
consult with all employees and subcontractors before commencing any work. If you cannot remove or
control the hazard, please contact your construction supervisor for advice before starting any work.
Identify below any hazard (plant or substance or process) that could be a risk to WHS, and list the controls taken.
Hazard identified
Risk
(1-6)
Controls implemented
Risk
(4-6)
By whom
Risk rating score 1-6
POSSIBLE RISK
Very likely
Likely
Unlikely
Very unlikely
Death or permanent disability
1
1
2
3
Long term illness or serious injury
1
2
3
4
Medical attention or days off work
2
3
4
5
First aid needed
3
4
5
6
Page 22 of 40
This SWMS has been developed and authorised by:
Insert:
1. Company Logo or Business Card
2. ABN Number
Name:
Position:
Date:
Phone:
Signature:
Mobile:
SAFE WORK METHOD STATEMENT (SWMS) (Job Safety Analysis Worksheet – Scope of Works)
DESCRIPTION OF WORK SPECIFIC TO THE ACTIVITY / TASK BEING UNDERTAKEN:
Trades involved with undertaking this Work Activity / Task:
This Safe Work Method Statement is submitted to: (Principal / Head Contractor)
COMPANY:
CONTACT NAME:
PHONE NUMBER:
SITE ADDRESS:
PROJECT DETAIL:
This Safe Work Method Statement was reviewed by: (Principal / Head Contractor)
NAME:
POSITION:
SIGNATURE:
DATE:
PHONE NUMBER:
MOBILE NUMBER:
Responsible person who will implement, review supervise, oversee, approve & inspect workplace, plant, tools, protective measures & equipment on Contractors
behalf).
NAME:
POSITION:
SIGNATURE:
DATE:
PHONE NUMBER:
MOBILE NUMBER:

Equipment To be used
Extension Ladder
Step Ladder
Scaffold (Mobile)
External Scaffold
Fire extinguisher
Trestles
Electrical Leads
Power Tool
Generator
RCD power board
Hand Tools
Nail Gun
Wheelbarrow
Shovel
Insert other equipment
Cement Mixer

Personal Protective Equipment to be
used. has PPE been supplied
Hard Hat
Safety Boots
Safety Vest
Gloves
Hearing Protection
Safety Glasses
Barrier Cream
Safety Lines
Safety Harness
Dust Masks
Other:
Y/N
Common Hazard

Fall from ladder
Fall from heights
Fall from scaffold
Contact with electricity
Dermatitis
Slip, trips and falls
Manual handing
Inhalation of dust or fumes
Exposure to noise
Contact with moving plant
Cuts
Other:
How to complete the following form
 List the step-by-step sequence of tasks required to carry out a work activity from start to finish.
 List the potential hazards associated with each step, and the related WHS risks.
 List what controls you will implement to reduce the risks to the lowest possible level.
 List the names or positions of the persons responsible for ensuring that the controls are implemented.
A separate SWMS is required for each work activity.
Assessing the Risk
High
RISK
ACTION
REQUIRED
Medium
Low
Potential death, permanent disability or major structural
failure/damage.
Hospitalisation or medical treatment, potential temporary disability
or minor structural failure/damage.
Hazard that has the potential to cause persons to
require first aid.
Cease work immediately
Implement suitable controls as soon as practical.
Review task / situation/ condition
Task / situation/ condition to be reviewed and reinforce control
measures where applicable.
Review task and reinforce control measures where
applicable.
Additional risk controls and must be documented
& implemented
Ensure all parties are aware of risk control
Hierarchy of Controls
Eliminate the risk
altogether
Substitute the risk
Isolate people from the risk
Engineer out the risk
Page 24 of 40
Apply Administrative
Controls
Use Personal Protective
Equipment (PPE)
S
T
E
P
Job Step
Break the job down into
steps, Outline each task
to do the job
Hazards Identification
Identify any potential hazards associated
with each job step. Access any risks that
could lead to an incident or lead to an
adverse environmental impact and rate
each risk accordingly.
Controls Implemented
Using the previous two columns as a guide, decide
what actions are necessary to eliminate or minimise the
hazards that could lead to an accident, injury or
occupational illness or environmental impact.
1.
2.
3.
4.
Page 25 of 40
Person
Responsible
S
T
E
P
Job Step
Break the job down into
steps, Outline each task
to do the job
Hazards Identification
Identify any potential hazards associated
with each job step. Access any risks that
could lead to an incident or lead to an
adverse environmental impact and rate
each risk accordingly.
Controls Implemented
Using the previous two columns as a guide, decide
what actions are necessary to eliminate or minimise the
hazards that could lead to an accident, injury or
occupational illness or environmental impact.
5.
6.
7.
8.
Page 26 of 40
Person
Responsible
S
T
E
P
Job Step
Break the job down into
steps, Outline each task
to do the job
Hazards Identification
Identify any potential hazards associated
with each job step. Access any risks that
could lead to an incident or lead to an
adverse environmental impact and rate
each risk accordingly.
Controls Implemented
Using the previous two columns as a guide, decide
what actions are necessary to eliminate or minimise the
hazards that could lead to an accident, injury or
occupational illness or environmental impact.
9.
10.
11.
12.
Page 27 of 40
Person
Responsible
S
T
E
P
Job Step
Break the job down into
steps, Outline each task
to do the job
Hazards Identification
Identify any potential hazards associated
with each job step. Access any risks that
could lead to an incident or lead to an
adverse environmental impact and rate
each risk accordingly.
Controls Implemented
Using the previous two columns as a guide, decide
what actions are necessary to eliminate or minimise the
hazards that could lead to an accident, injury or
occupational illness or environmental impact.
13.
14.
15.
16.
Page 28 of 40
Person
Responsible
S
T
E
P
Job Step
Break the job down into
steps, Outline each task
to do the job
Hazards Identification
Identify any potential hazards associated
with each job step. Access any risks that
could lead to an incident or lead to an
adverse environmental impact and rate
each risk accordingly.
Controls Implemented
Using the previous two columns as a guide, decide
what actions are necessary to eliminate or minimise the
hazards that could lead to an accident, injury or
occupational illness or environmental impact.
17.
18.
19.
20.
Page 29 of 40
Person
Responsible
ITEMS REQUIRED FOR THIS WORK ACTIVITY
TRAINING and QUALIFICATIONS
Examples:




Workcover Construction Induction
HR Licence
Backhoe Licence
Trade Licence
WorkCover General Induction to Construction
Please attach relevant copies of the above
NSW WHS LEGISLATION
 WHS ACT
 WHS Regulation
 National Standard for Construction Work
NSW WHS Act 2011
NSW WHS Regulation 2011
National Standard for Construction Work
Examples of these which may be relevant to your work
activity please add or delete as necessary i.e.
CODES OF PRACTICE








Manual Handling
Moving Plant and Equipment
Hazardous Substances
Electrical Practices for Construction Works
Working At Heights
Work Near Overhead Power Lines
Manual Handling
Excavation
 Electrical Practices for Construction Works
 Manual Handling
and Guides:
 Safe work at Heights
 Falling Objects
 Masonry Wall
AUSTRALIAN STANDARDS: (relevant)
 AS/NZ (list)?





Guide Lines for Scaffolding AS4576 & AS1576:1-3
Domestic Guard Rail AS4994:1-3 & AS1576:1-3
Electrical Wiring Rules AS3000 / AS3018
Ladders AS1892.5
Respiratory Protection Devices AS1715 & 1716
 Eye Protection AS1336 &1337
COMMUNICATION AND CONSULTATION
Consult with employees and give them the opportunity,
encouragement and training to be involved in WHS matters i.e.

hazard and risk identification,

control measures for managing hazards and risks

development of SWMS and SSRA’s.
Record monthly consultation and communication using:

Toolbox Form 6 and provide an example

Keep these on file for due diligence
Page 30 of 40
Declaration by Contractors & Workers:
1. I have been consulted and assited in the development of this Safe Work Method Statement (SWMS).
2. I have been given the opportunity to make comment on the content of this SWMS I have read and understood how I am to carry out the tasks listed in this
SWMS.
3. I have been supplied with the appropirate Personal Protective Equipment that has been identified on this SWMS and I have been given training in the safe
use of this equipment.
4. I have read and understood the requirements set out in the Mateial Safety Data Sheets for the Hazardous Substances which have been identified in this
SWMS for this particular work activity.
PLEASE LIST ALL MATERIAL SAFETY DATA SHEETS USED ON SITE.
All Contractors/Workers/Employees to sign
NAME
SIGNATURE
DATE
Page 31 of 40
WHS FORM 06: COMMUNICATION & CONSULTATION: - RECORD OF TOOL BOX TALK
Company Name:
Date:
Name of presenter:
Subject: Delivery & Installation of (Insert product or work activity)
Time:
Persons present
Name (Print)
Signature
Issues raised: Example of potential subject matter
(add & delete as appropriate)
1. New / Existing client I.e. MDJH
2. Overview of SWMS & Sign Declaration
3. Site Specific Risk Assessment (SSRA) Overview
(Must be completed prior to undertaking the work
activity task & attached to invoice)
4. Safety of Vehicle Load & Off Loading
5. Basic Traffic Management (Parking)
6. Overhead Electrical (If Applicable)
7. Underground Services (DBYD) – Pits (If Applicable)
8. Working at Heights (If Applicable)
9. Safe Delivery i.e. (Stacked / Stored Level)
10. EPA – Mud on the road & noise etc
11. Complete documentation (If Applicable)
12. Site Security – Ensure site left secure
13. Any issues on site with delivery please contact
operations to address prior to leaving site.
14. Any other issues?
Name
Comments arising:
Signature
Y N (Place any action outcomes in table below)
Action/s
Action completed
Person
responsible
Name
Signature
Comments:
1
2
3
4
5
6
Actions Required: On Completion scan a copy for communication & consultation files & Keep for 5years.
Page 33 of 40
Date
WHS FORM 07: EMPLOYEE TRAINING REGISTER
Name: _______________________________________________________________ Date employment started: ________________________
Examples of training:




WHS general induction for construction work
basic scaffold
mobile crane licence
skid steer or front end loader licence




excavator licence
forklift licence
vehicle loading crane licence
use of hazardous substances
 trade or contractor licence
 work activity training
 tools and equipment.
Please write clearly.
Type of training or certification
Certificate or card number
(if applicable)
Instructor’s name
Date of training
Expiry or renewal date
(if applicable)
Page 35 of 40
WHS FORM 08: PLANT AND EQUIPMENT REGISTER (IF APPLICABLE-
Insert N/A if not)
Include details of all plant and equipment to be used during the work activities.
Examples include lifting gear, fire-fighting equipment, mobile plant and fall restraint equipment.
Company name:
Address:
Plant or equipment type
Serial no or registration no
Make and model
Page 36 of 40
Date last serviced or
maintained
(record required)
Required maintenance frequency
(as per manufacturer’s instructions)
WHS FORM 09: ELECTRICAL EQUIPMENT REGISTER (IF APPLICABLE-
Insert N/A if not)
Inspect, test and tag all electrical equipment, including extension leads.
Company name:
Address:
Equipment
description
Electrical company (if required):
Address:
Manufacturer
Serial
number
Date of
inspection
and test
Result
Action to be
taken
Electrical item
Signature of
person
undertaking the
work
Certificate
number (if
appropriate)
Frequency of inspection and test
Tools and leads
Every three months
RCD unit (sub-board earth leakage device)
Trip-test on a monthly basis
Calibrate every three months
Page 37 of 40
Date for next
inspection and
test
WHS FORM 10: HAZARDOUS SUBSTANCE REGISTER AND RISK ASSESSMENT
(If Applicable- INSERT N/A IF NOT)
Product name
Application
Product
labelled?
(Yes/No)
MSDS date of issue no
older than five years?
(Yes/No)
Page 38 of 40
Risk
rating
(1–6)
Controls to be implemented
Note: Incorporate these controls into the
SWMS
WHS FORM 11: INCIDENT AND INJURY REPORT
Details of incident (e.g. property, plant or environmental damage)
am  pm 
Time of incident
Date of incident
Nature of incident
Location of incident
Description of incident
Details of damage to
equipment or property
Name of person who
received the report
Reported to
authorities?
Telephone
Yes
Provide details (when and whom):
No
Details of injury (e.g. to a worker or visitor) and treatment
Date of incident
Time of incident
Name of injured person
Date of birth
Address
Telephone
Occupation
Employer
am  pm 
Activity in which the
person was engaged at
the time of injury
Exact site location
where injury occurred
Nature of injury – e.g.
fracture, burn, sprain,
foreign body in eye
Body location of injury
(indicate location of
injury on the diagram)
Treatment given on site
Referral for further
treatment?
Name of treating
person
Yes
No
Name of doctor or hospital:
Medical certificate
received?
Yes Attach copies
No
Injury management
required?
Reported to authorities
Yes Notify return to work coordinator
No
Yes
No
Name of return to
work coordinator
Provide details (when and whom):
Witness to incident (each witness may need to provide an account of what happened)
Witness name
Witness contact
Witness name
Witness contact
INVESTIGATION
Cause of incident or injury
Preventative actions (include what needs to be done, who will do it and when it will be done)
Completed by
Name
Position
Signature
Date
Page 40 of 40