Employer’s Name
Construction Work Hazard Inspection Checklist
Work Health and Safety Management Plan
Project Details
Project Title
Project Number
Project Address
Proposed Completion Date:
Start Date:
Contractor/Employer/Owner Employers Name
Details
Type of Appointment of Principal Contractor
Person Accepting Duties of Principal Contractor:
Management Structure for the Project:
Address:
Phone:
Mobile:
Fax:
E-mail:
Client Details
Client Name
Address:
Phone:
Mobile:
Fax:
E-mail:
ABN
Construction Project
Details:
Type of Construction Work
Address of the Workplace
Anticipated Start and End Date
Approval
Approved by:
Name
Signature
Date
This document MUST be completed, approved, and signed before the commencement of work. It is
acknowledged that this Work Health and Safety Management Plan has been tailored to this particular
project and MUST be kept at the workplace (site) at all times.
Page 1 of 38
Compiled –10/2012
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4.13.2
Employer’s Name
Table of Content
ITEM
PAGE NUMBER
Definitions ………………………………………………………….…....
Introduction ……………………………………………………………...
Construction Project……………………………………………………
Site Supervision ………………………………………………………...
Contractors Engaged Listing ………………………………………….
Scope of Project ………………………………………………………..
High Risk Construction Work (Safe Work Method Statements)
Risk Assessment ……………………………………………………….
Site Specific Safety Processes

Amenities …………………………………………………………..

Common Plant …………………………………………………….

PPE Requirements ………………………………………………..

Induction ……………………………………………………………

Site Rules …………………………………………………………..

Consultation ………………………………………………………..

Site Supervisors Responsibilities ………………………………..

Workers Responsibilities ……………………………….…………

Contractor’s Responsibilities ……………………………..………

First Aid ……………………………………………………………..

Accident / Incident Reporting ……………………………..……...

Emergency Procedures …………………………………………..

Traffic Control ..……………………………………………….……

Public Access ………………………………………………………

Barricading & Signage …………………………………………….

Plant & Equipment Control ……………………………………….

High Risk Work License ………………………………………….

Hazardous Chemicals …………………………………………..
Site Inspections …………………………………………………………
Monitoring & Review …………………………………………………..
Attachment A– Safety Induction Guide ………………………………
Attachment B – Safety Induction Record…………………………....
Attachment C – Record of Certificates & Licences …………………
Attachment D – Toolbox Talk Register ………………………………
Attachment E – Daily Inspection Checklist ………………………….
Attachment F – Monthly Inspection Checklist ………………………
Attachment G - Hazardous Chemical Listing on Site …………….
Attachment H – Project Risks & Controls Chart ……………………
Page 2 of 38
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Employer’s Name
Definitions
Principal Contractor (PC)
A person conducting a business or undertaking that commissions a
construction project is the principal contractor for the project.
If the person above engages another person conducting a business or
undertaking as principal contractor for the construction project and authorizes
the person to have management or control of the workplace and to discharge
the duties of a principal contractor, the person so engaged is the principal
contractor for the project.
If the owner of residential premises is an individual who directly or indirectly
engages a person conducting a business or undertaking to undertake a
construction project in relation to the premises, the person so engaged is the
principal contractor for the project if the person has management or control of
the workplace.
A construction project has only one principal contractor at any specific time.
Construction Project
Is a project that involves construction work where the cost of the construction
work is $250 000 or more?
Construction Work
Means any work carried out in connection with the construction, alteration,
conversion, fitting-out, commissioning, renovation, repair, maintenance,
refurbishment, demolition, decommissioning or dismantling of a structure .
Construction Work includes the following:
(a) any installation or testing carried out in connection with an activity referred
to above;
(b) the removal from the workplace of any product or waste resulting from
demolition;
(c) the prefabrication or testing of elements, at a place specifically established
for the construction work, for use in construction work;
(d) the assembly of prefabricated elements to form a structure, or the
disassembly of prefabricated elements forming part of a structure;
(e) the installation, testing or maintenance of an essential service in relation to
a structure;
(f) any work connected with an excavation;
(g) any work connected with any preparatory work or site preparation (including
landscaping as part of site preparation) carried out in connection with an
activity above*;
(h) an activity referred to above*, that is carried out on, under or near water,
including work on buoys and obstructions to navigation.
Construction Work does not include any of the following:
(a) the manufacture of plant;
(b) the prefabrication of elements, other than at a place specifically established
for the construction work, for use in construction work;
(c) the construction or assembly of a structure that once constructed or
assembled is intended to be transported to another place;
(d) testing, maintenance or repair work of a minor nature carried out in
connection with a structure;
(e) mining or the exploration for or extraction of minerals.
Page 3 of 38
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Employer’s Name
High Risk Construction
Work
Means construction work that:
(a) involves a risk of a person falling more than 2 metres; or
(b) is carried out on a telecommunication tower; or
(c) involves demolition of an element of a structure that is load-bearing or
otherwise related to the physical integrity of the structure; or
(d) involves, or is likely to involve, the disturbance of asbestos; or
(e) involves structural alterations or repairs that require temporary support to
prevent collapse; or
(f) is carried out in or near a confined space; or
(g) is carried out in or near:
(i) a shaft or trench with an excavated depth greater than 1.5 metres; or
(ii) a tunnel; or
(h) involves the use of explosives; or
(i) is carried out on or near pressurised gas distribution mains or piping; or
(j) is carried out on or near chemical, fuel or refrigerant lines; or
(k) is carried out on or near energised electrical installations or services; or
(l) is carried out in an area that may have a contaminated or flammable
atmosphere; or
(m) involves tilt-up or precast concrete; or
(n) is carried out on, in or adjacent to a road, railway, shipping lane or other
traffic corridor that is in use by traffic other than pedestrians; or
(o) is carried out in an area at a workplace in which there is any movement of
powered
mobile plant; or
(p) is carried out in an area in which there are artificial extremes of
temperature; or
(q) is carried out in or near water or other liquid that involves a risk of drowning;
or
(r) involves diving work.
Civil Construction Work
means construction work in relation
to any of the following structures—
(a) an underground works (including shafts and tunnels), pipe, pipeline, sea
defence works, river works, earthworks or earth retaining construction or other
construction designed to preserve or alter a natural feature;
(b) a road or highway, footpath or driveway, railway line or siding, tramway line,
airfield, dock or harbour, water storage or supply system (including a
constructed lagoon), sewerage or drainage system, electricity or gas
generation facility, transmission or distribution facility, gasholder, park or
recreation ground (including, for example, a golf course, playing field,
racecourse or swimming pool);
(c) production, storage or distribution facilities for heavy industries;
(d) a bridge;
(e) a pumping station;
(f) a refinery;
(g) a telecommunications structure.
means work to demolish or dismantle a structure, or part of a structure that is
load-bearing or otherwise related to the physical integrity of the structure, but
does not include—
(a) the dismantling of formwork, falsework, or other structures designed or used
to provide support, access or containment during construction work; or
(b) the removal of power, light or telecommunication poles.
Demolition work
Page 4 of 38
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Employer’s Name
Work Health and Safety
Management Plan
In relation to a construction project, means a management plan prepared or
revised under part 6.4 (Work Health and Safety Regulation 2011)
The principal contractor for a construction project must prepare a written WHS
Management plan for the workplace before work on the project commences.
A WHS Management plan must include the following:
(a) the names, positions and health and safety responsibilities of all persons at
the workplace whose positions or roles involve specific health and safety
responsibilities in connection with the project;
(b) the arrangements in place, between any persons conducting a business or
undertaking at the workplace where the construction project is being
undertaken, for consultation, co-operation and the co-ordination of activities in
relation to compliance with their duties under the Act and these Regulations;
(c) the arrangements in place for managing any work health and safety
incidents that occur;
(d) any site-specific health and safety rules, and the arrangements for ensuring
that all persons at the workplace are informed of these rules;
(e) the arrangements for the collection and any assessment, monitoring and
review of safe work method statements at the workplace.
The principal contractor for a construction project must ensure, so far as is
reasonably practicable, that each person who is to carry out construction work
in connection with the project is, before commencing work, made aware of—
(a) the content of the WHS management plan for the workplace; and
(b) the person’s right to inspect the WHS management plan under section 313.
The principal contractor for a construction project must review and, as
necessary, revise the WHS management plan to ensure that it remains up to
date.
The principal contractor for a construction project must ensure, so far as is
reasonably practicable, that each person carrying out construction work in
connection with the project is made aware of any revision to the WHS
management plan.
The principal contractor for a construction project must take all reasonable
steps to obtain a copy of the safe work method statement relating to high risk
construction work before the high risk construction work commences.
The principal contractor for a construction project must ensure that a copy of
the WHS management plan for the project is kept until the project to which it
relates is completed.
If a notifiable incident occurs in connection with the construction project to
which the statement relates, the person must keep the WHS management plan
for at least 2 years after the incident occurs.
The person must ensure that for the period for which the WHS management
plan must be kept under this section, a copy is readily accessible to any who is
to carry out construction work in connection with the construction project.
The person must ensure that for the period for which the WHS management
plan must be kept under this section, a copy is available for inspection under
the Act.
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Employer’s Name
Safe Work Method
Statements
Means in relation to high risk construction work—a safe work method statement
mentioned in section 299 (as revised under section 302) Work Health and
Safety Regulation 2011. .
Safe Work Method Statement required for high risk construction work
A person conducting a business or undertaking that includes the carrying out of
high risk construction work must, before high risk construction work
commences, ensure that a safe work method statement for the proposed work:
(a) is prepared; or
(b) has already been prepared by another person.
A safe work method statement must:
(a) identify the work that is high risk construction work; and
(b) specify hazards relating to the high risk construction work and risks to
health and safety associated with those hazards; and
(c) describe the measures to be implemented to control the risks; and
(d) describe how the control measures are to be implemented, monitored and
reviewed.
A safe work method statement must:
(a) be prepared taking into account all relevant matters, including:
(i) circumstances at the workplace that may affect the way in which the
high risk construction work is carried out; and
(ii) if the high risk construction work is carried out in connection with a
construction project—the WHS management plan that has been
prepared for the workplace; and
(b) be set out and expressed in a way that is readily accessible and
understandable to persons who use it.
If a safe work method statement for high risk construction work that involves a
risk of a person falling more than 2m states that the only control measures to
be implemented will be administrative controls or the provision of personal
protective equipment, the safe work method statement must describe all control
measures considered in determining which control measures to implement
(including by addressing the general fall protection requirements in section
79(3)).
A person conducting a business or undertaking that includes the carrying out of
high risk construction work must put in place arrangements for ensuring that
high risk construction work is carried out in accordance with the safe work
method statement for the work.
If high risk construction work is not carried out in accordance with the safe work
method statement for the work, the person must ensure that the work—
(a) is stopped immediately or as soon as it is safe to do so; and
(b) resumed only in accordance with the statement.
A person conducting a business or undertaking that includes carrying out high
risk construction work in connection with a construction project must, before the
high risk construction work commences, ensure that a copy of the safe work
method statement for the work is given to the principal contractor.
A person conducting a business or undertaking must ensure that a safe work
method statement is reviewed and, as necessary, revised if relevant control
measures are revised under section 38.
A person conducting a business or undertaking must keep a copy of the safe
work method statement until the high risk construction work to which it relates
is completed.
If a notifiable incident occurs in connection with the high risk construction work
to which the statement relates, the person must keep the statement for at least
2 years after the incident occurs.
The person must ensure that for the period for which the statement must be
kept under this section, a copy is readily accessible to any worker engaged by
the person to carry out the high risk construction work.
Page 6 of 38
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Employer’s Name
Introduction
Employer’s Name acknowledges it has an obligation under the Work Health and Safety Act 2011, associated
Regulation, Standards and Codes for the safety of its employees, contractors, visitors and members of the
public at or near the workplace.
It is also recognised that Employer’s Name is sub contracting to the Principal Contractor (PC) for this project.
This Work Health and Safety Management Plan was compiled ………/……../………. and approved on
……./……./…… by (Name) …………………………………….. and that this particular Work Health and Safety
Plan has been tailored to this particular project.
This Work Health and Safety Plan is to be used in conjunction with the following documentation:
(Inset relevant documents)
1. Quality Plan ………………………………………………………………………………
2. Traffic Management Plan…..…………………………………………………………...
3. Environmental Management Plan………………………………………………………
4. WHS Plan….……………………………………………………………
5. ………………………………………………………………………………………………
6. ………………………………………………………………………………………………
7. ………………………………………………………………………………………………
8. ………………………………………………………………………………………………
.
Construction Projeject
Yes


Construction project over
$250,000
No


Construction work under $250,000
Date:
Comments:
Page 7 of 38
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Employer’s Name
Site Supervision
Title
Name
Contact Details
Project Engineer
Phone:
Mobile:
Project Manager
Phone:
Mobile:
Phone:
Mobile:
Project Supervisor
Site Foreman
Phone:
Mobile:
Safety Advisor
Phone:
Mobile:
Phone:
Mobile:
Phone:
Mobile:
Phone:
Mobile:
Phone:
Mobile:
Health and Safety
Representative
First Aid Officer
Emergency out-of-hours
Contact (list at least two)
Other
Page 8 of 38
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Employer’s Name
Sub - Contractors Engaged Listing
Name
Company
Trade
Scope of Project
Detail the project work:
The project involves construction....
Briefly list the type of construction work to be conducted by Employer’s Name and SubContractors
Page 9 of 38
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Employer’s Name
Employer’s Name
Sub-Contractors
Page 10 of 38
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Employer’s Name
Safe Work Method Statements
The WHS management plan must provide details of the arrangements for the preparation, collection and
any assessment/approval, monitoring and review of safe work method statements at the workplace.
The principal contractor must ensure that there are arrangements in place for the consultation,
coordination and cooperation of all persons engaged in high risk construction work so that the SWMS
used do not conflict or create new hazards or risks to health and safety.
Any contractor or subcontractor undertaking high risk construction work must provide a copy of the SWMS
to the principal contractor prior to commencing the work, and should provide a copy to the contractor that
engaged them to undertake the work.
The plan should include arrangements to ensure that SWMS are followed by all affected workers,
contractors and subcontractors, and that work is ceased if the SWMS is not followed.
Mandatory High Risk Construction Work (Work Health and Safety Regulation 2011,
S299)
Tick for Yes
Is a Safe Work Method Statement (SWMS) for the following
high-risk construction work available? That is, construction
work that:
Safe Work Method Statements
Employers
SWMS
Contractors
SWMS
1
Involves a risk of a person falling more than 2 metres.


2
Is carried out on a communications tower.


3
Involves demolition of an element of a structure that is load-bearing or
otherwise related to the physical integrity of the structure.


4
Involves, or is likely to involve, the disturbance of asbestos.
5
Involves structural alterations or repairs that require temporary
support to prevent collapse.




6
Is carried out in or near a confined space.
7
Is carried out in or near: (i) a shaft or trench with an excavated depth
greater than 1.5metres; or (ii) a tunnel.




8
Involves the use of explosives.
9
Is carried out on or near pressurised gas distribution or mains or
piping.




10
Is carried out on or near chemical, fuel or refrigerant lines.
11
Is carried out on or near energised electrical installations or
services.




12
Is carried out in an area that may have contaminated or flammable
atmosphere.


13
Involves tilt-up or precast concrete.
14
is carried out on, in or adjacent to a road, railway, shipping lane or
other traffic corridor that is in use by traffic other than pedestrians.




15
Is carried out in an area at a workplace in which there is any
movement of powered mobile plant.


16
Is carried out in an area in which there are artificial extremes of
temperature.


17
Is carried out in or near water or other liquid that involves a risk of
drowning.


18
Involves diving work.


Page 11 of 38
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Employer’s Name
Risk Based High Risk Activities (Examples)
1
Protection against Falling Objects
2
Working with cranes.
3
Bitumen Sealing.
4
Using Common Plant.
5
Using Earth Moving Equipment
6
Ladder Single or Extension.
7
Removing Lead Based Paint.
8
Entering a Trench less than 1.5m deep.
9
List Others:
11
12
13
14
15
Have the above indicated Safe Work Method Statements been reviewed to
ensure they meet the requirements, associated risks and controls for this project?






























Who Reviewed: Employer’s Name…………………………………………………..Date: ……./………/……….
Who Reviewed: (Sub-Contractors) …………………………………………………..Date: ……./………/……….
Are the above indicated Safe Work Method Statements attached to this Work
Health and Safety Management Plan?
Page 12 of 38
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
Employer’s Name
Risk Assessment
Where Employer’s Name and /or the Sub-Contractor identifies a high-risk activity, a risk
assessment is to be conducted prior to any work commencing on site. If the risk assessment
concluded that the activity is of an extreme (E) or high (H) risk, a Safe Work Method Statement must
be compiled and communicated by toolbox talks to all relevant workers.
Hierarchy of Control
ELIMINATE – Can the process, material, or
substances be eliminated completely?
SUBSTITUTE – Can the process, material, or
substances be replaced with a safer one?
ISOLATE – Can the process, material,
substances or person be isolated from the
risk?
ENGINEER – Can the process, material, or
substances be re-designed?
ADMINISTRATION – Can we limit exposure
to the risk, by:
 work procedure  training  other
PPE – Can we use Personal Protective
Equipment?
Refer to Attachment H for ‘Project Risk & Control Chart’. This chart allows the opportunity to
insert more risks as they are identified as the project advances.
Note: These are generic risk assessments and need to be tailor to suit the individual site
work.
Site Specific Safety Processes
AMENITIES

Site Office
Location:

Toilets
Location:

Room or sheltered area to eat

Crib Area
Location:

Hand and Washing Facilities
Location:

Drinking Water

First Aid Kit
Location:

External / Security Lighting
Location:
A person with management or control of a workplace at which construction work is carried out must
ensure, so far as is reasonably practicable, that the workplace is secured from unauthorized access.
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Employer’s Name

Other:
Common Plant on Site
Location:
(List and refer to the SWMS for Using Common Plant)

Perimeter Fencing

Scaffolding

Barricading

Toilets

Signage

Wash Areas

Electrical Switchboards

Rubbish Skip






PPE Requirements on Site
(List)

Protective clothing

Respirators (disposal)


Wet weather clothing

Respirators (cartridge)


Safety Footwear

Relevant gloves for
chemicals (refer to MSDS)


Safety Glasses / Goggles

Sun screen


Safety Helmet

Ear muffs or plugs

Refer to Attachment A & B
Induction
General Construction Industry Induction

(Reference: S316, S326, Work Health
and Safety Regulation 2011)
A person conducting a business or undertaking must ensure that
general construction induction training is provided to a worker
engaged by the person who is to carry out construction work, if
the worker:
has not successfully completed general construction
induction training; or
successfully completed general construction induction
training more than 2 years previously and has not carried
out construction work in the preceding 2 years.
A worker carrying out construction work must keep available for
inspection under the Act—
(a) his or her general construction induction training card;
Or
(b) in the circumstances set out in section 319(4) (Work Health
and Safety Regulation 2011), a general induction training
certification held by the worker, until a decision is made on the
application for the general construction induction training card.
Employer’s Name must not allow a person to start construction
work unless the contractor has sighted general induction
evidence for the person. This includes all contractors on site.
Page 14 of 38
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Employer’s Name
Site Specific Induction
The Contractor must ensure that all workers including
contractors are given a specific site induction (as part of site
rules) before allowing the work to commence.

This is to be recorded on at the ‘Site Specific Induction’.
Site Rules
The plan must detail any project specific WHS rules that the principal contractor requires persons to comply
with and the arrangements for ensuring that all persons at the workplace are informed of these rules.
The follow are the rules that are minimum requirements on this Project:
1
All accident/incidents/near misses must be documented and immediately reported to the Site Supervisor
and the Principal Contractors Safety Advisor.
2
All sub-contractors and workers on site must have completed a Construction Induction training course and
must show their ticket to the Site Supervisor.
3
All visitors including delivery drivers, sub-contractors including sales representatives and suppliers must
report immediately on arrival to the site office.
4
Visitors must be provided with a site-specific induction before entering the site and/or must be
accompanied by a person who has completed an induction.
5
All personal protective equipment shall be worn / used on site.
6
Safe Work Method Statements are to be discussed with all staff and sub-contractors.
7
All certificates are to be checked before any plant / equipment is operated.
8
Risk assessments shall be conducted on site for any high-risk activity upon the direction of the Site
Supervisor and the Principal Contractors Safety Advisor.
9
All hazards are to be reported and control measures implemented.
10
No pets are allowed on the construction site.
11
All fire safety precautions must be observed.
12
Private cars are allowed in designated car park area only.
13
No non-prescribed drugs or alcohol is allowed on site.
14
All penetrations of floors & protrusions are to have fixed covers.
15
Hazardous Chemicals and Dangerous Goods must not be allowed on site unless accompanied by Safety
Data Sheets (SDS) and must be risk assessed.
16
All workers must receive appropriate training, induction and instruction in the use of these substances.
17
No domestic ladders are allowed on site.
18
No ladder except a trestle ladder shall support a plank.
19
Scaffold guardrails and edge protection shall not be removed without confirmation from site management
and/or Site Safety Advisor.
20
Rubbish must be placed in the appropriate bins / areas each day before leaving site.
21
Removal of rubbish and housekeeping is the responsibility of the Site Supervisor.
22
All electrical equipment must be tested, tagged and tagged every 3 months.
23
All portable electrical equipment must have RCD protection.
24
Double adaptors or piggyback adaptors are not be used on site
25
All electrical leads are to be kept out of water.
Page 15 of 38
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Employer’s Name
Site Rules
26
All safety signs are to be in full view and are to be obeyed.
27
A spotter will guide vehicles or plant reversing onto or off site where the public could be affected.
Consultation, Cooperation and Coordination
Refer to the Contractor’s Consultation Procedure
This section should include how the principal contractor will consult and cooperate with other duty holders.
There should be ongoing consultation and cooperation between all duty holders so that when work overlaps,
each person is aware of other construction activities and they can control the hazards and risks created by
this. Examples of how the Principal Contractor may do this include:






Hold pre-commencement WHS meetings with contractors and subcontractors
Schedule regular contractor / sub-contractor WHS meetings
Hold tool box WHS Meetings
Establish a construction project WHS Committee
Distribute a regular WHS newsletter
Provide support, resourcing and training of health and safety representatives
The WHS management plan must detail the arrangements the principal contractor will use to coordinate the
construction work to ensure compliance. It must also include the process for developing, reviewing and
distributing SWMS. This would include providing training to workers and contractors.
Employer’s Name Site Supervisor will be responsible for monitoring general workplace health and
safety compliance on the project by.
1
Consulting with the workers and sub-contractors on site.
2
Conducting a pre-start meeting before the work actually commences.
3
Conducting regular toolbox talks and ensure sign off on the relevant form (Refer to Attachment D)
4
Formally reviewing the Safe Work Method Statements.
5
Conducting a toolbox talk with relevant staff and sub-contractors on the Work Method Statements with
sign off.
6
Monitor and maintain this Work Health and Safety Management Plan.
7
Conduct, or delegated the responsibility to conduct regular site inspection as outlined.
8
Investigate any accidents / incidents / injuries on site in consultation with the Principal Contractor’s
Safety Advisor.
9
Appoint a WHS Committee member to attend the Principal Contractors WHS Committee Meeting.
10
11
12
Site Supervisors Responsibilities
The Site Supervisor will be responsible for:
1
Setting a good example for staff to follow and encourage a positive attitude to health and safety.
2
Ensuring that work is carried out in accordance with this Work Health and Safety Management Plan
and the relevant Safe Work Method Statements.
3
Knowing the incident investigation and reporting procedures and to report all incidents as soon as they
become aware of the incident.
4
Investigating on-site accidents / incidents / injuries in consultation with the Principal Contractor’s Safety
Advisor.
5
Ensuring that safety is included in all on-the-job training, induction and instruction.
Page 16 of 38
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Employer’s Name
6
Ensuring that PPE and clothing applicable to the job is used or worn by all staff under their supervision.
6
Assisting in the preparation of safe work practices or procedures by conducting risk assessments.
7
Maintaining a system of hazard identification and assessment of workplace risks.
8
Conducting inspections on site.
9
Maintaining good housekeeping at all times in the workplace.
10
11
12
13
14
Workers and Sub-Contractors Responsibilities
Worker and Sub-Contractors on site will be responsible for:
1
Complying with all instructions given by supervisors and Principal Contractor’s Safety Advisor in
relation to WHS matters.
2
Reporting all incidents & near miss incidents to supervisory staff as soon as practicable after the event.
3
Reporting all hazards identified at the workplace.
4
Taking reasonable care for the WHS of other persons at the workplace.
5
Complying with all established and/or documented work practices appropriate for the work being done.
6
Wearing personal protective equipment as instructed or as required by established and/or documented
work practices
7
Maintaining workplace health and safety related licences, certifications and any other qualification
necessary for the execution of duties.
8
9
Contractor’s Responsibilities
Contractors on site will be made aware of all WH&S requirements for the site.
1
Be made aware of the Employer’s Name safe work methods and practices on site by the site
supervisor through the site-specific induction process.
2
Follow the Safe Work Method Statements as well as any other obligations imposed on them by
Workplace Health and Safety legislation
3
Bring onto the site & only use equipment, which conforms to Workplace Health and Safety legislation
together with any applicable Australian Standards.
4
Give to the Principal Contractor any relevant Safe Work Method Statements before work commences.
5
6
First Aid on Site

First Aid Attendant on site.

First aid kit provided.




Page 17 of 38
Inspected monthly.
Content list in kit.
Revised 10/2012
Revision 1 -
Employer’s Name
Incident Reporting
The WHS management plan should document the actions that will be taken and who will represent the
principal contractor. The following should be included (covering both the process involved and the person
responsible for it):
 Incident management
 Emergency situations
 First aid arrangements
The WHS management plan should also include arrangements for reporting and acting upon near misses that
occur.

Staff and contractors advised at Induction to report all
incidents.

Relevant forms on site.




Safety Advisor advised of all incidents.
Safety Advisor advised of any
emergencies.
Emergency Procedures

Staff and contractors advised at Induction of emergency
procedures.



Emergency plans and contact numbers displayed.


Traffic Control





Traffic Controllers appointed. (Number
)
Traffic Management Plan on site.
Segregation of heavy machinery and public vehicles.





Traffic Controllers been inducted.
Traffic controlled coming onto site.
Warning lights required.
Traffic cones required.
Public Access

Residents are advised of the work prior to
commencement.

Access to the public to their residences
is maintained.

Staff and contractors advised of the requirements of the
public reporting to the site office.

Clear signage is available for public
access.


Alternate pedestrian walkways required.


Barricading & Signage

Fencing to deter public accessing the site (especially
children).
Page 18 of 38

Signage used:






Unauthorised Entry signs.
Mandatory Footwear signs
Mandatory Hearing signs
HazChem signs
Revised 10/2012
Revision 1 -
Employer’s Name


Type of fencing / barricading used:



Plant & Equipment

All plant and equipment to be inspected.



All maintenance records are to be discussed.


All certificates are to be checked (Refer to Attachment
C)

Any breakdown of equipment will be
reported to the workshop.

High Risk Work Licence

All licenses for high risk work are to be checked (Refer
to Attachment C).


Authority is required to perform the
work.

Hazardous Chemicals

All hazardous chemicals brought on site are to be
recorded in the Hazardous Chemicals Register
(Refer to Attachment G)


Refer to the Safe Work Method Statement

All hazardous chemicals are to have an
associated SDS and risk assessment with the
chemical.
Site Inspections

The Site Supervisor is to
ensure that daily
inspections are conducted
on:

 All plant and
The Site Supervisor is to
ensure that monthly
inspections are conducted
on:
 Hazard inspection on
machinery.
entire site.
 Fencing and
 Manual test of RCD.
 First aid kit.

barricading.
 Workers & contractors
work methods.

The Site Supervisor is to
ensure that 3 monthly
inspections are conducted on:
 All electrical equipment.
 RCD.
 Fire extinguishers.

 Compliance with the
Safe Work Method
Statements


Refer to Attachment E
Refer to Attachment F
Monitoring and Review
Both the Work Health and Safety Plan and the Safe Work Method Statements are to be
regularly reviewed to ensure that the identified control measures are operating effectively.
List down any revisions that have occurred on site.
Page 19 of 38
Revised 10/2012
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Employer’s Name
Construction Safety Plan
Date
Page 20 of 38
Work Method Statements
Revised 10/2012
Revision 1 -
Date
Employer’s Name
Attachment A
SAFETY INDUCTION GUIDE
Employer’s Name is to ensure that every person entering the workplace to perform work has undertaken
a specific site induction. The following topics are essential but more may be added.
Site Induction Topics
Administration







No drugs / alcohol on site
Reporting of Accidents / Incidents



Refer to site rules

Identify site

Principal Contractor

Site Supervisor

Safety Advisor

HSR
Hours of Work
Amenities / Toilets / Wash up area / Crib area
Emergency procedures
First Aid facilities

First Aid Attendant (if applicable)

Fire extinguishers

Notice board
Contractors / visitors parking

If affected by alcohol will not be allowed on
site
Site Layout



Barricades / public protection
Warning signs
Hazardous areas



Material deliveries



Leads off the ground
Materials storing & stacking
Equipment



All power leads, RCD to be tested and tagged
Maintenance, equipment in good order
Licenses checked and recorded on Attachment
C
Ladders are industrial and in good condition
PPE

All PPE to be work where required:

Safety Footwear

Safety Helmet

Safety eyewear / goggles

Specific Hazards
Refer to Safe Work Method Statement where applicable

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Page 21 of 38
Revised 10/2012
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Employer’s Name
Attachment B
SAFETY INDUCTION RECORD
Employer’s Name is to ensure that every person entering the workplace to perform work has undertaken
a specific site induction. Please record relevant details and ask the person to sign.
Site Induction Record
Date
Name (Print)
Company
General
Signature
Construction
Induction
No.
Note: Please retain this record on the site file.
Page 22 of 38
Revised 10/2012
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Employer’s Name
Attachment C
RECORD OF CERTIFICATES & LICENCES
Employer’s Name is to ensure that every person working at the workplace has a relevant certificate and
licence to the work performed. Please record relevant details and ask the person to sign.
Certificates / Licence Record
Date
Name (Print)
Company
Certificate /
Licence
Description
Number
Note: Please retain this record on the site file.
Page 23 of 38
Revised 10/2012
Revision 1 -
Signature
Employer’s Name
Attachment D
TOOLBOX TALK REGISTER
Employer’s Name is to ensure that every person working at the workplace has access to relevant and up
to date information. This can be easily achieved through regular toolbox talks. Please record relevant
details and ask the person to sign.
Toolbox Talk Records
Date
Name (Print)
Topic
Signature
Note: Please retain this record on the site file.
Page 24 of 38
Revised 10/2012
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Employer’s Name
Attachment E
DAILY INSPECTION CHECKLIST
Employer’s Name is to ensure that every person working at the workplace is safe from risk of injury.
Employer’s Name may delegate the responsibility to conduct the daily inspection.
Daily Inspection
No
Items to Check
Y
N
NA
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
Comment
1. Barricading
1
Boundary fencing / barricading in place?
2
Warming signs still erected?
3
Any star pickets have caps on them?
4
Any trenches still barricaded?
5
Floor openings covered?
6
2. Plant & Machinery
1
Daily checks being done?
2
In good order?
3
Guards all in place?
4
3. Electrical
1
Are leads off the ground?
2
Any new electrical equipment brought onto site
is checked?
3
4. Housekeeping
1
Site is cleaned up each day.
2
5. Work Methods
1
Workers and contractors are complying with the
relevant Safe Work Method Statements.
2
Name: ……………………………….. Signature: ………………………………… Date: ……. /……../……..
Note: Please retain this record on the site file.
Page 25 of 38
Revised 10/2012
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2.8.8
Employer’s Name
Attachment F
MONTHLY INSPECTION CHECKLIST
Monthly Inspection
Insert
Employer’s
Logo Here
CONSTRUCTION WORK
HAZARD INSPECTION CHECKLIST
LOCATION OF INSPECTION ....……………………………………………………….…..………………………
Inspected By (1) ......…..…....................………………....... (2) …………………………..…........................…
PRINT
PRINT
Signature (1): …………………………………………….…… (2) ……………………………………...………….
Date of Inspection: ……..../……..../….…. Time: ...............……...AM/PM
PURPOSE:
RISK ASSESSMENT CALCULATOR
The purpose of this document is to provide
guidelines for the identification of Hazards
and Risks in the workplace.
DEFINITION:
Hazard: A hazard is a source of potential
harm or a situation with the potential to
cause loss.
Risk:
A chance that an event will occur
which will result in personal injury or
loss to the Employer’s Name.
INSPECTION PROCEDURES:
Code: E – Extreme Risk, H – High Risk, M – Moderate risk, L – Low risk
1.
Use this checklist to inspect for hazards at the workplace as requires (monthly).
2.
HSRs and the road works foreman are to inspect for hazards.
3.
For any ‘N’ ticked, conduct a risk assessment using the ‘Risk Assessment Calculator’ and write down the risk
level on the checklist. (Any code E or H risks must be immediately reported to the Manager and WHSO so a
formal, documented risk assessment may be conducted).
4.
When completed, transfer all hazards that can’t be rectified immediately to the ‘Corrective Action Plan’ (CAP).
5.
Forward the checklist and RAP to the Site Supervisor and then the Manager for further action (if required) and
sign-off.
Note: When recommending control / corrective actions, always consider both short term and long-term
control options.
6.
Forward the checklist and CAP to the WHSO for further action (if required) and sign-off.
7.
The Safety Advisor is to table the CAP at the Safety Committee meeting.
8.
The Work Health and Safety Committee is to discuss the control/corrective actions (if necessary) and monitor if
the CAP has been effectively actioned, verified and signed off.
9.
The site Supervisor is to discuss the checklist and CAP with his/her staff at the regular toolbox talks.
10. Always conduct a risk assessment before any controls are implemented and a risk assessment after the controls
are implemented to ensure the risk has been reduced.
NOTE: All questions should be answered by marking the appropriate column with a ().
(Y) = Yes (N) = No (NA) = Not Applicable
Page 26 of 38
Revised 10/2012
Revision 1 -
Employer’s Name
No
Construction Work Hazard Inspection Checklist
Items to Check
Y
N
NA
Risk
Comment
1. Fire Protection
1
2
3
4
Are inspection tests up to date for: (every 6 months)
Inspected Fire Extinguishers ___, ___ & ___
 Fire extinguishers?
Date of last test .…/200..
Is the correct type of equipment available?
Are fire equipment identification markers (2 - signs) in place
for:

Fire extinguishers?

Hose Reels?

Break Glass Alarms?
Are all fire extinguishers accessible, clear from obstruction?
2. Emergency Evacuation
1
Are written procedures in existence and current?
2
Are assembly positions allocated and understood?
3
Do practice drills occur to see if the emergency plan works?
4
Are all exits kept clear?
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(Check different
extinguishers each time)
3. First Aid
1
Are there sufficient first aid kits at the workplace?
2
3
Are first aid kits checked on a regular basis?
Date of last check
.…/200..
Is all content in date? (check expiratory dates)
4
Do contents of kits agree with contents list?
5
Are first aid officer’s identities displayed?
6
Are emergency telephone numbers displayed?
7
Are all injuries reported and recorded (view book or form)?
8
When first aid equipment is used, is it recorded?
9
Is a sharps kit available?
10
Is eye wash available?
4. Electrical
1
2
3
Is electrical equipment tested and tagged on a regular
basis? Date of next test …/200….
Is the site shed protected by an RCD?
5
Is the RCD manually tested to ensure correct operation?
Date of test …/200…
Are correct power boards used RCD Protected (no double
adaptors or piggy back plugs)?
Are leads off the ground?
6
Are supplied Safety Switches tested on a regular basis?
7
Are emergency stop buttons regularly tested?
8
Are extension leads in good condition?
9
Is clear access provided to switchboards?
4
(Check some tags)
5. Signage
1
Are relevant signs displayed near equipment?
2
Are unauthorised entry signs displayed?
3
Are signs in good condition (not faded)?
4
Are out of service / danger tags available for use?
5
Is the evacuation plan displayed?
6
Are sufficient signs in use – internally and externally
including:

Information signs (first aid, general signage)?

Caution signs?
Page 27 of 38
Compiled –10/2012
Revision 1 -
Employer’s Name
No

Items to Check
Danger signs?

Mandatory signs?
Y
N
NA
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Risk
Comment
6. Personal Protective Equipment
1
6
Is appropriate PPE available and being used and
maintained correctly e.g.  foot,  ear
 eye,  head,  hand,  respiratory,  high vis
shirt/vest
Is adequate signage in place where PPE is required to be
used?
Is all PPE maintained in good condition? (Check some
PPE)
Are respirators stored correctly?
 stored in plastic bags (dust free)?
 all disposable are 2 straps?
Are the correct impact rating / chemical goggles / visors
being used? (Check some)
Do visitors wear the relevant PPE?
7
Do visitors obey Mandatory Signage?
8
Are staff trained in the use and maintenance of PPE?
2
3
4
5
7. Noise
1
2
3
Has a noise exposure survey been conducted on all
machinery?
Is the hearing protection provided appropriate for the level
of noise emitted?
Is hearing protection correctly maintained?
8. Hazardous Chemicals
1.
Have all chemicals been identified?
2
Are chemicals correctly stored?
3
Are containers well marked/labelled correctly?
4
Is there appropriate ventilation for use and storage?
5
9
Are Safety Data Sheets (SDS) provided and available to all
staff?
Is there an SDS register available on site? (Check if
several hazardous chemicals found in the workplace are in
the register).
Has all the Hazardous Chemicals on the register been risk
assessed and located with SDS’s?
Is there an appropriate decanting system in place for
hazardous chemicals?
Is a spills kit available?
10
Has bonding been installed where required?
11
Is there a procedure for disposal of products?
12
Is there appropriate signage in place?
6
7
8
9. Lifting Equipment
1
2
3
Is all lifting gear tagged, current, and stored appropriately
and in good condition?
 Slings
Date of last test ……/ 200...
 Chains
Date of last test ……/ 200...
 Shackles
Date of last test ……/ 200...
 Lifting bars
Date of last test ……/ 200...
Is the SWL displayed on relevant lifting equipment
(including lifting beams)?
Are hooks used for slinging loads fitted with safety latches?
4




Is the correct lifting equipment being used for lifting
activities?
5
Are all staff using the correct manual handling techniques
when lifting materials?
11. Registrable Plant and Plant Design (Schedule 3, Work Health and Safety Regulation 2011)
Page 28 of 38
Revised 10/2012
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Employer’s Name
No
1
Items to Check
Plant been registered? Date of registration.…/200..
2
Has the services been located?
3
Are maintenance records available?
Y
N
NA
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Risk
Comment
12. Plant / Equipment / Machinery
1
3
Are bench grinders maintained?
 guards in place at sides?
 guards - glass spark arrestor at front?
 work rests close to grinding wheels?
 grinding wheel in good condition?
 easy access to turn grinder off/on?
Are ladders in good condition? (No domestic ladders on
site)
Are emergency stop buttons provided?
4
Are emergency stop buttons easily accessible?
5
Warning lights and reversing beepers operating?
6
Operator holds appropriate certificate/licence?
7
Do trainee operators maintain a written training record / log
book as is required?
Are trainee operators supervised at all times?
2
8
9
10
Are daily checks conducted on machinery and recorded in
a log book?
 excavators?
 rollers?
 other machinery?
Are all anti-slip surfaces in good condition?
11
Is maintenance of machinery recorded?
12
Is the floor around machinery clear and in good condition?
13
15
Is the plant correctly parked including tyres and bucket on
ground?
Are tyres regularly checked to ensure they are not
damaged or badly worn?
Is machinery correctly cleaned?
16
Are dust, fumes etc, extracted?
14
13. Hand Tools
1
Are hand tools in good condition? (Check some items)
2
Are handles or shafts free from splits, deep cut or
damages?
3
Are hand tool heads checked regularly to ensure they are
secured?
14. Portable Power Tools
1
2
Are portable power tools in good condition? (Check some
items)
Are adequate storage facilities provided?
3
Does staff use the power tools correctly with RCD?
4
Are all guards in place?
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15. Explosive Power Tools
1
Is the explosive power tool regularly serviced?
2
Are maintenance logbooks in place?
3
Is PPE signage in place for glasses & ear protection?
16. Welding & Cutting
1
2
3
4
Are gas cylinders correctly stored – secured by chain or
bar?
Are welding screens in place when welding?
Are all gas cylinders turned off and hoses rewound when
not in use?
All welding hoses and leads are in good repair?
Page 29 of 38

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Revised 10/2012
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Employer’s Name
No
5
Items to Check
Are flash back arrestors in place?
Y
6
PPE available and used for welding?
7
Is a fire extinguisher located in the area?
N
NA
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Risk
Comment
16. Traffic Control
1
2
Is there sufficient signage in place advising work in
progress?
Are traffic control ahead signs in place if required?
3
Is this signage clear and clean?
4
Are flashing hazard/ warning lights in use?
5
Are sufficient traffic cones (witches hats) in use?
6
Do Traffic Controllers have traffic control permits on site?
7
Is the traffic observing speed limits set?
8
Are side tracks in good condition?
17. Barricading
1
Are barricades erected around the work area?
2
Are thoroughfares provided for the public along footpaths
etc?
Are vehicles and plant, not directly involved in construction
activities, parked clear of public thoroughfares?
Are Unauthorised Entry signs placed on barricading?
3
4
18. Work Areas/Housekeeping
1
Are work areas tidy?
Are work areas cleaned regularly?
2
Does regular waste removal occur?
3
Are there adequate storage facilities?
4
Do staff use good stacking and storage practices?
5
The floor surfaces are in good condition (No loose material,
debris)?
Do lighting levels appear to be satisfactory?
6
19. Notice Board (site shed)
1
Is the WH&S Policy displayed?
2
Is the Rehabilitation Policy displayed?
3
4
Are the following names displayed?
 Safety Advisor  HSRs  First Aid Officers
 Rehab and Return to Work Coordinator
 Fire
Wardens
HSR’s powers notice?
5
Emergency evacuation plan or procedures?
6
Is the Issue Resolution flowchart displayed?
20. Amenities
1
Are toilet and lunchroom facilities available?
2
Are washrooms and food preparation areas clean?
3
Are following provided adequately:
4

Male and Female Toilets?

Showers?

Change Rooms?
Where mobile toilets are provided, are they:


Detached from the vehicle in a stable and
Secure position?
Provided with suitable access, water

Toilet paper and soap?

Cleaned regularly?
Page 30 of 38
Revised 10/2012
Revision 1 -
Employer’s Name
No
Items to Check
Y
N
NA
Risk
Comment
21. General
1
5
Has a Work Health and Safety Plan been completed for
the project / work?
Are Safe Work Method Statements available for work
activities?
Has risk assessments been conducted on activities, such
as  Plant  Equipment
 Specific work procedures?
Have all staff and contractors received specific siteinduction?
Are incident / injury forms available?
6
Are Hazard Reports forms available?
7
Do staff have their induction cards on them?
2
3
4
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22. Work Method Statement
1
2
3
Are Safe Work Method Statements in place for ALL high
risk construction work?
Are Safe Work Procedure in place for all tasks?
Are Operating Instructions available with plant and
equipment?
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23. Confined Spaces
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Is equipment and all materials clear from the edge of the
trench to avoid the collapse?
Are trenches deeper than 1.5 m shored, benched, battered
or certified by an engineer (Geo-tech)?
Are adequate access ladders provided along the length of
the trench?
 
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4
Are all internal combustion engines kept well clear of
trenches?
 
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5
Are ladders used at the correct angle (4 up/ 1 out) and are
they restrained?
 

6
Is signage in place?
 

1
2
3
4
5
Have all confined spaces been:
 Identified?  Register compiled?
Have all confined spaces been signed?
Has a confined space Work Instruction been issued to all
staff conducting confined space work?
Are risk assessments available for Confined spaces?
7
Is the Permit to Enter book completed before a staff
member enters a confined space?
Are gas detectors and escape kits used in accordance with
work procedures/ instruction?
Are emergency communications available?
8
Is emergency rescue equipment available at the site?
9
Are gas detectors in good condition, stored correctly and
maintained? (check maintenance log book)
Date of
last check ……/200….
Does an observer attend all confined space work?
6
10
11
Have all workers involved been trained in confined space
entry/work?
12 Are safety harnesses, life line rescue equipment and gas
detectors regularly maintained?
13 Is inspections and maintenance of this equipment
recorded?
24. Concrete Works
1
Are exposed vertical starter bars protected with end caps?
2
Are concrete pipes stored appropriately, chocked at each
end?
25. Excavation & Trenching
1
2
3
26. Scaffolding (Ladders/Trestles/Hoists/Planks)
Page 31 of 38
Revised 10/2012
Revision 1 -
Employer’s Name
No
1
Items to Check
Y
Are scaffolding in good condition?
2
Is maintenance and repairs carried out as required?
27. Other
1
Are any Hazards / Risks caused by Contractors?
2
Has this Inspection been discussed with staff in this work
area?
Have recommendations or options been suggested and
communicated to the work area Supervisor?
3
N
NA
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Risk
Comment
Other Hazards identified that were not included in the checklist
28. Other Hazards
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1
2
3
4
5
Site Supervisor
Name:
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Signature:
Date:
Signature:
Date:
Signature:
Date:
Comments
Manager
Name:
Comments
Safety Advisor
Name:
Comments
Page 32 of 38
Revised 10/2012
Revision 1 -
Employer’s Name
Construction Work Hazard Inspection Checklist
Corrective Action Plan (CAP)
No.
Hazard / Non-Compliance
WH&S-CSP-4.12.1
Control / Corrective Action
Short or Long Term Control
Indicate ST/LT
ST/LT
Risk Level
before
Control
Page 33 of 38
Risk Level
after
Control
Officer
Responsible
Proposed
Completion
Date
Actual
Completion
Date
Verified
By
Revision 1 (10/2012)
Employer’s Name
Work Health and Safety Management Safety Plan
Attachment G
Hazardous Chemical Listing
ID No.
Common / Chemical Name of
Substance
Quantity
Held
Purpose / Use
Page 34 of 38
How Purchased
(Container size /
type)
Hazardous
Yes / No
SDS on site
Yes / No
Risk
Assessment
on site
Yes / No
PPE
Yes /No
Reviewed 10/2012
Revision 1-
Employer’s Name
Work Health and Safety Management Safety Plan
Attachment H
PROJECT RISK & CONTROL CHART
Employer’s Name is to ensure that every person working at the workplace is safe from risk of injury. These are generic project hazards / risks and controls, they will
need to be tailored and added to suit the individual site work and discussed at toolbox meetings.
Project Risks & Controls
Tick
Task Hazard / Risk
Consequences
Method Of Control

Worker exposed to general site
hazards.


Safety boots are mandatory and must be worn at all times
onsite and is a condition of entry.

Safety helmets are to be worn where there is a likelihood of
being struck on the head or when working near or under and
load or machinery.

Signage indicating these requirements will be displayed at the
site entrance.

The Site Supervisor will monitor compliance.

Death.
Serious injury.
Risk after
Control



Lack of Amenities on site


Heat stress.
Infection.

Drinking water will be made available.

Provision and maintenance of an on-site portable toilet with a
washbasin.


Page 35 of 38
Reviewed 10/2012
Revision 1-
Employer’s Name
Work Health and Safety Management Safety Plan
Tick
Task Hazard / Risk
Consequences
Method Of Control

Electrocution from general supply
of electricity on site





Death.
Electrocution.
Serious injury.
Burns.




Risk after
Control
Electrical supply to be connected by a licensed electrician.
Switchboards if applicable are weatherproof.
Have a protective lid attached in a way not to damage flexible
electrical extension leads.
Fitted with a push button RCD.
The PC is responsible for testing the RCD each month.


Workers exposed to hazard die to
poor housekeeping practices and
inadequate access to site



Strains / Sprains.
Slips / Trips /
Falls.
Serious Injury.

Refer to the Safe Work Method Statement for Common
Plant.

The entrance of the site to be clear at all times.

Equipment and material not to be left on the footpath.

Materials and storage areas to be barricaded off.

Signage indicating these requirements will be displayed at the
site entrance.

A rubbish skip to be provided.

Contractors and workers are to clean up each day and put
rubbish in the skip.

Site Supervisor is to monitor housekeeping each day.



Workers exposed to hazardous
manual tasks

Work exposed to lasers risks.

Strains / Sprains.
Eye Damage.











Manage risks to health and safety related to muscular skeletal
disorder associated with hazardous manual tasks
Refer to Safe Work Method Statement
Use Class 1 lasers where possible.
Isolate persons from laser beam where possible.
Provide training.
Erect warning signs.
Use PPE (eg: appropriate safety glasses)
Page 36 of 38
Reviewed 10/2012
Revision 1-
Employer’s Name
Tick
Task Hazard / Risk
Work Health and Safety Management Safety Plan
Consequences
Method Of Control
Risk after
Control
Hearing Damage
and/or loss.
Electrocution.
Tissue Damage.
Serious Injury.









Select equipment with silencers etc.
Isolate noise source.
Rotate workers.
Use PPE (eg ear muffs / plugs).
Use residual current devices (RCDs).
Maintain tools and leads.
Protect leads from damage.
Use mechanical means to minimise manual exposure to vibration.
Burns.
Asphyxiation.
Long term health
effects.
Short Term.
Exposure - Allergies

Refer to Safe Work Method State for ‘Hazardous Chemicals.

Refer to Safe Work Method State for ‘Asbestos’.


Refer to relevant Safe Work Method Statement
















Workers exposed to risk using power
tools.





Workers exposed to hazardous
chemicals.






High Risk Construction Work -
Page 37 of 38
Reviewed 10/2012
Revision 1-
Employer’s Name
Tick
Task Hazard / Risk
Work Health and Safety Management Safety Plan
Consequences
Method Of Control
Risk after
Control

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
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
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Page 38 of 38
Reviewed 10/2012
Revision 1-