Form Health & Safety Unit People, Learning & Culture [email protected] PH: 02 9842 8052 Safe work method statement Job Task Summary: This SWMS is applicable to the following worker type: employee contractor volunteer student visitor other SWMS completed by: (Name) Site: (Name) Date: (Name) How to complete the form: 1. Discuss with relevant workers the steps, and associated hazards, risks and controls 2. In the ‘Procedural steps’, list the work steps in sequence of how they will be carried out 3. In the ‘Possible hazards’, list the hazards and risks for each step 4. In ‘R1’ rate the risk without controls using the risk matrix (see over page) 5. In the ‘Safety controls’ list how the hazards will be controlled and who is responsible to implement the controls 6. In ‘R2’ rate the risk with controls (residual risk) using the risk matrix (see over page) 7. Specify other requirements for the task 8. Each person involved with this task must sign acknowledging that they have understood the steps R1 Risk without controls R2 Risk with controls PROCEDURAL STEPS POSSIBLE HAZARD(S) R1 SAFETY CONTROL(S) PERSON RESPONSIBLE R2 INT15/56218 PAGE 1 V3.1/05-2016