SWMS Name

Issue Date

Revision Date

Business Contact Name

Phone Number

Responsible Person

Phone Number

Date

Principal Contractor

Address

Phone Number

Job Site Address

Date SWMS Provided

Is the work associated with a construction project?

YesNo

If yes - This SWMS must align with the requirements of the Site Management Plan in place for the construction project

Confined spacesUsing explosivesMobile plant movementDriving workDemolition of a load-bearing structureArtificial extremes of temperatureAsbestos disturbanceTilt-up or pre-cast concretePressurised gas distribution mains or piping chemical, fuel or refrigerant lines energised electrical installation or servicesStructures of buildings involving structural alteration or repairs that require temporary support to prevent collapseInvolves a risk of a person falling from 2 meters or more, including work on telecommunications towersWork in a celling space (W.A. only)Working at depths greater than 1.5 meters, including tunnels or minesWork carried out adjacent to a road, railway or shipping lane, traffic corridorWork in an area that may have a contaminated or flammable atmosphereIn or near water or other liquid that involves the risk of drowning

L1: Work on the ground or solid constructionL2: Use a passive fall restraint system e.g. guard rails, scaffolding, EWPL3: Use a work positioning system e.g. travel restraint, rope accessL4: Use a fall arrest system e.g. safety harness, catch platformsL5: Implement administrative controls e.g. signage or instructions

More than one of these measures to reduce risk be used. For example, engineering controls like edge protection can be implemented with administrative controls like training and use of this SWMS, while wearing PPE (non-slip shoes). Please describe why it is not reasonably practicable to use higher-order control measures. E.g. The job is less than 5 minutes on a ladder

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