Safety Analysis and Incident Report

Name*

First Last

Email*

Job Reference

Date*

Time*

: HH

MM

Location*

Task

1. Stop, Step Back and Think

Do I understand what I need to do?*

Yes
No

Further action required

Do I need a SWMS for any 'High Risk Construction Work'?*

Yes
No

Further action required

Do I need any permits (e.g. hot work/confined space/dig)?*

Yes
No

Further action required

Do I have the correct PPE in good condition for the task?*

Yes
No

Further action required

Do I have the suitable tools and equipment for the task?*

Yes
No

Further action required

Do I have my vehicle parked appropriately?*

Yes
No

Further action required

Am I trained, competent, licensed and fit to perform the task?*

Yes
No

Further action required

2. Identify the Hazard(s)

Manual handling*

Yes
No

e.g. Lifting, awkward positions, impacts, over-exertion

Safe Work Method Statement

Risk Rating	How will hazards and risks be controlled?	Actions
		Edit Delete
There are no Entries.

Maximum number of entries reached.

Gravity*

Yes
No

e.g. Slips, trips and falls and struck by fallen objects

Safe Work Method Statement

Risk Rating	How will hazards and risks be controlled?	Actions
		Edit Delete
There are no Entries.

Maximum number of entries reached.

Mechanical*

Yes
No

e.g. Caught in moving parts, struck by plant or flying objects

Safe Work Method Statement

Risk Rating	How will hazards and risks be controlled?	Actions
		Edit Delete
There are no Entries.

Maximum number of entries reached.

Electrical*

Yes
No

e.g. Electrocution from faulty tools or working close to live power

Safe Work Method Statement

Risk Rating	How will hazards and risks be controlled?	Actions
		Edit Delete
There are no Entries.

Maximum number of entries reached.

Chemical*

Yes
No

e.g. Inhaling, swallowing or touching acid, solvents or asbestos

Safe Work Method Statement

Risk Rating	How will hazards and risks be controlled?	Actions
		Edit Delete
There are no Entries.

Maximum number of entries reached.

Pressure*

Yes
No

e.g. Contact with highly pressurised fluid/gas or air

Safe Work Method Statement

Risk Rating	How will hazards and risks be controlled?	Actions
		Edit Delete
There are no Entries.

Maximum number of entries reached.

Noise*

Yes
No

e.g. Hearing damage, masking of emergency alarms

Safe Work Method Statement

Risk Rating	How will hazards and risks be controlled?	Actions
		Edit Delete
There are no Entries.

Maximum number of entries reached.

Biological*

Yes
No

e.g. Contracting diseases, e.g. Hepatitis and Legionnaires

Safe Work Method Statement

Risk Rating	How will hazards and risks be controlled?	Actions
		Edit Delete
There are no Entries.

Maximum number of entries reached.

Radiation*

Yes
No

e.g. Exposure to radiation such as X-rays, sunlight or ultra-violet

Safe Work Method Statement

Risk Rating	How will hazards and risks be controlled?	Actions
		Edit Delete
There are no Entries.

Maximum number of entries reached.

Psychological*

Yes
No

e.g. Stress, violence, fatigue, depression

Safe Work Method Statement

Risk Rating	How will hazards and risks be controlled?	Actions
		Edit Delete
There are no Entries.

Maximum number of entries reached.

Heat and Cold*

Yes
No

e.g. Working with hot or cold objects or exposure to environment

Safe Work Method Statement

Risk Rating	How will hazards and risks be controlled?	Actions
		Edit Delete
There are no Entries.

Maximum number of entries reached.

3. Assess the Level of Risk

Risk(s) worked out?*

Yes
No

4. Control the Hazards

Safe Work Method Statement (SWMS) completed

Yes
No

5. Proceed Safely

Safe to proceed*

Yes
No

Name/s

Name	Signature	Date	Actions
			Edit Delete
There are no Entries.

Maximum number of entries reached.