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Safety Analysis and Incident Report
Name
*
First
Last
Email
*
Job Reference
Date
*
Date Format: DD slash MM slash YYYY
Time
*
:
HH
MM
AM
PM
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.
Add Entry
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.
Add Entry
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.
Add Entry
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.
Add Entry
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.
Add Entry
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.
Add Entry
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.
Add Entry
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.
Add Entry
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.
Add Entry
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.
Add Entry
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.
Add Entry
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
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Entries.
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What are the hazards and risks?
Risk Rating
How will hazards and risks be controlled?
What are the hazards and risks?
Risk Rating
How will hazards and risks be controlled?
What are the hazards and risks?
Risk Rating
How will hazards and risks be controlled?
What are the hazards and risks?
Risk Rating
How will hazards and risks be controlled?
What are the hazards and risks?
Risk Rating
How will hazards and risks be controlled?
What are the hazards and risks?
Risk Rating
How will hazards and risks be controlled?
What are the hazards and risks?
Risk Rating
How will hazards and risks be controlled?
What are the hazards and risks?
Risk Rating
How will hazards and risks be controlled?
What are the hazards and risks?
Risk Rating
How will hazards and risks be controlled?
What are the hazards and risks?
Risk Rating
How will hazards and risks be controlled?
What are the hazards and risks?
Risk Rating
How will hazards and risks be controlled?
Name
First
Last
Signature
Date
Date Format: MM slash DD slash YYYY