SAFE WORK METHOD STATEMENT
CHEYYAR SIPCOT INDUSTRIAL ESTATE, PLOT NO-6A, MANGAL VILLAGE, VEMBAKKAM
Project Name: ROCKMAN INDUSTRIES LIMITED Project Address: TALUK, TIRUVANNAMALAI – 631701.
MOA ENGINEERING 184/2B SUNGUVARCHATHIRAM POST, SRIPERUMBUDUR TK,
Company Name: PRIVATE LIMITED Company Address: SIRUMANGADU, TAMIL NADU- 602106
Supervisor Contact Name
Office Contact No: 9566373808 & No: PANDI & 6380560588
Work Activity / Trade: Work Location: VEMBAKKAM
Energised electrical installation / services. Structural alterations / repairs with a potential for structural collapse.
Works involving asbestos. Demolition of a load-bearing element of a structure.
Working at heights (risk of falling more than 2 metres). Works in or near a 1.5+ metre shaft / trench (excavation).
Use, transport or storage of chemical, fuel or refrigerant lines. Works in or near a tunnel.
High Risk Construction Work: Works near to or use of moving mobile plant. Works in areas exposed to artifical temperature extremes.
(Please tick relevant to work activity) Works in or near a confined space. Works in or near water or other liquids with a risk of drowning.
Works on or near pressurised gas / piping. Construction diving work.
Tilt-up or precast concrete work. Use of explosives.
Works involving traffic corridors or other non-predestrian traffic. Works carried out on a telecommunication tower.
Works in contaminated or flammable atmospheres / areas.
Person responsible for ensuring compliance with
Date of SWMS review:
SWMS:
What measures are in place to ensure compliance <XYZ company> WHS policies and procedures, general and workplace induction training, toolbox meetings, SWMS provided to and discussed with worker(s) at workplace and signed off,
with the SWMS? and ongoing workplace supervision by experienced leading hand.
Person responsible for reviewing the SWMS control
Date SWMS received by reviewer:
measures:
How will the SWMS control measures be reviewed?
(SWMS control measures to be reviewed (and revised if necessary) if work tasks / SWMS Monitoring Record Reviewed when scope of work changes
methods change or unexpected issues arise)
Reviewed during weekly / regular contractor meetings Site Inspection observations
Review date: Reviewer's signiture:
Document Name: Version: Correct as at: Page No.:
19.54 Safe Work Method Statement 10 08/06/2016 1 of 4
SAFE WORK METHOD STATEMENT
Description of Tasks Risks Identified Control Measures Taken
Document Name: Version: Correct as at: Page No.:
19.54 Safe Work Method Statement 10 08/06/2016 2 of 4
SAFE WORK METHOD STATEMENT
Name of Worker Licence / Permit Number Contact Number
Document Name: Version: Correct as at: Page No.:
19.54 Safe Work Method Statement 10 08/06/2016 3 of 4
SAFE WORK METHOD STATEMENT
Name of Worker Worker Signature Date Signed
Document Name: Version: Correct as at: Page No.:
19.54 Safe Work Method Statement 10 08/06/2016 4 of 4