Appendix 2Sample safe work method statement#
| ABN | |
|---|---|
| Safe work method statement |
| Working on, or adjacent to, a road | |
|---|---|
| High risk construction work |
If your work procedure or activity identifies the need to work on, or adjacent to, a road, then it is high risk construction work, and you will need to develop a safe work method statement. The following is a generic safe work method statement. It cannot be used as a safe work method statement onsite, unless the project specific section has been completed. It must be reviewed prior to undertaking the activity, and all site-specific details must be documented.
| Control measures | How to use control measures | Monitor and review | Responsible officer |
|---|---|---|---|
| 1. Road work signs will be erected prior to work commencing. | A road works signing layout will be developed. All signs will be in accordance with the MUTCD Part 3. | Daily inspections to be carried out and documented in project records. Signing layout to be approved before work commences. | Sup PM |
| 2. All workers will have general safety induction training and a site-specific induction before starting work. | General safety induction cards will be sighted and recorded for all workers. All workers, including sub-contractors, will be given a site-specific induction. Site-specific induction records will be kept for all inductions. | All training records to be checked. Safety audits to include check on training and induction records. | Sup Safety Coordinator |
| 3. Traffic controllers to be used as required. | All traffic controllers will be accredited by Queensland Transport. Traffic control will be conducted in accordance with the approved procedure. | All traffic controller tickets are to be checked and recorded. | Sup |
| 4. Work zone and separation distances to be delineated. | Work zones will be delineated in accordance with the Traffic Management Plan. | Traffic Management Plan to be reviewed and approved before work commences. | PM |
| Control measures | How to use control measures | Monitor and review | Responsible officer |
|---|---|---|---|
| All workers will remain within the work zone, unless traffic has been stopped by traffic controllers. Note: In the site-specific section, detail traffic control devices such as barriers. | Supervisor to constantly check on workers and take appropriate action. | Sup | |
| 5. All workers will wear appropriate personal protective clothing and equipment. | All workers will wear high visibility clothing, safety footwear, wide brim hat and any other equipment identified in the risk assessment. | Supervisor to constantly check and take appropriate action for breaches. | PM/Sup |
| 6. All control measures detailed above will be monitored and reviewed regularly during the work. | Signs will be checked before work starts each day and at regular intervals during the day. These inspections are to be recorded. Daily pre-start meetings will be held to ensure all workers are informed of control measures. Any failure of a control measure will be reported to the supervisor immediately for action. | Sup Sup Sup All |
Tick relevant boxes to indicate all occupational licences and certificates employed for this activity on this project.
Cranes or hoists
Loadshifting equipment#
Backhoe Excavator Roller Grader Dozer Forklift Skid steer loader Front end loader Scraper
Riggers#
Advanced Intermediate Basic Dogger
Scaffolder#
Advanced Intermediate Basic
Approved by manager: _____________________ _____/_____/____ (Safety and Risk Management) Signature Date
| Project: | Project manager: | |||
|---|---|---|---|---|
| Control measures | How to use control measures | Monitor and review | Resp. officer | |
| Describe the work activity where working on, or adjacent to, a road is required. | Either use a control measure from the generic section above or develop a project specific control measure. | Either use a control measure from the generic section above or develop a project specific control measure. | If using a project specific control measure, the method of monitor and review must be documented, as well as the responsible officer. |
Project specific details#
The following instructions are in addition to the standard safe work method statement instructions above and are specific to this project only. This section must be developed after a project specific risk assessment has been conducted and must take into account all hazards associated with the activity. For further assistance/information contact your local Safety Coordinator/Officer. For generic safe work method statements, the only section that can be edited is the project specific details. If instructions in the generic section are not being followed, this should be outlined in the project specific details and an alternative method must be documented.
Approved by Project manager: _____________________ _____/_____/____