relates is completed. If the SWMS is revised, all versions

46 CODE OF PRACTICE | CONSTRUCTION WORK NOTE: Work must be performed in accordance with this SWMS. This SWMS must be kept and be available for inspection until the high risk construction work to which this SWMS relates is completed. If the SWMS is revised, all versions should be kept. If a notifiable incident occurs in relation to the high risk construction work in this SWMS , the SWMS must be kept for at least 2 years from the date of the notifiable incident. [PCBU Name, contact details] Principal Contractor (PC) [Name, contact details] Works Manager: Contact phone: Date SWMS provided to PC: Work activity: [Job description] Workplace location: High risk construction work:  Risk of a person falling more than 2 metres (note: in some jurisdictions this is 3 metres)  Work on a telecommunication tower  Demolition of load-bearing structure  Likely to involve disturbing asbestos  Temporary load-bearing support for structural alterations or repairs  Work in or near a confined space  Work in or near a shaft or trench deeper than 1.5 m or a tunnel  Use of explosives  Work on or near pressurised gas mains or piping  Work on or near chemical, fuel or refrigerant lines  Work on or near energised electrical installations or services  Work in an area that may have a contaminated or flammable atmosphere  Tilt-up or precast concrete elements  Work on, in or adjacent to a road, railway, shipping lane or other traffic corridor in use by traffic other than pedestrians  Work in an area with movement of powered mobile plant  Work in areas with artificial extremes of temperature  Work in or near water or other liquid that involves a risk of drowning  Diving work Person responsible for ensuring compliance with SWMS: Date SWMS received: What measures are in place to ensure compliance with the SWMS? Person responsible for reviewing SWMS control measures: Date SWMS received by reviewer: How will the SWMS control measures be reviewed? Review date: Reviewer’s signature: APPENDIX D – SAFE WORK METHOD STATEMENT TEMPLATE

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