Safe Work Method Statement Template Page 5

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Safe Work
Method Statement
SPECIFIC TASK REQUIREMENTS
Qualifications & industry
safety certificates
Experience
Relevant Codes of Practice,
• Occupational Health and Safety Act 2004
Legislation or Standards
• Occupational Health and Safety Regulations 2007
Plant/equipment
Daily Pre-Start Checklist
1. Are all workers present during the pre-start meeting?
m Yes m No
2. Are all staff wearing the correct PPE for this activity?
m Yes m No
3. Are today’s weather conditions hazardous for this activity?
m Yes m No
4. Are there any additional risks on site today that require additional
m Yes m No
controls that have not been identified by the Risk Identification table?
If yes to item 4, detail these in the spare space on the Risk Identification table, and ensure controls are in place that lower the risk
rating to ‘Low’.
If this cannot be achieved, do not proceed with the activity.
Answers to questions 1 & 2 must be ‘yes’, and question 3 must be ‘no’ before works can commence.

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