SAFE WORK METHOD STATEMENT
Organisational Details
TEMPORARY SERVICES CONNECTION SWMS Company Name:
Approval Date:
Company Address:
Next Review Date:
Director / Manager Name:
Contact Number:
Type of SWMS:
Generic (multiple projects, jobs, or work requests)
SWMS Details
Site Specific Details
Principle Contractor:
n/a
Site Manager or Supervisor Name:
n/a
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Site specific (complete section below)
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Contact Number:
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Other PCBU’s: Site Address:
n/a
n/a
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What high risk work activities are covered by this SWMS?
Work on, in or adjacent to a traffic corridor in use by traffic other than pedestrians Work in an area with movement of powered mobile plant. Work on or near energised electrical installations or services. Work on or near pressurised gas distribution mains or piping
What is the scope of the works?
Scope of work includes the physical work of installing, maintaining, repairing, altering, removing, or adding to Plumbing works.
Who else was consulted/involved in preparing this SWMS? Additional compliance measures:
SWMS 012 TEMPORARY SERVICES CONNECTION Issue Date: 26/08/2022 Page 1 of 12
Workers / employees
Principle Contractor
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WHS Team
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Pre-start Hazard Risk Assessment
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Toolbox Talk
Workplace Safety Inspection
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