Company name:		
Client name:		
Site/Work Location:		
Description of the Work		

	Name	Signature	Date	
Plan Prepared By:				
Plan Approved By:				

Contents:

- Contractors Health & Safety Policy/Statement
- Schedule of Appointed Responsible Persons
- Management & Supervision Organisational Chart
- Construction Risk Assessment
- Fall Protection Plan
- Hazardous Work/Activities - Method Statements
- Personal Protective Equipment Requirements
- Measures to Control the Condition and Use of Tools and Equipment
- Fire Prevention and Control Measures
- Use and Control of Hazardous Chemical Substances 11 - Environmental Protection Measures
12 - First Aid Arrangements 13 - Construction Site Signage

Appendices:

A - Client H&S Specification
B - Principle Contractor Appointment C - Appointment Letters
D - PPE Issue Registers
E - Equipment Inspection and Repair Registers
Ladders
Scaffolding
Portable Electrical Tools
Safety Equipment
Lifting Tackle
Lifting Machines
F - Material Safety Data Sheets H – Safe Disposal Certificates

Contractors Health And Safety Policy/Statement

(Insert Contractors health & safety policy statement)

Schedule of Appointed Responsible Persons

Appointments i.t.o. OHSAct

Section	Appointment Description	Details of Appointed Persons	
		Name	Qualification/Experience	
16 (2)	Assignment of duties by CEO			
37(2)	Employer/Mandatory agreement			
17	Health & Safety Representative			

Appointments i.t.o. Construction Regulations

Section	
Appointment Description	Details of Appointed Persons	
		Name	Qualification/Experience	
6 (1)	Construction supervisor			
6 (2)	Assistant construction supervisor			
6 (6)	Construction site health and safety officer			
7 (1)	Risk assessor			
8 (1) (a)	Fall protection plan developer			
10 (a)	Formwork & support work supervisor			
11 (1)	Excavation work supervisor			
12 (1)	Demolition work supervisor			
14 (2)	Scaffolding supervisor			
15 (1)	Suspended platform supervisor			
17 (1)	Material hoist inspector			
18 (1)	Batch plant supervisor			
19 (2) (g) (i)	Explosive powered tool issuer			
21 (1) (j)	Construction vehicles & mobile plant inspector			
22 (e)	Temporary electrical installation controller			
26 (a)	Stacking and storage supervisor			
27 (h)	Fire extinguisher inspector			

Appointments i.t.o. General Machinery Regulations (GMR)

Section	
Appointment Description	Details of Appointed Persons	
		Name	Qualification/Experience	
2 (1)	Supervisor of Machinery			

Construction Management and Supervision Organisational Chart

Construction Risk Assessment

Risk assessment leader:

Risk assessment team members: Date of risk assessment:
Severity Index

Probability	Impact	
A	Common	1	Fatality or permanent disability	
B	Has happened	2	Major injury	
C	Could happen	3	Average lost time injury	
D	Not likely	4	Minor injury	
E	Practically impossible	5	Medical treatment only or less	

PI
Index	Probability	
	A	B	C	D	E	
Impact	1	1	2	4	7	11	
	2	3	5	8	12	16	
	3	6	9	13	17	20	
	4	10	14	18	21	23	
	5	15	19	22	24	25	

1 – 6	HIGH	
7 - 15	MEDIUM	
16 - 25	LOW	

Construction Risk Assessment	
Risk No.	
Description of Risk	
Probability	
Impact	PI
Index	Control Measures/Procedures/Methods to Manage the Risk	
					Description	Resp	
1.							
2.							
3.							
4.							
5.							

Fall Protection Plan

Elevated Work Risk Assessment	
Risk No.	
Description of Risk	
Probability	
Impact	PI
Index	Control Measures/Procedures/Methods to Manage the Risk	
					Description	Resp	
1							
2							
3							
4							

	Measures/Procedures/Requirements	Resp	

Physical & Psychological Fitness
of Workmen Working At Height	Describe the measures to be taken/procedures to be followed to ensure that the workmen performing work at elevated heights are physically & psychologically fit to perform the work:		

Training Requirements for Workmen Working at Height	Define the training requirements/programme for workmen who will be working at elevated heights.		

Fall protection equipment - Inspection testing & maintenance.	List & describe the procedures/methods/requirements for ensuring that the fall protection equipment is safe to use.		

Hazardous Work/Activities - Method Statements

HWA
No.	
Description of Hazardous Work Activity	
Method To be Followed/Used to Safely Carry Out the Hazardous Activity	
Work Method Specified by	
Responsible Person	
1					
2					
3					

CONTRACTOR HEALTH AND SAFETY PLAN

Personal Protective Equipment Requirements

Protective Equipment Description	Work Required to Be Used For	

	Overall		

	Contamination Suit Pants		

	Contamination Suit Top		

	Dust Coat		

	Apron		

	Hard Hat		

	Gum Boots		

	Safety Shoes		

	Gloves		

	Safety Goggles		

	Face Shield		

	Welding Hood		

	Self Contained Respirator		

	Respirator		

	Dust Mask		

	Hearing Protection		

	Safety Harness & Life Line		

	Thermal Suit		

	Thermal Jacket		

	Jersey		
	Other		

Item	Description of Tools/Equipment	
Measures & Procedures To Ensure Safe Condition & Use of Tool/Equipment	Responsible Person	
1	Portable electric tools	Weekly inspection of all portable electrical tools by competent person (artisan or supervisor).
Tools found to be unsafe tagged “do no use” and withdrawn from the worksite until repaired.
Details of all portable electrical tool inspections and repairs are to be recorded in a register kept on site. All register entries to be signed and dated by the person performing the inspection.
All portable electrical tools to be removed from the work area and stored in suitable tool boxes overnight.
Only persons who have been trained to use the particular portable electrical tool shall be allowed to use it.		
2	Ladders	Weekly inspection of all ladders by competent person (artisan or supervisor).
Ladders found to be unsafe tagged “do no use” and withdrawn from service until repaired.
Details of all ladder inspections and repairs recorded in a register kept on site. All register entries signed and dated by the person performing the inspection.
Ladders removed from the work area and stored in suitable tool boxes overnight.
All ladders to be secured during use.		
3	Lifting Tackle			
4	FLT			
5	Crane/Lifting Machine			
6	Other (specify)			

SCHEDULE OF INFLAMABLE SUBSTANCES TO BE STORED & USED AT THE WORK SITE	

Item	Name of Inflammable Substance	Expected Max. Qty.
on Site	
MSDS	
To Be Used For	Details of Control & Safety Measures To Be Taken During Storage & Use of the Inflammable Substance	Responsible Person	
1			Yes/no				
2			Yes/no				

SCHEDULE OF HOT WORK TO BE PERFORMED	
Item	Hot Work To Be Performed	Location of the Hot Work	Combustible Materials in the Vicinity of the Hot work	Measures & Procedures To Prevent a Fire Starting and to Handle a Fire Should One Start	Responsible Person	
1						
2						

SCHEDULE OF HAZARDOUS CHEMICAL SUBSTANCES	
HCS
No.	
Name of HCS	Expected
Max. Qty. on Site	
MSDS	
To Be Used For	Details of Control & Safety Measures To Be Taken During Storage & Use of the HCS on Site	Responsible Person	
HCS 1			Yes/no				
HCS 2			Yes/no				

SCHEDULE OF WASTE MATERIALS & EFFLUENTS	

Waste No.	
Description of Waste/Effluent Generated on the Site	
Expected Quantity of Waste/Effluent	
Waste/Effluent Disposal Method & Procedures	
Final Disposal Location	Safe disposal certificate required	
Name, address & contact details of company & persons responsible for disposal	
1					Yes/no		
2					Yes/no		
3			
		Yes/no		

CONTRACTOR HEALTH AND SAFETY PLAN

First Aid Arrangements

Name(s) of first aiders on the work site		
Number of and location of first aid boxes		
Details of other first aid/emergency medical arrangements made		
Construction Site Signage

	Description of Signage	Location Required	

MV1 – Eye Protection shall be worn		

	MV2 – Respiratory protection shall be worn		

MV3 – Head protection shall be worn		

	MV4 – Hearing Protection shall be worn		

MV5 – Hand protection shall be worn		

	MV7 – Foot protection against crushing shall be worn		

	MV8 – Safety harness & lifelines shall be worn		

	PV3 – Thoroughfare of Pedestrians Prohibited		

	PV6 – Proceeding beyond this point prohibited		

WW1 – General Warning of Danger		

	WW8 – Warning of Suspended Loads Hazard		

WW14 – Warning of Workers Overhead		

-	Other – (specify)