/

SAFETY MANAGEMENT PLAN (SMP)

Document Reference No: CMA 177 FORM
  1. Introduction

The Safety Management Plan is to be completed for fieldwork. Not for construction activity.

All service providers must be inducted prior to the commencement of project activity.

This planis to be completed by the service provider and, where required, in consultation with the Mallee CMA Contractmanager.

This does not replace any other legal obligations.

2. Contact details

Service provider company name:
Phone number:
Contract/work order number:
Location of work:
Duration of work (approximate or generic plan duration): / Start date: / / / End date: / /

3. Scope of work

Briefly describe the work being undertaken

______

______

______

4. Safety responsibilities

Detail who will be the service provider’sonsite contact and have responsibility for safety on-site during the contracted work. This will include ensuring all persons performing work under this SMP have been inducted into the site and briefed on this SMP.

Name: / Position held:
Safety responsibilities:
Contact number (direct/mobile):

5. Emergency contact details

Detail who is the key service provider contact or next of kin who should be contacted in an emergency (must be different to previous).

Name / Position / Contact number (direct/mobile)

6. Documented work procedures including permit to work

List your company’s relevant documented work procedures i.e. Job Safety Analysis (JSA), Safe Work Procedures (SWP), Safe Work Method Statements (SWMS) etc. that will apply to the work to be undertaken. Copies must be provided to the Mallee CMA’s contractmanager prior to commencing the work.

Note:

All key tasks must be detailed in the documented work procedures. SWMS must be prepared for all high risk construction work.

Reference Number / Task covered / Is this assessment relevant for work at this site?
(Yes / No)

The service provider is responsible for implementing appropriate permit to work systems such as confined space entry, hot work, electrical installations, and excavations. This information must be listed above and provided to the Mallee CMA’s contract manager.

7. Specialist and licensed work

List all specialist tasks/licenced work to be undertaken and provide details of workers and licences/competencies i.e. High Risk Work Licences – Fork Lift Operation, Crane Operation, and Asbestos Removal Licence.

Specialist tasks / Name of worker/s / Details of licence/competency
(issuing authority/expiry date/number)

8. Powered mobile plant and equipment register

For any plant or equipment to be brought on site for the scope of work within the SMP, complete the attached Plant and Equipment Register. *Plant risk assessments and plant maintenance records must be provided if requested by the Mallee CMA’s contractmanager.

Item of plant or equipment / Registration or plant identification / Plant owner / *Plant Risk Assessment available (Yes/No) / *Plant maintenance records available (Yes/No)

9. Hazards substances and dangerous goods management

For any hazardous substances or dangerous goods to be brought on site for the contract work, complete the attached Chemical Register. Material Safety Data Sheets (MSDS) must be made available upon request by the Mallee CMA’s contractmanager.

*If chemical/s are to be stored on site for longer than five days, the service provider must provide a copy of the MSDS to the Mallee CMA’s contractmanager.

Product name / Hazardous Substance Yes/No / Dangerous Goods Yes/No / Are all risks controlled? / *Location to be stored / Quantity

10. Emergency procedures

In an emergency detail what procedures will be followed?

______

______

11. First aid

Provision of first aid will be provided by:

(Detail location of supplies and name of first aider)

______

______

12. Welfare and amenities

Briefly describe the welfare and amenity needs of workers and how they will be provided for.

______

______

13. Parking and traffic management

Detail the parking and traffic management arrangements for the work within the scope of this SMP.

______

14. Other issues

Detail any other specific health or safety issues that need to be managed e.g.working in isolation, communication plan.

Details / Management

15. Service providers are to note the following arrangements are in place whilst conducting workfor the Mallee CMA:

In addition to service provider incident reporting processes, all OHS incidents and near misses are to be reported to the Mallee CMA’s contractmanager.

Appropriate Personal Protective Equipment and/or clothing required by workers as described within the documented work procedures must be worn when the contract work are undertaken.

Minimum standards of dress on site are long pants/trousers, long sleeved shirt, boots (hiking/safety), broad brimmed hat.

The Mallee CMA will undertake to monitor the performance of all service providers. This may be by organised or random inspections. All non-conformances will be documented and must be corrected as directed.

16. Service provider acknowledgement

I acknowledge that the details outlined in the Safety Management Plan are accurate and that this plan will be implemented in the delivery of the contract work.

Name: / Position:
Signature: / Date:

17. Responsibilities

As a service provider or employee of a service provider I understand that I have individual OHS responsibility for the following:
  1. taking reasonable care for the safety of myself and others
  2. ensuring that any hazardous conditions or situations, near misses and injuries are reported immediately to a supervisor
  3. using equipment in compliance with relevant training, instructions and manuals, without willful interference or misuse.

Declaration:

To be completed by all workers (including any service providers and subcontractors).

It is the responsibility of the service provider to inform the Mallee CMA if there is a change in persons conducting the work.

I acknowledge that I have been provided with details regarding the Service Provider Safety Management Plan and will abide by the documented process where practicable. I will alert my immediate supervisor or the Mallee CMA’s contract manager if I have any issues or incidents:

Name / Signature / Date
Evaluation of service provider
Provide feedback on the performance of the work as agreed within the Service Provider Safety Management Plan.
Please record any safety incidents or non-conformances on the Quality & Safety Report.
Mallee CMA use only
Name of Project Manager:
Date:

File Action: This form is to be filed on the respective project file with the project OHS documentation.

Metadata / Approved by / Manager Corporate Services / Last Updated / May 2015
Owner/Custodian / Manager Corporate Services / Replaces / N/A
Date of First Issue / May 2015 / Review Date / April 2017
Version / 1.0 / Review Trigger / OHS Act (Vic) 2004 OPS / OHSW committees
Search terms / Safety, management plan, responsibilities / Reference: CMA 177 FORM

Page 1 of 6