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Safe Work Instruction Template v1 Responsible Officer: Manager, OH&S Page 1 of 1
Date of first issue: August 2015 Date of last review: N/A
03/08/2015
For the latest version of this document please go to: http://www.monash.edu.au/ohs/
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SAFE%WORK%INSTRUCTION%TEMPLA TE%
TITLE%/DESCRIPTION%OF%AC TIVITY:%
Faculty/Division%
%
School/Unit%
%
Created By
Document No.
Risk
Assessment
No.
Initial Issue Date
Current
Version
Next Review
Date
SCOPE
(List whom this procedure applies to and the specific location this work can be conducted in)%
AUTHORISATIONS:%%
(List specific operator competency requirements, e.g. area induction, qualifications, certificates, OHS
training, supervision. List who can approve that competency has been achieved)
%
HAZARDS:%
%
(List all the potential hazards and associated consequence, e.g. chemical exposure inhalation or skin
absorption, leading to irritation, burns, acute or chronic injury).%
SAFETY%CONTROLS:%
(e.g. fume-hoods, biosafety cabinets, emergency equipment, machine guarding, spill kits, specific
personal protective equipment requirements, first aid response, any after-hours work restrictions or
rules)%
PRESTART%
REQUIREMENTS:
(List tasks to be completed before commencement of work, e.g. conduct a prestart safety check of
equipment; review chemical MSDS, risk assessment or lab rules; prepare work area, equipment and/or
operator)%
INSTRUCTION S :%
(List step by step procedures for the task. You can use photos, flow charts, diagrams etc.)
CLEAN%UP/%SHUT%
DOWN%
PROCEDURES:%
(List procedures for disposal of waste, decontamination, storage, shut down of equipment)%
EMERGENCY%
PROCEDURES:
(Emergency response procedures e.g. power isolation procedures, spill containment procedures, first
aid response)
FURTHER%
INFOR MATIO N :%%
%
(e.g. Monash procedures, relevant legislation, definitions, reference to other safety information)%
%
APPROVALS%
Title%%
Name%%
Signature%%
Date%
Supervisor!
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Safety!Officer!!
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AS/NZS%4801%
OHSAS%18001%
OHS20309%
SAI%Global%
Safe Work Instruction Template
source: monash.edu
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