Owner-Builder Companion

Reference Only — Not Your Actual Documents

WHS Site Safety Pack — Worked Examples

SafeWork NSW's official Housing Industry Site Safety Pack gives you 10 blank forms and no worked example of how to fill them in. Below is one hypothetical build, filled in end to end, so you can see what reasonable content looks like before you or your subcontractors complete your real ones.

Example Only — Not A Template To Copy

Every value below is invented for one fictional scenario. Your site, your trades, your hazards, and your subcontractors' circumstances are different — copying this content instead of working through your own site's real conditions could leave a real hazard uncontrolled. Use these as a guide to the kind and level of detail expected, then complete the real, current, official forms yourself.

Who actually fills each form out

The pack is written for small subcontractors (0–10 workers) to complete and hand to you as evidence of their WHS system — not primarily for you to fill out yourself. As the owner-builder you become the principal contractor, so two forms are genuinely yours: the site-specific risk assessment, and any incident and injury report.

Watch it explained

SafeWork NSW's own YouTube channel — general site-safety tips, not a form-by-form walkthrough. We could not find an official video that actually demonstrates filling out the pack itself, so this is the closest genuine resource, not a substitute for the worked examples above.

"Build it safely. Plan ahead." — SafeWork NSW →
More SafeWork NSW videos →

Forms your subcontractors give you

WHS Form 01

Organisation details

Example Only

Your framing subcontractor gives you this before starting the frame stage.

Business/trading name
— left blank: insert the subcontractor's real business name —
No. of employees
4
Scope of works
Wall frame erection, roof truss installation
Workers compensation
Policy WC-EXAMPLE-001, expiry 30/06/2027
Public liability
$10,000,000 cover, expiry 30/06/2027
Contract licence number
— left blank: insert their real licence number —
Person responsible for WHS on site
Site foreman — named on the form
Intend to subcontract further?
No — own crew for this scope

WHS Form 02

Roles and responsibilities

Example Only

Mostly pre-written duties (owner/director, supervisor, worker) — the subcontractor just names who holds each role and signs.

Business owner/director
Named, signed, dated
Manager/supervisor or leading hand
Named, signed, dated — this is who runs toolbox talks and SWMS on site
Worker
Duties apply to every worker automatically — no extra fields to fill

WHS Form 03

Work health and safety policy

Example Only

A standard policy statement — the subcontractor's director signs to commit to it.

Name
Business owner/director
Position
Director
Signature / Date
Signed and dated before work starts

WHS Form 05

Safe work method statement (SWMS)

Example Only

Required for high-risk construction work — here, installing roof trusses (risk of falling more than 2m).

Work activity
Installation of roof trusses
High risk construction work
Risk of a person falling more than 2 metres
Task: Lifting trusses into position
Hazard: fall from height, truss swinging/manual handling. Control: mechanical lift (crane or truss lifter), harness with fixed anchor point, exclusion zone marked below the lift path
Task: Working on top plate/frame
Hazard: fall from height. Control: edge protection or harness system, no work in high wind, sequence checked with foreman before starting

The real form has a full task/hazard/control table — this shows 2 rows as examples.

WHS Form 06

Record of toolbox talk

Example Only

A short record before starting a high-risk activity.

Topics discussed
Truss lifting sequence, exclusion zone boundaries, harness anchor point locations, weather check (wind)
Persons present
All workers on site that day — named and signed

WHS Form 07

Worker training, instruction and/or information register

Example Only

One row per worker, per piece of training.

Type of training
General construction induction (White Card)
Licence/card number
example: 123456789
Person providing training
Accredited RTO — sighted and recorded by supervisor
Expiry/renewal
White Card does not expire, but site-specific induction is refreshed per job

WHS Form 08

Electrical test and tag register

Example Only

Portable equipment (like extension leads and power tools) needs testing every 3 months.

Equipment
15m extension lead
Date of inspection/test
— left blank: use today's actual date, not this page's —
Result
Pass — tagged
Date for next inspection
3 months from the real test date above

WHS Form 09

Hazardous chemicals register

Example Only

Any hazardous product brought on site gets logged.

Product name
Construction-grade adhesive (bracing/gang-nail plates)
Application
Bracing fixings during frame assembly
Product labelled?
Yes
SDS available?
Yes — current within 5 years, kept on site

Forms you complete yourself

WHS Form 04

Site specific risk assessment

Example Only

You (or your Principal Certifier's expectations) complete this — a walk-around before work starts on your own site, at the footings/slab stage.

Scope of works
Excavation and pour for footings and slab
Open trenches or excavations?
Yes — trench fenced with temporary barricade, warning signage at both access points
Overhead or underground services?
Yes — Dial Before You Dig plan on file, services marked on site before digging
Parking arrangements?
Concrete truck access via driveway only — neighbours notified of pour day/time
Impaling hazards? (reo bars, star pickets)
Yes — all exposed reo bar ends capped

The real form has 12 prompts — this shows 4 as examples, not the full list.

WHS Form 10

Incident and injury report

Example Only

You (as principal contractor) complete this if something happens on your site — here, a minor first-aid example, not a real incident.

Nature of incident
First aid
Activity at time of injury
Carrying timber offcuts to the waste bin
Nature of injury
Small splinter, removed on site
Treatment given on site
First aid kit — splinter removed, wound cleaned and covered
Reported to authorities?
No — did not meet the threshold for a notifiable incident. Call SafeWork NSW on 13 10 50 if unsure whether yours does.

Get the real, blank pack

The official forms are free, current, and the ones you should actually print, complete and keep on file.

Download the official Housing Industry Site Safety Pack →
Example Only

These worked examples are informational only, not legal or WHS advice, and not a substitute for your own risk assessment. Every site has different hazards, trades and conditions — always base your actual forms on your own site's real circumstances, not on this page.