MethodStatement
Contractor Name: Address: Tel: Email:
ProjectName Descriptionofthe Task/Activity Site Address/Location:
Start Date/Time: Finish Date/Time Name Role/Trade
PersonnelInvolved
Tel: Tel:
SiteSupervisor: SafetyOfficer KeyPlant&Tools (AttachCertification) KeyMaterials OtherEssential Equipment:
(i.e.accessplatforms/winches/ladders,etc)
JAN2011CopyrightofConstructionIndustryFederationMethodStatement
MethodStatement
Specific Identified Residual Hazards: (orrefertothe taskspecificrisk assessment(s)) SpecificStaff Training
1. 2. 3. 4. Sequenceof 5. Operations: (includesketches 6. ifrequired) 7. 8. 9. 10.
Temporary Supportsand Propsneededto facilitatethe works: Methodof Accessand Egresstothe workarea:
(ifnone,statenone)
(i.e.Ladders/MEWPS/Scaffold/Trestles/StepLadder,etc)
JAN2011CopyrightofConstructionIndustryFederationMethodStatement
MethodStatement
FallProtection Measures:
(Whereworkat heightcannotbe eliminatedconsider bothPersonnel& Materials) (i.e.GuardRails/ToeBoards/BrickGuard/SafetyHarnesses/ExclusionZones,etc.)
Hazardous Substances: (AttachMSDSif required)
AcuteToxic
HealthHazard
Corrosive
Applicable: Storage Arrangements: Detailsof PermitstoWork: SWLs:
Dangerous Forthe environment
Oxidising
Highly flammable
Explosives
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
(Detailanylimitsontheloadingsapplicabletotemporaryplant/equipmentorfixedelementsofthestructurewheretheworkistaking place)
Other:
SafetyBoots
Required Personnel Protective Equipment:
HardHats
SafetyGloves
Hearing Protection
EyeProtection
Respiratory Protection
1.HiViz 2.Coveralls 3.
EmergencyProcedures:
NameofOnSiteFirstAider: FirstAid FirstAidBoxLocation: Facilities: LocationofNearestHospital: WelfareRequirements Servicestobesupplied byOthers Otherinformation& Comments
JAN2011CopyrightofConstructionIndustryFederationMethodStatement
MethodStatement
Allworkwillbeundertakenbyqualifiedcompetentpersonswithexperienceofthetypeofworkdescribed above,andinallcasesinfullaccordancewithsafetyproceduresspecifiedinthecompanyshealthandsafety Policy. Preparedby: Position: Date: Reviewedby: Position: Date: ItemsAttached: Sketches CertificationofPlantetc. ProgrammeofWork RiskAssessments Yes No
MethodStatementBriefingRecord
Briefingdeliveredby: Position: Date: We (the undersigned) have read and understood the attached method statement and will comply with the specified requirements and control measures. If the work activity changes or deviates from that originally envisaged,wewillseekfurtheradviceandrequestanamendedmethodstatement. Name(Print) Signature Date
JAN2011CopyrightofConstructionIndustryFederationMethodStatement
