Power & Water Utility Company for Jubail Document ID No : MSSF-1-SF-040

and Yanbu (MARAFIQ) Page: 1 of 1

Rev. No.: 0
OHSMS FORMS
Date of issue: 10 Feb 2015

40. METHOD STATEMENT TEMPLATE

Project name /# : Yasref housing Project-Yanbu Expected duration: Two days

Company: Abdullah Faleh Al Dossary Sons Exact location: As per drawing attached
Scope of work with plan / drawing:

Tie in Connection for Potable Water System (04 Locations)

Job title # Personnel
No of personnel / job title 1. Tie In for Potable Water 06
System
2
1. Sets of Generator, Power & electricity, excavation,
Materials, tools & equipment plumbing tools.
2
3
Specify all the required PPEs Helmet, Gloves, Safety glass, Safety Shoes, Safety Vest
Waste removal & Housekeeping: Disposed at Approved designated Potable landfill by
RCY
Sequence of works. Significant risk Mitigation plan
1. Excavation & Shoring 1. Collapse of Shoring Proper Shoring Protection
2. Backfilling 2. Property Damage Proper PPE / MSDS
3. Lifting 3. Falling Object Third party inspection
Chemical name Precautions
Attach Material Safety Data Sheets for
all chemicals to be used

Details of training Expert Plumbers & Pipe Fitters

Emergency arrangements: De-watering Pump

Prepared by Supervisor:
Nikhil G
Approved by the Job coordinator:

OPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MARAFIQ. ANY DISCLOSURE OR USE IS
EXPRESSLY PROHIBITED EXCEPT UPON WRITTEN PERMISSION BY MARAFIQ. Only document with stamps are considered official.