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Project Name: PCA Automobiles India Pvt Ltd Address: PCA Automobiles India Pvt Ltd
Adhigathur,kadambathur post,thiruvallur,Tamil Nadu- 631203
E - Extreme Risk: The hazard has the potential to kill or permanently disable a person H - High Risk: The hazard has the potential to cause a LTI ≥ 7 days
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (ie: Nil LTI)
Document Name: Page No.
Safe work method statement 1 of 11
Safe Work Method Statement
Person who
Procedure (in steps) Possible Hazards
Risk Control Measures will ensure
Rating (Describe what action or procedure will be taken to this happens
(Break the job down into (Identify the hazards associated with each (See eliminate or minimize the risk of injury or damage. Use the
steps. Each step should step. Examine each to find possibilities below) Hierarchy of Controls below as a guide
accomplish some major task that could lead to an accident or potential 1. Eliminate the Hazard
and be in logical sequence.) harm arising.) 2. Substitute the material or equipment
3. Isolate the hazard
4. Implement Engineering control
5. Implement Administrative control
6. PPE
E - Extreme Risk: The hazard has the potential to kill or permanently disable a person H - High Risk: The hazard has the potential to cause a LTI ≥ 7 days
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (ie: Nil LTI)
Document Name: Page No.
Safe work method statement 2 of 11
Safe Work Method Statement
Person who
Procedure (in steps) Possible Hazards
Risk Control Measures will ensure
Rating (Describe what action or procedure will be taken to this happens
(Break the job down into (Identify the hazards associated with each (See eliminate or minimize the risk of injury or damage. Use the
steps. Each step should step. Examine each to find possibilities below) Hierarchy of Controls below as a guide
accomplish some major task that could lead to an accident or potential 1. Eliminate the Hazard
and be in logical sequence.) harm arising.) 2. Substitute the material or equipment
3. Isolate the hazard
4. Implement Engineering control
5. Implement Administrative control
6. PPE
Dust hazards Provide the Dust hazards to the workers those who Mr.
Excavation activities by JCB Damages to the underground H working near by the activities Veerabathar
and Excavator Machine utilities Hazard awareness through tool box talk an
Suffocation of inhaling due to dust Provide the sign boards prior to the activities. Banks
Machinery /Vehicle and men slip at man should be provided . Proper
excavation area access should be provided
Water Stagnate Ensure the excavation permit before starting the
Chances of Cave-In excavation activities
Ensure the underground utilities clearance for the client
Identify the underground cables by thorough
investigation with the help of utility drawings..
Provide Nose mask and safety goggles to the worker
those who involved in the task
Sprinkling the water on loose soil to avoid the flying
dust
Hazard awareness through tool box talk
Provide the hard barricade with sign boards to the
excavation area
E - Extreme Risk: The hazard has the potential to kill or permanently disable a person H - High Risk: The Provide reflective
hazard has lights/
the potential stickers
to cause a LTI to
≥ 7identify
days the
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (ie: Nil LTI)
Document Name: Page No.
Safe work method statement 3 of 11
Safe Work Method Statement
Person who
Procedure (in steps) Possible Hazards
Risk Control Measures will ensure
Rating (Describe what action or procedure will be taken to this happens
(Break the job down into (Identify the hazards associated with each (See eliminate or minimize the risk of injury or damage. Use the
steps. Each step should step. Examine each to find possibilities below) Hierarchy of Controls below as a guide
accomplish some major task that could lead to an accident or potential 1. Eliminate the Hazard
and be in logical sequence.) harm arising.) 2. Substitute the material or equipment
3. Isolate the hazard
4. Implement Engineering control
5. Implement Administrative control
6. PPE
E - Extreme Risk: The hazard has the potential to kill or permanently disable a person H - High Risk: The hazard has the potential to cause a LTI ≥ 7 days
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (ie: Nil LTI)
Document Name: Page No.
Safe work method statement 4 of 11
Safe Work Method Statement
Person who
Procedure (in steps) Possible Hazards
Risk Control Measures will ensure
Rating (Describe what action or procedure will be taken to this happens
(Break the job down into (Identify the hazards associated with each (See eliminate or minimize the risk of injury or damage. Use the
steps. Each step should step. Examine each to find possibilities below) Hierarchy of Controls below as a guide
accomplish some major task that could lead to an accident or potential 1. Eliminate the Hazard
and be in logical sequence.) harm arising.) 2. Substitute the material or equipment
3. Isolate the hazard
4. Implement Engineering control
5. Implement Administrative control
6. PPE
Vehicle access and parking at Hitting the nearest structure /People M Vehicle should be checked as per the inspection Mr.
work spot and other vehicle checklist and statutory document. Saravanan
workers may take rest beneath Driver having valid driving license.
vehicle Vehicle movement should be separated from
Toppling of vehicle pedestrian walkway
Follow speed limit 15 km/Hr inside the factory limit.
Parking of vehicle on leveled place and designated
park area.
Signal man should be engaged.
Should not be over load carrying.
Clear road surface should be provided
Checking will be done regarding any hydraulic oil
leakages.
E - Extreme Risk: The hazard has the potential to kill or permanently disable a person H - High Risk: The hazard has the potential to cause a LTI ≥ 7 days
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (ie: Nil LTI)
Document Name: Page No.
Safe work method statement 5 of 11
Safe Work Method Statement
Person who
Procedure (in steps) Possible Hazards
Risk Control Measures will ensure
Rating (Describe what action or procedure will be taken to this happens
(Break the job down into (Identify the hazards associated with each (See eliminate or minimize the risk of injury or damage. Use the
steps. Each step should step. Examine each to find possibilities below) Hierarchy of Controls below as a guide
accomplish some major task that could lead to an accident or potential 1. Eliminate the Hazard
and be in logical sequence.) harm arising.) 2. Substitute the material or equipment
3. Isolate the hazard
4. Implement Engineering control
5. Implement Administrative control
6. PPE
Dozing and compaction Mechanical failure H Maintenance of the vehicle maintained periodic ally. Mr.
Crush injury General inspection of the vehicle should done by the Veerabathar
Hit to structure operator prior to the vehicle start. an
Fire hazard only trained and authorized operator to be deployed
Burn injury due hot engine body with valid license
Cordon off the area and deploy the banks man.
No loose connections of the wires.
Cover all the hot surface where there is a chance to
come in contact with human body.
Ventilation hole should be clean to avoid the explosion
in battery.
E - Extreme Risk: The hazard has the potential to kill or permanently disable a person H - High Risk: The hazard has the potential to cause a LTI ≥ 7 days
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (ie: Nil LTI)
Document Name: Page No.
Safe work method statement 6 of 11
Safe Work Method Statement
Person who
Procedure (in steps) Possible Hazards
Risk Control Measures will ensure
Rating (Describe what action or procedure will be taken to this happens
(Break the job down into (Identify the hazards associated with each (See eliminate or minimize the risk of injury or damage. Use the
steps. Each step should step. Examine each to find possibilities below) Hierarchy of Controls below as a guide
accomplish some major task that could lead to an accident or potential 1. Eliminate the Hazard
and be in logical sequence.) harm arising.) 2. Substitute the material or equipment
3. Isolate the hazard
4. Implement Engineering control
5. Implement Administrative control
6. PPE
Equipment ,Tools & tackles Used: Excavater, Roller-Compactor, Tipper, Spade etc.
Mandatory PPE’s: Safety Helmets, Reflective jacket, Goggles, Hand gloves, Nose mask, Safety shoe / Gum boot.
Role of Supervisor :
E - Extreme Risk: The hazard has the potential to kill or permanently disable a person H - High Risk: The hazard has the potential to cause a LTI ≥ 7 days
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (ie: Nil LTI)
Document Name: Page No.
Safe work method statement 7 of 11
Safe Work Method Statement
Personnel Summary
SUPERVISOR’S DETAILS
Supervisors Name & Qualifications: Name: Mr.Veerabatharan
Experience: 30 yrs
Qualifications: civil
Supervisor’s Responsibilities: In addition to the above, the supervisor is to provide training in the use of this WMS, issue PPE and provide training in
the same, supervise the work, ensure conformity with this WMS, amend the WMS when additional hazards are found
(and if applicable, ensure all workers receive a tool-box talk to discuss the control measures for the additional hazards).
DESCRIPTION OF TRAINING THAT HAS BEEN GIVEN TO PEOPLE INVOLVED WITH THE WORK
WORK ACTIVITY TRAINING: SWMS is communicated to all, explained work related hazards as well as control measures.
SITE INDUCTION: All workers are inducted by site safety office and conducted TBT on daily basis.
OTHER: (List other training undertaken by workers): Height work, Hot work training has been conducted by safety officer
TICKETS, PERMITS or LICENCES REQUIRED undertaking this work (ie. Certificates of Competency, Confined Spaces etc):
N.B. - Copies of the above must be shown to the Principal Contractor during site induction.
LEGISLATION, CODES OF PRACTICE and GUIDELINES applicable to this work
All work to comply with the KONE H&S Acts and Regulations and amendments, Workplace Injury Management & Workers Compensation Acts
Serial Plant/Equipment Contractor Government Plant Hazards Maintenance/service records and log books
Registration No. identified and sighted by Principle Contractor prior to
controlled within equipment being used on site?
(Where applicable)
WMS?
Yes No Sign Date
1
2
3
4
ELECTRICAL EQUIPMENT USED DURING THE WORKS (Attach Electrical Equipment Register if applicable):
Item Tag/Item Testers Name & Signature License Number Test Date Result Test Date Result
Number
NA ____ /____ /____ ____ /____ /____
NA ____ /____ /____ ____ /____ /____
NA
HAZARDOUS SUBSTANCES or DANGEROUS GOODS USED IN THE WORKS and anticipated volumes (Attach MSDS if applicable):
MSDS
Date on Date Left Purpose Location & Volume Controls MSDS Attache
Product Name
Site Site (ie. Application on site) Used on Site (& PPE to be worn) Date d
(Y/N)
/ / / / NA / /
/ / / / NA / /
/ / / / NA / /
N.B. - All workers must be trained in the safe use of all chemicals and provided with the PPE required when using and storing these chemicals. Disposal is to be
as per the waste disposal methods in the MSDS. Spillage and leaks are to be cleaned up as per the spill/leak procedures identified in the MSDS.
We agree that we have been consulted in the hazards and control measures and agree to complete the work in accordance with our Work Method Statement
(WMS).
We have been provided with training in all tasks outlined in our WMS and in the Codes of Practice applicable to our work.
Any changes, additions or deletions made to this WMS are to be covered with the above personnel and the Principal Contractor’s representative at a Toolbox
meeting (Record date and time of Toolbox meeting below):
Date: Time:
Comments: