DOHA BRITISH SCHOOL RAWDAT AL HAMAMA

FORM – METHOD STATEMENT

FORM METHOD STATEMENT :
PART A – CONTRACTOR DETAILS
BNITC CONTACT NAME

ADDRESS - DBS PHONE

EMAIL

PART B – PROJECT DETAILS

PROJECT TITLE-DBS RAH SITE ADDRESS-RAWDAT AL HAMAMA

DESCRIPTION OF TASK / ACTIVITY

ADDRESS START DATE: END DATE:

START TIME: END TIME:

PART C – PERSONNEL INVOLVED

NAME ROLE / TRADE

SITE SUPERVISOR PHONE: EMAIL:

SAFETY OFFICER / ADVISOR PHONE: EMAIL:

PART D – EQUIPMENT REQUIRED

KEY PLANT & TOOLS (ATTACH CERTIFICATION IF APPLICABLE)
 DOHA BRITISH SCHOOL RAWDAT AL HAMAMA

KEY MATERIALS

OTHER ESSENTIAL EQUIPMENT

PART E – SAFETY
SPECIFIC RESIDUAL IDENTIFIED HAZARDS (OR REFER TO THE TASK SPECIFIC RISK ASSESSMENTS)

SPECIFIC STAFF TRAINING (E.G. CONFINED SPACE )

SEQUENCE OF OPERATIONS (INCLUDE SKETCHES IF REQUIRED)

DETAILS OF COORDINATION / INTERACTION REQUIRED WITH PROJECT SUPERVISORS,

CONTRACTORS AND OTHERS

TEMPORARY WORKS NEEDED TO FACILITATE THE PERMANENT WORKS (IF NONE, STATE NONE)

FALL PROTECTION MEASURES (WHERE WORK AT HEIGHT CANNOT BE ELIMINATED – CONSIDER

BOTH PERSONNEL AND MATERIALS)

SAFE WORKING LOADS (SWLS) – DETAIL ANY LIMITS ON THE LOADING APPLICABLE TO
TEMPORARY PLANT/EQUIPMENT OR FIXED ELEMENTS OF THE STRUCTURE WHERE THE WORK IS
TAKING PLACE
 DOHA BRITISH SCHOOL RAWDAT AL HAMAMA

DETAIL PERMITS TO WORK (IF APPLICABLE)

UTILITY / POWER SHUT DOWN REQUIRED?

REQUIRED PERSONAL PROTECTIVE EQUIPMENT (PPE)

SAFETY HARD SAFETY HEARING EYE RESPIRATORY HI-VIZ

BOOTS HATS GLOVES PROTECTION PROTECT PROTECTION
ION
YES YES YES YES NO YES YES NO YES NO
NO NO NO NO

OTHER PPE REQUIRED (PLEASE STATE)

SERVICES TO BE SUPPLIED BY OTHERS

OTHER INFORMATION AND COMMENTS

PART F – HAZARDOUS SUBSTANCES

ATTACH CHEMICAL RISK ASSESSMENTS IF REQUIRED
LIST HAZARDOUS SUBSTANCES & IDENTIFY RISKS BELOW

EXPLO FLAM OXIDIS COMPR CORRO ACUTE SKIN ASPIRA HAZAR

SIVES MABLE ING ESSD SIVE TOXICI IRRITA TION DOUS
LIQUID LIQUID GASES TY TION HAZAR TO THE
S S D AQUATI
C
ENVIRO
NMENT
YES YES YES YES YES YES YES YES YES
NO NO NO NO NO NO NO NO NO
STORAGE ARRANGEMENTS
 DOHA BRITISH SCHOOL RAWDAT AL HAMAMA

PART G – EMERGENCY PROCEDURES & WELFARE REQUIREMENTS

FIRST-AID FACILITIES

NAME OF FIRST AIDER PHONE

FIRST-AID BOX LOCATION

LOCATION OF NEAREST HOSPITAL

WELFARE REQUIREMENTS

DECLARATION
ALL WORK WILL BE UNDERTAKEN BY QUALIFIED, COMPETENT PERSONS WITH
EXPERIENCE OF THE TYPE OF WORK DESCRIBED ABOVE AND, IN ALL CASES, IN
FULL ACCORDANCE WITH SAFETY PROCEDURES SPECIFIED IN THE COMPANY’S
HEALTH AND SAFETY POLICY
PREPARED BY
NAME SIGNATURE DATE

REVIEWED BY
NAME SIGNATURE DATE

PART H – ITEMS ATTACHED

SKETCHES CERTIFICATIO PROGRAMME RISK TRAINING
N OF PLANT, OF WORK ASSESSMENTS RECORDS
ETC.
YES NO YES NO YES NO YES NO YES NO

INFORMATION SUPPLIED PREVIOUSLY

PART J – METHOD STATEMENT BRIEFING RECORD

BRIEFING DELIVERED BY
NAME SIGNATURE DATE
 DOHA BRITISH SCHOOL RAWDAT AL HAMAMA

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, WE WILL SEEK FURTHER ADVICE AND REQUEST AN
AMENDED METHOD STATEMENT.
NAME SIGNATURE DATE