Safe Work Method Statement
(Record Approval)
Nature of the work
Site / Building Name
Location (Indoor /
Outdoor Area, Building
Section, Floor, Room,
etc.)
Name of appointed
Supervisor on Site
Name(s) of Emergency
Contact Person(s)
Name(s) of the Client
Contact Person(s)
Description of the
method to follow
(attach sketches /
drawings if possible)
Risk Rating
Methodology
Severity
Acceptable Risk Control
Level
Document No.: GOV0-4-503
SharePoint Ver.: 10.0
Date: 2022-10-24
Exhaust extension for existing standby AFRIWATT 365 PTY LTD
Principal Contractor Name
generator set
106 York Street, George, Eastern Cape NIL
Contractor, other than the
Principle Contractor,
carrying out the work (sub-
contractor)
OUTDOOR AREA Planned Start Date TBA Time 08h00
TBA
Planned Finish Date Time
Lindiwe Mqweba +27 67 703 4159 Number of 3
Mobile Phone Number
Persons
KEVIN DHAPI Office Telephone or Cell 011 864 2584 / 067 698 5418
MUTONDI SADIKI Phone Number 067 699 4139
VONGANI CHIRINDI Office Telephone or Cell
Phone Number
 SITE PREPARATION – 1 DAY
 ACCESS, USE OF PLATFORM FOR EXHAUST EXTENSION
 STEEL/ MECHANICAL WORKS
 FITTING SLEEVE JOINT
 FITTING CLAMP TO JOINT
 FITTING SUPPORT BRACKET FOR EXTENSION
Health and Safety Environmental Business time loss Matrix
Catastrophic, Fatality, Loss of limb 80% of the environmental impact is irreversible 1 day or more 3 3 6 9
Lost Time Injury (> 3 days) 60% of the environmental impact is irreversible Less than 1 day 2 2 4 6
First Aid Treatment / Near Miss The environmental impact is fully reversible 1 hour or less 1 1 2 3
High Risk (4-9) - Supervision, Safe Work Procedure(s), Permit to Work System, as well as the controls listed below 1 Unlikely 2 Likely 3 Certain
for Medium and Low Risk. Probability
Medium Risk (2-3) - Competent Workers, Site Risk Assessment and Risk Controls Training.
Low Risk (1) - Method Statement Awareness Training.
Bidvest Facilities Company Restricted
Management (Pty) Ltd Author: J Taylor
Page 1 of 8
 Safe Work Method Statement (Record Approval)

Sequence of events
Potential Hazards and Risks Appropriate Controls

Risk Rating (S x P)
Job Step / Task

Probability (P)
Sequence No.:

Severity (S)
Activity / Task

[Engineering, Administrative, Personal

Describe, in detail and as far as List the potential hazards and risks associated Protective Equipment / Wear (PPE / PPW) Responsible Person
reasonably possible, the steps with each step, which could cause injury or to Mitigate the Risk
required to perform the activity or and Training]
damage to property when the activity or task List the control measures required to eliminate or
task in the sequence in which it is is performed. (Indicate the worst-case
carried out. minimise the risk of injury or damage to property
scenario, in terms of Severity and Probability, associated with the hazards identified.
for each step).
1 Offloading material and equipment offsite

Occupational driving/ driving Poorly maintained or improperly
1 onsite handled vehicles can lead to 2 2 4
crushing injuries onsite and
collisions.
Positioning of truck  Unstable or Wet ground and
2  Uneven surfaces
 Truck losing balance resulting in
property damage and injuries.
3 Suspended load  Equipment can fail unexpectedly,
and operator errors can have
serious ramifications including
 Construction vehicles to be Project manager /
installed with reverse alarms, Supervisor
ensure they are functioning on all
vehicles.
 Designate a spotter for direction
and assistance of driver when
driving vehicle onsite
 Competent driver of vehicles,
ensure vehicle is fit for purpose
and in good working order – pre-
inspection of vehicles before use
 Position the truck on level ground. Operator
2 2 4 All the wheels of the truck to be Supervisor
chocked and in contact with the
ground when the outriggers are set
(suspension not to be completely
unloaded).
 Load test certificate for the crane
truck
 Driver must have a valid certificate
for operating the crane.
 The crane must be inspected prior
to start of work activities
3 3 9  The work area must be barricaded Operator
off to avoid public interference. Supervisor
 No one must be under the

Document No.: GOV0-4-503 Bidvest Facilities Company Restricted

SharePoint Ver.: 10.0 Management (Pty) Ltd Author: J Taylor
Date: 2022-10-24 Page 2 of 8
 Safe Work Method Statement (Record Approval)

severe injuries/death suspended load during lifting

4 Lifting the load  Inclement Weather (high winds, 3 3 9
lightning, Rainy)- Poor Vision /
Dust / Electrocution
Manual Handling  Slips, Trips and Falls due to poor
5 housekeeping.
2 2 4
 Manual Handling – carrying of
material, equipment ladders, tools
INSTALLATION OF EXTENSION PIPES
Drilling support bracket Existing services in the wall can
6 cause electrocution and other
property damages 3 2 6
Awkward postures and repetitive 2 2 4
motions can lead to sprains, strains
and other musculoskeletal disorders
Exposure to Dust, inhalation causing 3 2 6
lung infections
Exposure to excessive weather 2 2 4
activities
 Access control must be
implemented around the work area
 No work will take place if the wind Operator
speed exceed 40km/h No Supervisor
work to be carried out during
adverse weather conditions
Risks shall be assessed prior to
lifting and must be then approved
by Bidvest Project
manager/Engineers before any
work commences.
 Good housekeeping practices for a
safe place of work. Clear access Installer
routes and signage. Continuous
removal of all waste. / Site Supervisor
 Hand tools are relatively lightweight
(tools to be carried in single
toolbox). Train employees in
Manual Handling techniques. Large
and awkward cable tray or ladder
rack to be handled/carried by two
workers.
 Confirm no services at points to be
dug, client to issue written
notification, if services are Site Supervisor
identified in the area, an isolation
certificate must be issued
 Implement manual handling SWP Site Supervisor
 Conduct toolbox talks about
manual handling
 Dust suppression – wet surface Site Supervisor
before digging, workers to wear
FFP2 type dust masks
 Allow short breaks and rotation of Site Supervisor

Document No.: GOV0-4-503 Bidvest Facilities Company Restricted

SharePoint Ver.: 10.0 Management (Pty) Ltd Author: J Taylor
Date: 2022-10-24 Page 3 of 8
 Safe Work Method Statement (Record Approval)

conditions causing hyperthermia/ task.

7 Portable electrical tools
8 Paint work, painting exhaust  Inhalation of fumes
extension
hypothermia - Dehydration and
dizziness
Faulty tools/ Equipment 3 2 6  Do not use defective tools Site Supervisor
 Inspect hand tools before use
 Do not modify hand tools
 Train employees on the SWP for
hand tools
 Portable hand drill must be
inspected before use
Noise-NIHL 2 2 4  Use ear protection when using Site Supervisor
portable drill
Electric shock  1.SWP, Monthly Portable Electric
Equipment Inspections
2.Use Personal Protective
Equipment
3.All defect tools must be reported
to the supervisor and removed from
site.
 Rinse eyes with water if they come
 Paint flung into eye
2 1 2 into contact with cement. Site Supervisor
 Use soap and water to wash off dust
to avoid skin damage.
 Wear full PPE; pants and long sleeve
jacket, apply hand protection –
crayfish gloves to avoid skin
irritation

Inserting clamps and backet  Installer shall wear appropriate

9 to hold extension in place.  Handling of sharp edges of steel PPE, leather gloves, goggles, ear
 Manual handling 2 2 4 plugs Site Supervisor
 Training in suitable lifting
techniques and assisted lifting, 2
employees to lift the palisade panel

Document No.: GOV0-4-503 Bidvest Facilities Company Restricted

SharePoint Ver.: 10.0 Management (Pty) Ltd Author: J Taylor
Date: 2022-10-24 Page 4 of 8
 Safe Work Method Statement (Record Approval)

and place where there are to be

installed

Using a ladder
10
Vehicles and Mobile Plant
(Cherry Picker, Back Actor, etc.,
List Registration Numbers)
Materials to be used
Working at height -Fall risk
Truck mounted crane
Cement, Palisade poles, concrete mix,
reinforcement steel, cable,
3 3 9  Fall protection and rescue paln Site Supervisor
must be implemented.
 Employees must be trained on
SWP for working at heights
 Employees must hook up at
heights
 Ladders must be inspected prior to
use
 SWP for Ladder must be trained on
employees
Equipment to be used Ladder, generator unit,
(Scaffold / Ladder, Compressor, Porta
Pack, Welding Machine, etc.)
Chemicals to be used (Paint, oil, Cement, coolant, engine oil, diesel
Thinners, etc.)

Grinder, extension cables Hand Pick, Shovels, Pliers,

Electrical Tools to be used Hand Tools to be used

Safety Signage and Site safety board, No entry, danger – Incident Management ✘ First Aid Kit available on site and adequate
Barricading to be used lifting operations. (Mark the item with an “X” if applicable) ✘ Spillage Kit available on site and adequate

The following records to be submitted as part of the Safe Work Method Statement conditional Site/Team/
Vendor
approval process. Clearly mark “X” in the appropriate block to indicate the location where Portal
Vehicle N/A Specify
documents can be reviewed. SHE File
Certificates of Specialised Equipment e.g. Lifting Equipment / Devices, Slings, etc. ☐ ☒ ☒ ☐ Submit records to ensure
compliance with CR and DMR
18
Company / Supervisor / Technical Staff Competency Records ☐ ☒ ☒ ☐ Qualifications of the Electrical
(e.g. HVAC, Electrical, Fire and Access, Plumbing, Carpentry, Welding, etc.). competent person
Site Supervisor
Fall Protection Plan and Rescue Plan ☐ ☐ ☐ ☒
Legal Appointments (Site Supervisor, Risk Assessor, Fall Protection Planner, First Aider, Rigger, ☐ ☒ ☒ ☐ Supervisory person on site
etc.).

Document No.: GOV0-4-503 Bidvest Facilities Company Restricted

SharePoint Ver.: 10.0 Management (Pty) Ltd Author: J Taylor
Date: 2022-10-24 Page 5 of 8
 Safe Work Method Statement (Record Approval)

Material Safety Data Sheets for Hazardous Chemical Substances ☐ ☒ ☒ ☐ Diesel, Antifreeze, oil,
(Risk of exposure to the product, e.g. toxic fumes / poisonous / corrosive substances, etc.). sanitiser
Mandatory / Section 37.2 Agreement Signed ☒ ☒ ☐ ☐
Medical Certificates of Fitness (Working at Heights, Suspended Platforms, Cranes, Mobile ☒ ☒ ☐ ☐
Elevated Work Platforms).
Public Liability Insurance / Contractor’s All Risk Insurance ☒ ☐ ☐ ☐
Safe Work Procedures (Working at Heights, Suspended Platforms, Cranes, Mobile Elevated Work ☐ ☒ ☒ ☐ Related to the Project and
Platforms, Electrical and Mechanical Equipment). LOTO
Site Induction (Client / Bidvest Facilities Management / Safe Work Method Statement). ☐ ☒ ☒ ☐ Toolbox for the site
installation
Statutory Training Certificates, e.g. Scaffold Supervisor, Erector and Inspector, Mobile Elevated ☐ ☒ ☐ ☐ Basic Fire Training
Work Platform Operator, Rope Access and Fall Prevention Certificates, etc.). First Aider
Mobile Crane Operator

Valid Letter of Good Standing (Compensation for Occupational Injuries and Diseases Act 130 of ☒ ☒ ☐ ☐
1993)
Vehicles, Mobile Plant and Equipment Inspections as per the list above. ☐ ☒ ☐ ☐
Certificates of Specialised Equipment e.g. Lifting Equipment / Devices, Slings, etc. ☐ ☒ ☒ ☐ Submit records to ensure
compliance with CR and DMR
18

Company Authority Name (I confirm, to the best of my knowledge, that the information above is correct and I will ensure that the prescribed
Confirmation (Designated health, safety and environmental precautions are implemented before work commences on site.)
Contractor Representative) Name: Mutondi Sadiki Designation: 16.2 Signature: Date: 2023 / 06 / 23

For office use only

Hot Work Excavations Isolation (electrical, water, mechanical, live / pressurised
Permit to Work Required
Maximum depth: _______m equipment, fire alarm and gas suppression system)
Confined Space Lifting Operations: Working at Heights:
Applicable Not Applicable
Maximum lifting weight: ±_________kg Maximum Height: ±_________m from floor level
Compliance Representative Company Authority Name (I confirm, to the best of my knowledge, that the above information is correct and that the prescribed health,
verifies the content when a safety and environmental precautionary measures are appropriate for the risk exposure. In addition, the Permit Issuer may proceed to
Permit to Work is required, conditionally approve this Safe Work Method Statement)
Operational or live work is Name: Designation: Signature: Date:
performed, or on request for
confirmation by the Permit
Issuer.
Applicable Not Applicable

Document No.: GOV0-4-503 Bidvest Facilities Company Restricted

SharePoint Ver.: 10.0 Management (Pty) Ltd Author: J Taylor
Date: 2022-10-24 Page 6 of 8
 Safe Work Method Statement (Record Approval)

Conditional Approval
Herewith provide conditional
approval to proceed with the
work, subject
Bidvest Facilities Management Authority Name / Permit Issuer (I confirm, to the best of my knowledge, that the above information is
correct and that all prescribed health, safety and environmental precautions have been verified as indicated.
Conditional Approval to proceed with the work is subject to the following conditions being implemented by the Designated Contractor
Representative, prior to work commencement on site);
 Hand tools, electrical tools, ladders and equipment inspected and in good condition.
 Personal protective equipment / wear (PPE / PPW) inspected and in good condition.
 All appropriate controls / precautionary measures, related to the Risk Assessment above, implemented.
 All employees have received awareness training on the content of this document.
 Documentation in the site / team / vehicle Safety, Health and Environment (SHE) file reviewed prior to work commencement.
 A Daily Site Risk Control Check (Task Risk Assessment) or Daily Safety Task Instruction (DSTI) conducted and risk controls
implemented.
 All conditions of this Permit to Work implemented.
 Other, specify:
Name: Designation: Signature: Date:

DESIGNATED CONTRACTOR REPRESENTATIVE TO COMPLETE THE FOLLOWING BEFORE WORK COMMENCEMENT ON SITE
Register and inspection of the condition of hand and electrical tools, ladders, equipment and personal protective equipment / wear (PPE / PPW)
List of critical tools, ladder(s) and Tool Identification Condition Employee Name List of PPE / PPW Condition
equipment Number (Good or Bad) (Good or Bad)

Document No.: GOV0-4-503 Bidvest Facilities Company Restricted

SharePoint Ver.: 10.0 Management (Pty) Ltd Author: J Taylor
Date: 2022-10-24 Page 7 of 8
 Safe Work Method Statement (Record Approval)

SAFE WORK METHOD STATEMENT BRIEFING

I, the undersigned, hereby confirm that I have read / discussed and understand the attached Method Statement and Risk Assessment, and that I will comply with the
specific requirements and control measures indicated. If work activities change or deviate from that originally envisaged, I will seek further advice and request an
amended Method Statement and Risk Assessment.
Name (Print) Signature Name (Print) Signature

WORK COMPLETION
Designated Contractor Representative (I hereby certify that the work specified in this Safe Work Method Statement has been completed.
In addition, I confirm that:
 All persons under my supervision, together with all work materials and equipment have been withdrawn, and that the site has been left clean, tidy, safe and free
of any risks (including fire) for normal work to resume.
 The completed Safe Work Method Statement and the attached Daily Site Risk Control Check (Task Risk Assessment) or DSTI will be submitted to the Bidvest
Facilities Management Facilities Manager or Technical Manager for record keeping.
Name: Designation: Signature: Date:

Bidvest Facilities Management Authority Name / Permit Issuer (I confirm, to the best of my knowledge, that the work has been completed, that equipment has
been tested, and that the area is safe and free of risk (including fire) for normal work to resume).

Name: Designation: Signature: Date:

Document No.: GOV0-4-503 Bidvest Facilities Company Restricted

SharePoint Ver.: 10.0 Management (Pty) Ltd Author: J Taylor
Date: 2022-10-24 Page 8 of 8