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