102 Method Statement Template

• Project Name / No.

• Contractor

• Contractor's Contact No.

• Conducted by

• Date

  Date
• Site Address/Location
  Address

• Take or Attach Photo of Site

  Media

• Job Title

• Description of Work (overview list of planned activities)

Supervision of Task

• Click '+' and add personnel in charge of task supervision (e.g site supervisor, safety officer, foreman, etc.)

Employee

• Name

• Role

• Contact No.

Employees Involved

Employee

• Name of personnel

• Role

Methodology

• In this section, provide step-by-step instruction as to how the work activity should be safely carried out and completed

• Sequence of Operations

• Plant & Equipment to be used

• Specific Staff Training

• Select the type of hazard associated with the planned activities below

Associated Hazard

• Hazard

  Select Working at heights/excavation Moving objects Slips, trips, and falls Material and manual handling Collapsing trenches Abestos Electricity Airborne fibers and materials Other

  • Working at heights/excavation
  • Moving objects
  • Slips, trips, and falls
  • Material and manual handling
  • Collapsing trenches
  • Abestos
  • Electricity
  • Airborne fibers and materials
  • Other

• Please specify

• Control Measures

• PPE (select the required ppe)

  Select Safety gloves Hearing Protection Eye Protection Respiratory Protection Coveralls Other

  • Safety gloves
  • Hearing Protection
  • Eye Protection
  • Respiratory Protection
  • Coveralls
  • Other

• Please specify

Emergency Procedures

• Name of Person with Health & Safety Responsibility

• Emergency Contact Details (include mobile no.)

• First Aid Provision - in the event of an emergency, the following procedures should be executed:

• Welfare Requirements

• Services to be Supplied by Others

Completion

• Other Information & Comments

• Prepared by (provide name & signature)

  Sign

• Reviewed by (provide name & signature)

  Sign