Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • Project client

  • Area

  • Site Address

  • Permit number

  • Operatives are obliged to carry out work to the standards required by the New Roads and Street Works Act 1991

  • Supervisors and operatives will have the relevant NRSWA accreditations from the relevant board

  • Brief description of works

  • Site operatives must continually monitor and assess risks to themselves and members of the public in the immediate vicinity

  • Traffic signs, barriers, cones and other apparatus for the control of traffic and pedestrians will be erected to conform to Safety at Street Works and Road Works (ACOP) and Chapter 8 Traffic Signals Manual

  • Persons affected by works

  • Describe how persons are affected

Hazards

  • Safety

  • Please specify

  • Health

  • Please specify

Site operatives

  • Name

  • Job

  • Name

  • Job

Welfare Facilities

  • Use on site if possible, otherwise public toilets

Plant & Equipment

  • Equipment on this site

Method of Works/Sequence

  • - Report to site contact, sign in and complete any applicable induction
    - Make sure vehicle is parked safely, legally and is locked
    - Review permission to work ensuring any permits are valid
    - Review risk assessments and safe working procedures
    - Ensure any additional or site-specific hazards or risks are noted on the risk assessment
    - Check and confirm any underground services in your works area using CAT and Genny. All services to be marked as appropriate
    - Footway and carriageway boxes will be tested and monitored for gas. No smoking or open flames permitted. Constant monitoring will be in place in open boxes
    - If there are any visible risks on site that you are unsure of, please contact your supervisor
    - Select the appropriate PPE and ensure it is fit for use, clean and in good condition
    - Make sure all plant is in safe condition and inspected before use and complete all pre-user checks
    - Only use plant and equipment if you are trained and competent to do so
    - Where applicable, make sure permit board is displayed with valid permit number clearly visible
    - Personnel check for debris at work areas including checks for syringes and broken glass before work commences
    - Carry out all works as described in the SML Fibre job pack
    - All work to br carried out in accordance with training and instruction
    - All accidents, incidents and near misses to be reported to your supervisor or manager
    - Dust will be controlled by water suppression/dampening down
    - Only competent trained personnel to Diamond/core drill
    - Personnel to follow the specific user instructions for the Diamond/core drill they are using
    - Measures should be taken to protect any equipment or services located inside footway and or carriageway chambers
    - Make good any defect caused by drilling operations
    - Diamond drill equipment will be 110V
    - All services to be assumed live unless otherwise proven
    - Remember: A clean site is a safe site!
    - Correct signage to be in place on both footpath and/or carriageway as per your Red Book
    - Continue to review any risks throughout the work day for possible changes
    - Remove all signs, barriers, spoil and debris from site at the end of the job
    - Complete documentation and report on all works carried out highlighting any significant changes
    - Sign out with site contact

PPE

  • Specification detail

COSHH

  • Product details

Emergency

  • Location of nearest hospital
  • Names of first aid trained personnel

  • Location of first Aid box

  • Location of nearest fire station
  • Location of fire assembly point
  • Site amendments

Risk Summary Overview

  • Tick all that apply

Sign off

  • I have read, understood and will adhere to this method statement. Before undertaking any changes to the above works I will immediately advise the site supervisor of the changes

  • Name

  • Sign

  • Date

  • Name

  • Sign

  • Date

  • Name

  • Sign

  • Date

  • Name

  • Sign

  • Date

Pre Site Set Up

  • Please upload pictures of site set up for approval before starting the job

  • Please upload pictures of your gas detector at any chambers you open and of the screen showing it is charged and calibrated.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.