Construction Method Statement Template

• Project Name / No.

• Contractor

• Owner of Project

• Conducted by

• Date

• Site Address/Location

• Take or Attach Photo of Site

  Media

• Description of Work (overview list of planned activities)

Foreman/Supervisor onsite for all task

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

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

Methodology

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

  Sign

• Sequence of Operations

• Tools & Equipment to be used

• Specific Staff Training

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.)

• Location Nearest Medical facility
  Address

Procedural Review Process

• Reviewed by ( Print Name )

  Sign

• Prepared by (provide name & signature)

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• Suggestion & Comments

  Yes

  No

  N/A

• Reviewed by (provide name & signature)

  Sign

• Briefing delivered by

• Position

• Date

  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, we will seek further advice and request an amended method statement.

Employee

• Name & Signature

  Sign