Health & Safety Method Statement (TEMPLATE) AL2

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• This method statement template can be used for most if not all construction based activities. If a section does not apply to your task then simply put a N/A in the answer box.

Section 1 - Validity

• Version Number

  Select 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20

• Changes from last version

• Intended start date and time

  Date

• Intended finish date and time

  Date

• OR

• Till further notice?

  Yes

  No

  N/A

Section 2 - Hazards

• Risk assessment(s) reference(s)

• Known hazards

Section 3 - Access

• Where exactly, on site, the work will be conducted

• Photos of specific work area or annotated drawings

  Media

• Access equipment required

• Specialist items required

Section 4 - Work Details

• Step by step detail of how work will be carried out

Section 5 - Permit(s) to Work

• Tasks requiring permit to work

• Person who will issue and co-ordinate permits

• Photo of issued permit(s)

  Media

Section 6 - Supervision

• Person(s) responsible for supervision is

Section 7 - Workforce Details

• Workforce required to carry out task, ie the number of people

• Special skill sets required (ie a Bricklayer, an Electrician etc)

• Details of competence cards (photos of cards)

  Media

Section 8 - Health and Safety Monitoring

• Duty supervisor responsible for safety standards is

Section 9 - Plant Inspection and Operator Training

• Types of plant to be used

• Operators qualifications (photo of CPCS card)

  Media

• Examination and maintenance details for above mentioned plant. (photo of documents)

  Media

Section 10 - Dis/Reconnection of Services

• Services to be disconnected

• How long will it be disconnected?

• How long will it take to reconnect?

• Person(s) carrying out dis/reconnection duties

• Method of locating buried services

• Person(s) declaring dis/reconnection

Section 11 - Hazardous Substances

• Hazardous substances to be used

• Communication to workers about health hazards achieved by?

• Protective measures

• Details of samplings

• Photo of sampling reports or other documentation

  Media

Section 12 - Personal Protective Equipment (PPE)

• Items of PPE/RPE required

Section 13 - Emergency Procedures

• Details of emergency procedures including site evacuation

• Photo's of supporting documents, signs, and information.

  Media

Section 14 - Environmental Controls

• Threats to the environment

• Environmental protection measures

• Waste storage and disposal

Section 15 - Safety of the Public and Occupiers

• What measures will be put in place to ensure safety of the public?

• What measures will be put in place to ensure safety of occupants?

Section 16 - Public Nuisance

• Possible sources of public nuisance

• Person responsible for neighbourhood liaison

Section 17 - Briefing Register

• The persons listed below have received this method statement brief and sign this briefing register as evidence of that fact

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