Method Statement

• Project Name / No.

• Task to be performed

• Conducted by

• Date

  Date

• Description of Work

Who is to do the work

Employee

• Company/Contracor

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

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

• Please specify

Hazardous substances to be used ( attach specific COSHH assessments )

• undefined

Supervision

• undefined

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:
  in the event of minor accident beyond normal first aid treatment seek treatment at croydon university hospital A & E department.
  
  in the event of serious accident phone 999 for an ambulance.
  
  All accidents must be reported to Gavin Musk or Tony Pendrigh immediately

• Welfare Requirements

• Services to be Supplied by Others

Completion

• Other Information & Comments

• Prepared by (provide name & signature)

  Sign

• 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