Method Statement Risk Assessment

• Contractor

• Task / Scope of Work

• Compiled by

• Date

  Date
• Site Address/Location
  Address

• Take or Attach Photo of Site

  Media

• Description of Work (overview list of planned activities)

Supervision

• Name

• Role / Title

  Site Manager

  Safety Officer

  Engineer

• Contact No.

Employees Involved

Employee

• Name of personnel

• Role

Task Details

• 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 Training Requirements

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

Associated Hazard

• Hazard

  Select Working at heights Plant / Machinery / Vehicles Slips, trips, and falls Material and manual handling Excavations Asbestos Electricity Dust Power Tools Hand Tools Interface with public Noise Other Contractors Other

  • Working at heights
  • Plant / Machinery / Vehicles
  • Slips, trips, and falls
  • Material and manual handling
  • Excavations
  • Asbestos
  • Electricity
  • Dust
  • Power Tools
  • Hand Tools
  • Interface with public
  • Noise
  • Other Contractors
  • Other

• Please specify

• Control Measures

• PPE (select the required ppe)

  Select Hard Hat Safety Boots Hi-Viz Vest Safety gloves Eye Protection Hearing Protection Respiratory Protection Coveralls Other

  • Hard Hat
  • Safety Boots
  • Hi-Viz Vest
  • Safety gloves
  • Eye Protection
  • Hearing Protection
  • Respiratory Protection
  • Coveralls
  • Other

• Please specify

Hazardous Substances

• Hazard

  Select Gas under pressure (Symbol: Gas Cylinder) Explosive (Symbol: Exploding Bomb) Oxidising (Symbol: Flame over Circle) Flammable (Symbol: Flame) Corrosive (Symbol: Corrosion) Health Hazard / Hazardous to Ozone Layer (Symbol: Exclamation Mark) Acute Toxicity (Symbol: Skulls and Crossbones) Serious Health Hazard (Symbol: Health Hazard) Hazardous to the Environment (Symbol: Environment)

  • Gas under pressure (Symbol: Gas Cylinder)
  • Explosive (Symbol: Exploding Bomb)
  • Oxidising (Symbol: Flame over Circle)
  • Flammable (Symbol: Flame)
  • Corrosive (Symbol: Corrosion)
  • Health Hazard / Hazardous to Ozone Layer (Symbol: Exclamation Mark)
  • Acute Toxicity (Symbol: Skulls and Crossbones)
  • Serious Health Hazard (Symbol: Health Hazard)
  • Hazardous to the Environment (Symbol: Environment)

• Material Safety Data Sheet Available

  Yes

  No

  N/A

• Control Measures

Emergency Procedures

• Name of Person with Health & Safety Responsibility

• Emergency Contact Details (include mobile no.)

• First Aid Provision

• Welfare Requirements

• Services to be Supplied by Others

  .....

  N/A

Completion

• Other Information & Comments

  .....

  N/A

• Prepared by (provide name & signature)

• Reviewed by (provide name & signature)

• Briefing delivered by

  .....

  N/A

• Position

  .....

  N/A

• 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

  .....

  N/A