• This method statement template can be used for most if not all 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

  • Changes from last version

  • Intended start date and time

  • Intended finish date and time

  • OR

  • Until further notice?

Section 2 - Hazards

  • Risk assessment(s) reference(s)

  • Known main hazards

Section 3 - Access

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

  • Photos of specific work area or annotated drawings

  • Machine name and reference number

  • Access equipment required

  • Specialist tools or equipment required

Section 4 - Work Details

  • Step by step detail of how work will be carried out or OEM maintenance manual reference

Section 5 - Permit(s) to Work

  • Tasks requiring permit to work

  • Person who will issue and co-ordinate permits

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 Electrician)

  • Details of competence cards (photos of cards)

Section 8 - Health and Safety Monitoring

  • Duty supervisor responsible for safety standards is

Section 9 - Plant Inspection and Operator Training

  • Types of plant or equipment to be used

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

  • Operators qualifications (photo)

Section 10 - Isolation and re energising of power sources and other services

  • Power sources or other services to be isolated

  • Person(s) carrying out isolation or energisation duties

  • Person(s) confirming isolation

Section 11 - Hazardous Substances

  • Hazardous substances to be used

  • Communication to workers about health hazards

  • Protective measures

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.

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 other workers

  • What measures will be put in place to ensure safety of visitors or public

Section 17- Briefing Register

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

  • Add signature

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