• WMS Title

  • Document No.

  • Client

  • Location
  • Personnel

  • Conducted on

  • Prepared by

  • 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

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.