METHOD STATEMENT
Date :
Project No :
Date of issue :
Revision :
Note: All fields must be completed and place N/A where necessary.
Contractor Name: Address: Tel:
E-mail:
Project Name
Description of the
Task / Activity
Start Date / Time:
Site Address / Finish Date / Time
Location:
Name Role/Trade
Personnel Involved
Subcontractor
Site Supervisor: Tel:
Safety Officer Tel:
Site Safety
Representative Tel
Key Plant & Tools
(Attach Certification)
Key Materials
Other Essential (i.e. access platforms/winches/ladders, etc)
Equipment:
Specific Identified
Residual Hazards:
(or refer to the task
specific risk
assessment(s))
Specific Staff
Training
Detailed Step by
Step Sequence
of Operations:
(include sketches
if required)
(if none, state none)
Temporary
Supports and
Props needed to
facilitate the
works:
(i.e. Ladders / MEWPS / Scaffold / Trestles / Step Ladder, etc) Ladders may only be used as a last resort and must be for
Method of
Access and
Egress to the
work area:
(i.e. Guard Rails / Toe Boards/Brick Guard / Safety Harnesses / Exclusion Zones, etc.)
Fall Protection
Measures:
(Where work at
height cannot be
eliminated – consider
both Personnel &
Materials)
Hazardous
Substances:
(Attach MSDS if Corrosive Dangerous Oxidising Explosives
Very Toxic Harmful/ Highly
required) Irritant For the flammable
environment
Applicable:
Aspect Tick Aspect Tick
Waste Handling & Disposal Spillage or leakage of hydrocarbons
Discharges to the Sewer Discharging /Dewatering from excavation / site
Noise and Vibration Renewable & Non-renewable Resource
Generation Consumption
Emission to Atmosphere Transport
Discovery of Archaeological Discovery of previously unknown contaminated
Environmental: Features ground
Working on a site of value to Wildlife and Natural
Litter
Features
Storage of hazardous
Contamination from firewater
resources on site
Odour and Dust Contractor Activity
Control Measures:
Storage
Arrangements:
Details of
Permits to Work:
SWL’s:
Other:
Required
Personnel
Protective
Equip.:
Safety Boots Hard Hats Safety Gloves Hearing
Protection Eye Protection Respiratory
Protection
Applicable Y/N:
Emergency Procedures:
Name of On-Site First Aider:
First Aid
First Aid Box Location:
Facilities:
Location of Nearest Hospital:
Accident Reporting:
Welfare Requirements
Services to be supplied
by Others
Other information &
Comments
All work will be undertaken by qualified competent persons with experience of the type of work described above, and in all
cases in full accordance with safety procedures specified in the company’s Health and Safety Policy and Risk Assessments.
Prepared by:
Position:
Date:
Method Statement Briefing Record
Briefing delivered by: ______________________________________________
Position: _________________________________________________________
Date: ____________________________________________________________
We (the undersigned) have had the contents of this method communicated to me / us and understood the attached method
statement and risk assessments 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.
Name (Print) Signature Date
Risk Assessments- These are the risk assessments which are applicable to works
onsite.
Risk Definition and Matrix
Probability Categories
Category Definition
1 Practically Impossible
2 Not Likely
3 Possible
4 Likely
5 Very Likely
Consequence Categories (Safety)
Category Definition
1 First Aid, Near Miss
2 LTA (1 Day), Medical Treatment
3 LTA (3 Day), Dangerous Occurrence
4 Single Fatality
5 Multiple Fatality
Consequence Categories (Environmental)
Category Definition
1 Release which has only a minor impact
2 Release, which has a moderate (short duration) impact
3 Release, which has a significant impact
4 Major environmental release which has a significant (long term) impact
5 Damage is major and permanent
RISK MATRIX
Probability
1 2 3 4 5
5 LOW MED HIGH HIGH HIGH
Consequence
4 LOW MED HIGH HIGH HIGH
3 LOW MED MED HIGH HIGH
2 LOW LOW MED MED MED
1 LOW LOW LOW LOW LOW
Low: Acceptable level of risk. Risk is controlled as far as reasonably practicable. Existing Controls to be
continuously monitored.
Medium: Should aim to reduce risk further to As Low As is Reasonably Practicable. (ALARP)
High: Unacceptable level of risk. Hazard MUST be avoided or level of Risk reduced significantly &
reliably by controls.
