Method Statement Template Contract:
Location:
Contract Start: As requested
Contract Finish:
Supplier / subcontractor: subcontractor: Activity to be carried out: Drainage Method statement by:
Date:
Risk Review
Working at height Plant & machinery Lifting operations Next to live services Manual handling Excavations Confined spaces COSHH
Others (please specify) Ye s Ye s Ye s
Inte Interf rfac ace e with with othe others rs
No
Noise/ vibration
No
Fire / explosion
No
Falling materials
Ye s Ye s Ye s Ye s
No
Ye s
Hot works
No
Stability of structures
No
Asbestos
No
Environmental
No
Resource requirements- Supervision – Names : Name
Designation
PPE for activity:
Contact Mobile
Office Offic e
Others
Hard hats
Yes
Eye protection
Protective boots
Yes
Masks / respirators
No
Hi Vis clothing
Yes
Ear protectors
No
Gloves
Yes
Harnesses / restraints
No
Key equipment / Plant to be used:
Tracked 360° Excavator Dumper Plate compactor – roller Small tools Disc cutter with water suppression methods Materials: • • •
• •
• • • • • •
Various pipe fittings depending specification. Clay pipe, plastic pipe, pipe collars, Chipping gravel sand as specified Pipe grease Concrete Manhole surrounds Backfill material
Yes
Method Statement Template
Brief description of task:
Installation of drainage
•
Sequence of task / activity: 1.
Prior to operatives commencing work activities site inductions will be carried out as required.
2. Further inductions will then be carried out on the contents of this method statement and all relevant risk and COSHH assessments. 3.
Check utilities drawing for location of underground services and overhead services.
4.
Scan area to be excavated using CAT device to locate live services. If services are present trail holes will need to be dug to ascertain the position – depth and type of service.
5.
Once service positions have been located, service positions will need to be marked with either marker posts or marked on the dig surface identifying type of service.
6.
The ground will be excavated to the required depth using either a tracked 360° or wheeled 180° excavator as the site conditions allow, with a banksman in attendance.
7. During digging, spoil should be kept far enough back so as not to place imposed loadings on trench sides. 8.
Where entry is required into any excavation, controls will be required to prevent collapse of excavation sides. Where ground cannot be; -
Step formed Battered back Trench box systems will need to be used.
9.
Any surplus material will be loaded into dumpers and transported to a temporary spoil heap, the location of which will be agreed with the principal contractor. Spoil will either used as backfill or removed from site to an approved licensed tip.
10.
During excavation works suitable barriers will need to be in place to warn others of the work and to prevent falls. Rigid barriers should be kept 2 metres back from edge to provide a safety zone. If wheeled plant access is required stop blocks will need to be implemented.
11.
Once dig has been completed and excavation is safe to enter pipe runs will be laid as per drawing. Verified clay pipe runs are normally laid with a laser level this ensures the correct fall is maintained. Plastic pipes come in longer runs and are easier to lay between manhole points.
12. Before backfill commences pipe lines should be checked for damage and blockages 13.
Bedding material – pipes will be delivered to site as required and placed in a suitable agreed storage location. Storage locations will need to be maintained at all times to prevent damage to materials and to prevent slips trips and falls.
14.
Materials for backfill operations will be transported using the site dumper, during tipping operations banksman will be in attendance to prevent dumper getting too close to edge.
15. Service runs will need to be backfilled with the correct cover levels. Class B Bedding detail for rigid pipes (Clayware) Class B bedding
Method Statement Template
16. Once pipe runs have been covered this will prevent any damage occurring. Trench lines should be back filled as soon as possible and the ground civilized. Marker tape should be used for the correct service. 17.
Backfill operations and compaction methods will depend on the classification required for the finished surface.
Access for workforce/materials to site:
Supervision, co-ordination / interface issues: (Supervision and monitoring, co-ordination with other contractors, the public etc)
Identify any special measures to be taken: (Permits, fire alarm isolations, special emergency procedures)
Housekeeping: (Details of who, when and how excess materials, rubbish and debris will be removed from the workplace
Additional information; environmental considerations, relevant technical information; comments or any other considerations:
Please remember all persons involved with the activity must be briefed on the method of work. Amendments can be made as required to reflect site conditions
Method Statement Template
Short Notice Change to Method Statement
(include any additional information to support short notice change) Item 1.
Risk Assessment
Contract name:
Location:
Contract number:
Date:
Work/operation/task/activity covered: House Drainage Works Significant hazards: (the potential to cause harm
Consider the severity of the outcome and the likelihood of the hazard occurring to determine the risk rating. H = High M = Medium L = Low I= Insignificant
H
M
L
I
Remember No Accidents On Site
Control Measures: (continue on the back of this sheet if necessary) •
•
•
•
•
Outline the measures to be taken to adequately control the risk Eliminate the hazard Use lower risk products and operations Provide information and training Restrict access to
the area
Yes
Identify who might be affected :
Employees -
No
X
Sub contractors Official visitors General public Others – (please specify
PPE Required Gloves Helmet High visibility Safety boots Dust mask Goggles Wellington Hearing Pro
Yes
No
the area
Completed by:
Signature:
Supervisor Checked: Name
Contract:
Signature
Location:
Scope of works:
In signing this form I the undersigned confirm that I have been briefed on all aspects of the forthcoming work and fully understand the method of work and associated risks relating to the task. (i.e. risk assessments, method statements, COSHH assessments, PPE requirements, etc, etc) Name:
Signature:
Date:
Completed by:
Signature:
Supervisor Checked: Name
Contract:
Signature
Location:
Scope of works:
In signing this form I the undersigned confirm that I have been briefed on all aspects of the forthcoming work and fully understand the method of work and associated risks relating to the task. (i.e. risk assessments, method statements, COSHH assessments, PPE requirements, etc, etc) Name:
Signature:
Date:
I __________________________________________________ as designated supervisor/manager for the forthcoming works can confirm that I have briefed the above signed in all aspects of the method statement, risk assessments and COSHH requirements. Signed
Date:
