Method Statement Format for Mep

Method Statement Promoter:

Engineer:

Main Contractor:

Contact Person/s:

Tel: E-mail:

Project Name

Document Number

Description of the Task/Activity Site Address/Location:

Issue No.: 00 Rev.No. : Start Date/Time Finish Date/Time Name

Date: 16/11/2010 Date:

Role/Trade

Personnel Involved

Site Supervisor: Tel: Safety Officer: Tel: Key Plant / Tools / Equipments (Attach Certification)

Key Materials (Materials Accepted by Quality) – Attach 1. Inspection Certificate –Material & Dimensional 2. Functional Test Certificate 3. Compliance Statement

Prepared by: K.Venketesubramonian K.Venketesubramonian

Material Specification

Handling & Storage Instruction/s

Page 1 of 6

Method Statement Promoter:

Engineer:

Main Contractor:

Contact Person/s:

Tel: E-mail:

Other Essential Equipment/s:

(i.e. access platforms/winches/ladders, etc)

Specific Identified Residual Hazards: (or refer to the task specific risk assessment(s))

Specific Staff Training

Prepared by: K.Venketesubramonian K.Venketesubramonian

Page 2 of 6

Method Statement Promoter:

Engineer:

Main Contractor:

Contact Person/s:

Tel: E-mail:

*Sequence of Operations:(include sketches if required) - *To be prepared only by the Process Owner – Site Engineer (Flow Diagram is preferable)

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Temporary Supports and Props needed to facilitate the works: Method of Access and Egress to the work area: Fall Protection Measures:

*Inspection & Testing - Instructions *To be prepared only by the Process Owner – Quality Engineer

*Safety – Precautions *To be prepared only by the Process Owner – Safety Engineer

1.

1.

2.

2.

3.

3.

4.

4.

5.

5.

6.

6.

7.

7.

8.

8.

9.

9.

10.

10.

(i.e. Ladders/MEWPS/Scaffold/Trestles/Step Ladder/ Power elevated work platform, etc)

(i.e. Guard Rails/Toe Boards/Brick Guard/Safety Harnesses/Exclusion Zones, etc.)

(Where work at height cannot be eliminated – consider both Personnel & Materials)

Hazardous Substances: (Attach MSDS if required)

Applicable:

Very Toxic

Harmful/ Irritant

Corrosive

Dangerous For the environment

Oxidising

Highly flammable

Yes/No

Yes/No

Yes/No

Yes/No

Yes/No

Yes/No

Prepared by: K.Venketesubramonian K.Venketesubramonian

Explosives

Yes/No Page 3 of 6

Method Statement Promoter:

Engineer:

Main Contractor:

Contact Person/s:

Tel: E-mail:

Special Storage Arrangements Details of Permits to Work: SWL’s:

(Detail any limits on the loadings applicable to temporary plant/equipment or fixed elements of the structure where the work is taking place)

Required Personnel Protective Equipment:

Other: 1. Hi-Viz Safety Boots

Hard Hats

Safety Gloves

Eye Protection Hearing Protection

Respiratory Protection

2. Coveralls

Emergency Procedures:

First Aid Facilities:

Welfare Requirements

Name of On-Site First Aider: First Aid Box Location: Location of Nearest Hospital:

Contact Number:

Contact Number Contact info. of the Welfare Officer

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 Health and Safety Plan and applicable legal requirements. Prepared by:

Date:

Position: Reviewed by:

Date:

Position: Prepared by: K.Venketesubramonian K.Venketesubramonian

Page 4 of 6

Method Statement Promoter:

Engineer:

Main Contractor:

Contact Person/s:

Tel: E-mail:

Items Attached: Sketches Certification of Plant etc. Programme of Work Inspection & Test Certificates Compliance Statement Special Process Validation Risk Assessments

Yes No

      

Remarks

      

Method Statement Briefing Record Briefing delivered by: Position: 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. Name (Print)

Prepared by: K.Venketesubramonian K.Venketesubramonian

Signature

Date

Page 5 of 6

Method Statement Promoter:

Engineer:

Main Contractor:

Contact Person/s:

Tel: E-mail:

Prepared by: K.Venketesubramonian K.Venketesubramonian

Page 6 of 6