Work Method Statement

Contractor: Address: Tel: 23232 412 / 7604 5220

MPHOHLO P. O. BOX 2152
MATSAPHA E-mail: info@mphohlo.com
INVESTMENT
Project Name MAYALUKA AND FACTORY MAINTENANCE

Description of the Task / Civil works (Maintenance)

Activity

Site Address / Location: Mayaluka old building Start Date / Time: 04/01/2021
Finish Date / Time 20/12/2021
Name Role/Trade

Sigudla Lwazi Driver

Mbhamali Musa Carpenter

Ndwandwe Thando Builder

Personnel Involved Lukhele Shadrak Builder

Ndlangamandla Mpendulo Painter

Simelane Sihle Semi-skilled

Dlamini Malangeni Semi-skilled

Site Foreman: Hlatjwako Lwazi Tel: (+268) 7680 4926

HSE Officer Masina Sibusiso Tel: (+268) 7804 2486

Site Supervisor: Msibi Themba Tel (+268) 7607 8799

Key Plant & Tools None

(Attach
Certification)
Key Materials Cement, paint, roof sheets

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

Other Essential Equipment: Scaffold, ladders, wheelbarrow, concrete mixer

Specific Identified Residual

Hazards: Falling from heights
(or refer to the task specific
risk assessment(s))

Specific Staff Training Working at heights

Detailed Sequence of
Operations:
(include sketches General Civil Maintenance
if required)

(if none, state none)

Temporary Supports and
Props needed to facilitate the None
works:

(Scaffolding, Mobile Towers). Ladders will only be authorized when the previous listed cannot work but must be risk assessed.
Method of Access and Egress Step ladder, Straight ladder and extension ladders
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 Toe boards, safety harness, life line, retractable lifeline
be eliminated – consider both
Personnel & Materials)

Hazardous Substances:
(Attach MSDS if required)

Applicable: Very Toxic Harmful/ Irritant Corrosive Dangerous Oxidising Highly flammable Explosives
For the
environment
Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No

Storage Arrangements: Always bring back tools and material to the local store room old building.

Details of Permits to Work: Always ask for permit to work from Ubombo responsible person.

(Detail any limits on the loadings applicable to temporary plant/equipment or fixed elements of the structure where the work is taking place)
SWL’s: None

Other:
Required Personnel Protective
Equip.: 1. Hi-Viz

2. Harness & Lanyard

Safety Boots Hard Hats Hearing
Safety Gloves
Protection Eye Protection Respiratory 3.
Protection
Applicable Y/N: Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No
Assembly Point : Next to the entrance gate
Emergency Procedures:
Escape Routes: Straight to the gate

Name of On-Site First Aider: HLATJWAKO LWAZI (+268) 76804926

First Aid
First Aid Box Location: SITE OFFICE
Facilities:

Location of Nearest Hospital: MAHHUNGA UBOMBO HOSPITAL

 Accident Reporting: All accidents and incidents must be reported to the area supervisor and Risk officer before end of the day.
All accidents must be reported no matter how minor they are
All near misses must be reported

Legal obligations The Contractor shall carry out the Works in accordance with all applicable statutory Acts, Regulations and Procedures including:
 Occupational Safety & Health Act, No. 9 of 2001

 Occupational Safety & Health Act, No. 85 1993 (Construction Regulations, 2014)

 NEMA No. 107 of 1998

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 read 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 Tittle Signature Date

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 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 Definitions
1 First Aid, Near Miss
2 (1 Day), Medical Treatment / Minor
3 (3 Days), Dangerous Occurrence ( Unable to Work)
4 Serious / Crippling Injury / Extensive
5 Fatality / Very Extensive

Consequence Categories (Environmental)

Category Definitions
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
Acceptable level of risk. Risk is
LOW
controlled as far as reasonably
5 LOW MED HIGH HIGH HIGH
practicable. Existing Controls to be
continuously monitored.

4 LOW MED HIGH HIGH HIGH

Should aim to reduce risk further to

CONSEQ
3 LOW MED MED HIGH HIGH MED As Low As is Reasonably
UENCE
Practicable. (ALARP)

2 LOW LOW MED MED MED

Unacceptable level of risk. Hazard

LOW MUST be avoided or level of Risk
1 LOW LOW LOW LOW HIGH
reduced significantly & reliably by
controls.
Project: Completed By: Date:

People affected / at risk of being harmed:

No Possible Pre Control Risk Rating Required Controls Post Control Risk Rating
TASK/ HAZARDS Affects / Harm (type “X” in the appropriate cell) (type “X” in the appropriate cell)
ACTIVITY
High Medium Low High Medium Low

Method Statement & Risk Assessment Template Date: 04/01/2021

Project: Completed By: Date:

People affected / at risk of being harmed:

No Possible Pre Control Risk Rating Required Controls Post Control Risk Rating
TASK/ HAZARDS Affects / Harm (type “X” in the appropriate cell) (type “X” in the appropriate cell)
ACTIVITY
High Medium Low High Medium Low

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Method Statement & Risk Assessment Template Date: 04/01/2021