COMPANY NAME / COMPANY LOGO
MANAGEMENT & CONTROL
Site Address: Date On Site:
Number of Men on Duration Of
Site: Works:
Supervisor on Site: Between The
Hours Of:
Contact Number on Contracts
Site: Manager:
Client Contact: Contact Number:
Required Permits:
STAFF ATTENDING SITE
Name: Position/Role:
SEQUENCE OF WORKS
Brief Task •
Description:
COMPANY NAME / COMPANY LOGO
Pre-Setup: •
Main Operations: •
Completion and •
Handover:
DOCUMENTS RELATING TO THIS METHOD STATEMENT
• Risk Assessments
COMPANY NAME / COMPANY LOGO
List of •
Plant/Equipment:
Nearest A&E
Hospital:
Emergency Contact
Numbers:
Appointed First
Aiders:
Welfare Facilities:
Personal Protective
Equipment:
☐ ☐ ☐ ☐ ☐ ☐
COMPANY NAME / COMPANY LOGO
Control Measures
•
Safety Procedures
Communication to
Workforce
Noise and Vibration
Management
Working at Height
Manual Handling:
Young Persons:
COMPANY NAME / COMPANY LOGO
Management Review
and Auditing
Alcohol & Drugs
Policy
Training
Requirements
Asbestos:
Sub-Contractor:
Security:
Emergency/Evacuati Fire/Evacuation Procedure
on Procedures:
The Assembly Points for Staff – To be confirmed during induction
Accident Reporting In the event of a workplace accident, incident, or near-miss, we require strict adherence to
and Investigation: the following protocol:
Immediate Response:
Reporting:
Investigation Process:
Key Investigation Areas:
COMPANY NAME / COMPANY LOGO
Follow-up Actions:
Access Equipment:
Hazardous
Substances:
Storage:
Waste Management:
COMPANY NAME / COMPANY LOGO
COMPLETION RECORD
Completed By:
Signature:
Position:
Date:
COMPANY NAME / COMPANY LOGO
RISK ASSESSMENT
Company Name: Task:
Assessment Date: Site Address:
Review Date: Assessor:
Reference: Signature:
ASSESSMENT Risk Rating Matrix
Severity Likelihood
Category Degree Description Category Degree Description
Minor injury to personnel
1 Insignificant Minor damage to equipment So Unlikely that occurrence may not be
1 Remote experienced.
Injury to personnel
2 Minor Damage to equipment Unlikely, but possible to occur during
2 Unlikely project.
Injury resulting in loss of time
3 Reportable Moderate damage to equipment 3 Occasional Likely to occur sometime during project
Serious injury to personnel
4 Major Major damage to equipment 4 Probably Will occur several time during project.
Fatal/ disability injury to
5 Catastrophic personnel, total equipment loss 5 Frequently Likely to occur frequently during project.
Likelihood Action criteria
HIGH- Unacceptable- further assessment or
Severity 1 2 3 4 5
12-25 action required to reduce risk to as low as
1 1 2 3 4 5 reasonably practicable
2 2 4 6 8 10 MEDIUM- further assessment or action required
3 3 6 9 12 15 5-10 if the team consider the risk not to be as low as
reasonably practicable
4 4 8 12 16 20 LOW- Acceptable- Adequate safeguards are in
5 5 10 15 20 25 1-4 place
COMPANY NAME / COMPANY LOGO
Hazard (Potential to Who is at Risk Risk Rating Existing Control Measures (Method used to remove or Additional Control Measures (Any further Risk
cause harm) before reduce the risk) controls to be considered immediately or long Rating
controls term)
COMPANY NAME / COMPANY LOGO
Assessor:
Signature: