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8/20/2019 Work Method Statement Toolkit
1/16
TOOL KIT IMPORTANTINFORMATION
In the Tool Kit you will find everything you need to
help you develop a WMS. It is the reader’sresponsibility to refer to legislation when reading thisguide or using any of the tools in the tool kit to ensurethe most up to date information is being used. Failingto do this ould lead to a breah of legislation andlegal ation being taken. These following pagesprovide brief information on getting you started withyour WMS. !efer to samples in the tool kit for further prompts on ompleting WMS.
WMS PART 1
Firstly you will need to hek the following areas forinformation and re"uirements on high riskonstrution ativities or presribed ativities beforeommening#
$%&S Workplae 'ealth and Safety !egulation
())*
+ompleted ,ob safety analysis’s
Site speifi risk assessments
Inident-in,ury reords
fter you have heked for any high risk onstrutionativities or presribed ativities ommene filling inall the relevant information in /!T 0 of your blankwork method statement.
1e sure to omplete all relevant information in thefields provided about the ativity. Missing anyinformation may result in a serious inident ourringor a breah of legislation.
When ompleting this page onsult with persons whohave relevant e2periene and knowledge about theativity.
WMS PART 2Completing your WMS from a SA
To be able to omplete this part of the proess you willneed to have with you either a opy of your ompleted
3S for the high risk onstrution ativity and or presribed ativity and-or your site speifi riskassessment.
%ooking at the olumn in your 3S titled 4Steps In tivity5 see where you an group some of the smaller steps into larger steps and insert in the first olumn of your WMS titled 4Ma,or Steps In tivity5
T!e "tep" "!oul# not $e "o #etaile# t!at a largenum$er of "tep" re"ult nor "o general t!at $a"i%"tep" are omitte#&
• 6ow ne2t to olumn titled 4Ma,or Steps In tivity5 inthe WMS is a olumn titled 4/otential 'a7ards5insert all the ha7ards that were identified in the 3Sthat relate to the ma,or steps into this olumn. 1esure to inlude all ha7ards as missing any of themmay lead to an inident ourring.
• 8ne you have ompleted this repeat the same
proess again for risk assessment sore.
'ou (ill !a)e "e)eral "%ore" $e%au"e of t!e num$er of "tep" in t!e SA * u"e t!e !ig!e"t "%orei#entifie#&
• The same applies for ontrol measures9 insert all
ontrol measures identified in the 3S into theolumn titled 4+ontrol Measures5 on your WMS.:nsure they are relevant to the ha7ards identified.
• In the ne2t olumn titled 4!esponsible 8ffier5 insert
titles of persons responsible for maintaining theontrol measures# this may inlude several differentpersons.
;ou are almost there<
• 8ne you have ompleted this proess onsult with
relevant and e2periened persons performing theativity and any other persons who may be affetedby the ha7ards assoiated with the ativity toensure all vital information has been aptured. If you make any amendments in the 4+ontrolMeasures5 olumn be sure to hek that theyomply with any presriptive ontrol measuresfound in assoiated legislation.
This ompletes the proess for developing a workmethod statement. 'ave you missed anything=
Safety Act and Regulation for furtherinformation
on requirements for risk assessments,construction
&o not go any further if you have notompleted the above. !efer to $ueensland’sWorkplae 'ealth and Safety t and !egulationfor further information on re"uirements for riskassessments9 onstrution safety plans and workmethod statements.
TOOL KIT
FORMS + or F
Template for /art 0 of WMS for a 'igh !isk+onstrution tivity an be found on page >)
Template for /art 0 of WMS for a /resribed tivity an be found on page >0
19
19TOOL KIT
TOOL KIT
FORM ,
sample of WMS /art ( is available in theTool Kit on page >(
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safety plans and work method statements.
FORMS TO -S+ W.+N /+0+LOPIN, 'O-R FIRST WORK M+T.O/ STAT+M+NT
F8!M 1 ? !ISK SS:SSM:6T F8!M PA,+ 2Ri" A""e""ment Form @ Ase this form to identify any high risk onstrution ativities9 presribedativities or demolition work that were reorded on this form at the site inspetion during the tendering
proess or after the ontrat was won that re"uire a WMS to be ompleted.
Potential.a3ar#"
+4i"ting ControlMea"ure"
Ri" S%ore1*25
Ri" ControlMea"ure"
Re"i#ual Ri"S%ore1*25
Re"pon"i$lePer"on
/ate
Insert potential ha7ardsassoiated with ontratand site in this olumn
This form an also beused to review e2istingontrol measures. Inserte2isting ontrols in thisolumn if reviewingontrol measures
Insert risk sore usingRi" Matri4 * Form C
+hek legislation and insertontrol measures. If noontrol measures presribedin legislation use hierarhy of ontrols and onsult withworkers.
Insert new risk soreusingRi" Matri4 * Form C
Insert personsresponsible forfollowing9 implementing9or maintaining ontrolmeasures in this olumn
Insert date in thisolumn
F8!M + ? !ISK MT!IB PA,+ 26Ri" Matri4 Ase this form to help you prioritise risks when ompleting F8!MS 1 and-or & and-or C.
LIK+LI.OO/'ow likely is it to happen=
CONS+7-+NC+S 'ow severely ould it hurt someone if it happens=
INSI,NIFICANTD6o in,uriesE
MINORDFirst aid only9 spillage
ontainedat siteE
MO/+RAT+DMedial treatment
spillage ontained withoutside helpE
MAORD:2tensive in,uries9loss of produtionE
CATASTROP.ICD&eath9 to2i release of
hemialsE
ALMOST C+RTAIN:2peted in most irumstanes
0.
0).
GA
>A
0A
LIK+L'Will probably our in most
irumstanes
0HM
0.
H.
A
(A
F8!M & ? 381 SF:T; 6%;SIS PA,+ 28O9 SAF+T' ANAL'SIS * Ase this form to ondut a risk assessment on a high risk onstrutionativity9 presribed ativity9 demolition work or other ativity where there are no risk assessments9 WMSor proedures. 3SJs are generally site speifi and used for the task at hand. They are not used arossother sites as a generi doument as they apture the ha7ards at a speifi plae and during a speifitime.
68T: Two e2tra olumns have been added to the !isk ssessment Form and 3S Form so that theyan be used to review e2isting ontrol measures for a ha7ard or a speifi ativity for e2ample# whenhanges are being onsidered or after an inident has ourred. If you are starting from srath you willnot need to fill in the :2isting +ontrol Measures.
ST+PS IN ACTI0IT' POT+NTIAL.A:AR/S
+;ISTIN,CONTROL
M+AS-R+S
RISKSCOR+
1* 25
RISK CONTROLM+AS-R+S
R+SI/-ALRISK
SCOR+1* 25
R+SPONSI9L+P+RSON
/AT+
1
.
Insert steps in ativity inthis olumn in these"uene the ativity is
to be arried out9 stepby step
Insert all foreseeableha7ards assoiatedwith eah step
If reviewing anativity insert e2istingontrol measures in
this olumn
Asing !iskMatri2 assessthe risks of
e2isting ontrolmeasures ifany and insertrisk sore here
+hek legislation andinsert new ontrolmeasures. If no ontrol
measures written inlegislation use hierarhyof ontrols and onsultwith workers andprofessionals
Asing !iskMatri2 insertnew risk sore
here
Insert title or name of persons responsiblefor following9
implementing9 ormaintaining ontrolmeasures
Insert dateontrolmeasures
must bemet
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F8!M : ? WMS /!T 0 D'IC' !ISK +TILITI:SE PA,+ Work Method Statement ????????????????????????????????????????????????????????????????????????????????????
/!:S+!I1:& +TILIT;
COMPAN' /+TAILS Insert !elevant /ersons +ompany 6ame9 ddress9 T.+ ARRAN,+M+NTS Insert relevant training for
/hone 6umber here FOR APPROPRIAT+ presribed ativity and howTRAININ, S-P+R0ISION supervision will be arried
out
A9N Insert !elevant /ersons +ompany 16 .I,. RISK WORK CLASS %ist lass of any high risk here e.g. person arrying out work work here
SIT+ A//R+SS Insert work site address here
PR+SCRI9+/ Insert name of /resribed tivity or /AT+ WMS /+0+LOP+/ Insert &ate ))-))-))ACTI0IT' &emolition Work e.g. !emoval of ) /+MOLITION WORS s"uare metres of bonded asbestos9 0+RSION N-M9+R Insert Lersion 6umber
&emolish wooden bridge
PR+SCRI9+/ ACTI0IT' Insert !elevant +ertifiate 6umber LINKS
C+RTIFICAT+ N-M9+R
F8!M C ? WMS /!T (PA,+
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FORM A
CONSTR-CTION SAF+T' PLAN :;' Ci)il Contra%tor" Pty Lt#
OR,ANISATIONAL /+TAILS
/!I6+I/% +86T!+T8!’S 6M:
/!I6+I/% +86T!+T8!S 16
/!I6+I/% +86T!+T8!S &&!:SS
W8!K/%+: &&!:SS DInsert the address where the onstrution work is to be performedE
T;/: 8F +86ST!A+TI86 +ivil +onstrution @ :2avation
:B/:+T:& ST!T &T:
:STIMT:& &A!TI86 8F T': W8!K
W'S +8MMITT::
W'S 8FFI+:!
FI!ST I& 8FFI+:!
The risks the /rinipal +ontrator is obliged to manage9 the proposed ontrol measures for those risks and how theontrols will be monitored and reviewed an be loated in the following douments e.g.
:BM/%: +86T:6TS
• +ompany Safety /oliy
• Ceneral Safety !e"uirements
• 'a7ardous Substane !egister
• Site !ules
• /lant /rovided For +ommon Ase
• !isk ssessments
• 3ob Safety nalysis
• Work Method Statements
• Traffi Management /lans
• :mergeny /roedures
• :mergeny /hone 6umbers
• /ubli Safety Strategy
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http://www.deir.qld.gov.au/workplace/business/construction/whso/index.htmhttp://www.deir.qld.gov.au/workplace/business/construction/whso/index.htmhttp://www.deir.qld.gov.au/workplace/business/construction/whso/index.htmhttp://www.deir.qld.gov.au/workplace/business/construction/whso/index.htmhttp://www.deir.qld.gov.au/workplace/business/construction/whso/index.htm
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FORM 9 RISK ASS+SSM+NT FORM
PRINCIPAL CONTRACTOR @R+L+0ANT P+RSON
Insert name here
CONTRACT
Insert ontrat here e.g. Subdivision 8rmeau
SIT+ A//R+SS
Insert site address here
WORK AR+A
Insert work area e.g. &ivision 0
ACTI0IT'
Insert name of ativity here e.g. Site /reparation
/AT+
Insert date assessment ompleted here
POT+NTIAL.A:AR/S
+;ISTIN,CONTROL
M+AS-R+S
RISK SCOR+1*25
RISK CONTROLM+AS-R+S
R+SI/-AL RISKSCOR+1* 25
R+SPONSI9L+P+RSON
/AT+
Insert potential ha7ardsassoiated with ontrat andsite in this olumn
This form an also beused to review e2istingontrol measures. Inserte2isting ontrols in thisolumn if reviewingontrol measures
Insert risk sore usingRi" Matri4 * Form C
+hek legislation and insertontrol measures in this olumn.If no ontrol measurespresribed in legislation usehierarhy of ontrols and onsultwith workers
Insert new risk soreusing Ri" Matri4 *Form C
Insert personsresponsible forfollowing9implementing9 ormaintaining ontrolmeasures in thisolumn
Insert date inthis olumn
:.C. :2avation 8btain information onloation of servies from &ial1efore ;ou &ig
/erimeter fening re"uiredfor 0( weeks
+omplete WMS for thisativity
*
*
0>
/rinipal+ontrator-!elevant /erson
1efore workommenes
:.C. :ntering trenh morethan 0. metres
+omplete WMS for thisativity
0> /rinipal+ontrator
-!elevant /erson
1efore workommenes
:.C. Working nearunderground servies
8btain information onloation of servies from &ial1efore ;ou &ig
ppoint ompetent person toloate and mark servies
+omplete WMS for this ativity
*
0>
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FORM C RISK MATRI;
This !isk Matri2 is to be used to identify and assess risks assoiated with identified ha7ards when ompleting Forms1 and-or Form & and or Form C.
LIK+LI.OO/'ow likely is it to
happen=
CONS+7-+NC+S 'ow severely ould it hurt someone if it happens=I6SIC6IFI+6T
D6o in,uriesE
MI68!DFirst aid only9
spillage ontainedat siteE
M8&:!T:DMedial treatment
spillage ontainedwith outside helpE
M38!D:2tensive in,uries9
loss of produtionE
+TST!8/'I+D&eath9 to2i release of
hemialsE
%M8ST +:!TI6:2peted in most
irumstanes
0.
0).
GA
>A
0A
%IK:%;Will probably our inmost irumstanes
0HM
0.
H.
A
(A
/8SSI1%:Might our at some time
((L
0*M
0>.
*A
A
A6%IK:%;+ould our at some
time
(L
(0M
0M
0(.
A
!!:May our only in
e2eptionalirumstanes
(L
(>L
()M
0G.
00.
SCOR+ ACTION
1 * 6A * A%ute
ACT NOW > -rgent #o "omet!ing a$out t!e ri"" imme#iately& Reuire"imme#iate attention
H ? 0G' ? 'igh
Isolate the ha7ard and seek the highest management deision urgently
0 ? (0
M ? Moderate Isolate the ha7ard and follow management instrutions
(( @ (% ? %ow
8K for now. !eord and do something about the risks as soon as possible
+86T!8% M:SA!:S
When deiding on ontrol measures they should be implemented in the following order
+LIMINATION ,et ri# of t!e !arm or pre)ent t!e ri" D$e"t out%omeE
IF T'IS IS 68T /8SSI1%:
Substitution !eplae ha7ardous materials9 e"uipment9 hemials with something less harmful# and-or
Isolation Separate people from harm9 for e2ample using barriers
:ngineering Separate people from the harm9 hange the physial working environment9 for e2ample9 byredesigning work9 plant9 e"uipment9 omponents or premises# and-or
dministration :stablish administrative proedures suh as work method statements9 safety instrutions andprovide staff with training in them# and-or
//: Ase protetive lothing
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FORM / 381 SF:T; 6%;SIS
PRINCIPAL CONTRACTOR @R+L+0ANT P+RSONInsert name here
CONTRACTInsert ontrat here e.g. Subdivision 8rmeau
SIT+ A//R+SS Insert site address here
WORK AR+AInsert work area e.g. &ivision 0
ACTI0IT'Insert name of ativity here e.g. !eplae drivers seat e2avator
/AT+Insert date assessment ompleted here
ST+PS IN ACTI0IT' POT+NTIAL.A:AR/S
+;ISTIN,CONTROL
M+AS-R+S
RISKSCOR+
1* 25
RISK CONTROLM+AS-R+S
R+SI/-AL RISKSCOR+
1* 25
R+SPONSI9L+P+RSON
/AT+
0
Insert steps in ativity
in this olumn in these"uene the ativityis to be arried out9step by step
Insert all
foreseeableha7ards assoiatedwith eah step inthis olumn
If reviewing an
ativity inserte2isting ontrolmeasures in thisolumn
Asing !isk Matri2
assess the risks of e2isting-ontrolmeasures and insertrisk sore here.Ri" Matri4 * Form C
+hek legislation and
insert new ontrolmeasures in thisolumn. If no ontrolmeasures written inlegislation usehierarhy of ontrolsand onsult withworkers andprofessionals
Asing !isk Matri2
insert new risksore hereRi" Matri4 * Form C
Insert title or name
of personsresponsible forfollowing9implementing9 ormaintaining ontrolmeasures in thisolumn
Insert date ontrol
measures must bemet in this olumn
(
:.C. rrive at site Moving plant !ead and obey allsignsStay alert and wath for moving plant
0> /lant 8perators t all times
/edestrians Stay alert and give wayto pedestrians
0> /lant 8perators t all times
>
ess e2avator Falls-slips-trips /ark as lose to
e2avator as possible
Stay alert and removeany trip ha7ards wheresafe to do so
0 /lant 8perators t all times
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T': F8%%8WI6C /:!S86S 'L: !:+:IL:& T!I6I6C 86 T'IS 3S
??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 6ame and sign
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FORM +WMS MAST 1: SIT: S/:+IFI+ 6& MAST 1: /!:/!:& 1:F8!: 6; .I,. RISK CONSTR-CTION ACTI0IT' +8MM:6+:S
PART 1 :'; Ci)il Contra%tor" Pty Lt# > Work Method Statement
'IC' !ISK +86ST!A+TI86 +TILIT;
COMPAN' /+TAILS Insert !elevant /ersons +ompany 6ame9 ddress9 .I,. RISK WORK %ist lass of any high risk work here/hone 6umber here
A9N Insert +ompany 16 here /AT+ WMS /+0+LOP+/ Insert date ))-))-))
SIT+ A//R+SS Insert work site address here 0+RSION N-M9+R Insert version number
.I,. RISK Insert name of 'igh !isk +onstrution LINKS Insert links here e.g. other WMS9 3SJsCONSTR-CTION tivity-8ther e.g. :ntering trenh moreACTI0IT' @ OT.+R than 0.. metres
'8W +86T!8% M:SA!:S !: T8 1: M86IT8!:& 6& !:LI:W:&
Insert how ontrol measures will be monitored and reviewed9 by whom and when e.g. ontrol measures will be monitored by
employees and site supervisor and reviewed during pre start heks-tool bo2 talks daily
/%+: TI+K I6 18B:S T8 I6&I+T: +8M/A%S8!; !:$AI!:M:6TS T8 1: 1%: T8 +8M/%:T: T'IS +TILIT;
Plant @+uipment
1akhoe +rane &o7er
:2avator
menities Crader %oader
!oad !oller
Sraper Skid Steer 1arriers
Fall rrest System Fall !estraint System
%ights %adders Signage
3akhammer
Li%en%e"@Permit"@Ti%et"
1akhoe+rane
&emolition Ceneral Safety Indution D1lue +ardE
&o7er
&ogger
:2avator
Crader %oader
:2plosive /ower Tools !igger
Saffold Sraper
Skid Steer Traffi +ontrol
Training
Site Speifi Indution Task Speifi Training
+ert > In +ivil
+onstrution +onfined Spaes
:mergenies
First id
Manual Tasks
Moving /lant
MAT+& /art >
%evel 0 MAT+& /art >
%evel ( MAT+& /art >
!isk Management
Slips9 Trips9 Falls Working 6ear Atilities Working t 'eights
Appli%a$leLegi"lation@Referen%e"
ACTS D7L/E W'S &angerous Coods :letrial Safety
R+,-LATIONS D7L/E W'S &angerous Coods :letrial Safety
CO/+ OF PRACTIC+Traffi Management
For +onstrution or Maintenane Work Working 6ear %ive
/arts
OT.+R Cuide To Safety In The
+ivil +onstrutionIndustry
Maintenan%eC!e%"
ll :letrial Tools ll :2avations-/its
&aily
menities tmospheri Testing
Monitoring :"uipment
ll :"uipment /re Start+heks
Cas Monitoring:"uipment
ll Signage &aily //:
PP+
Ot!er Insert any other omments-re"uirements here e.g. fire e2tinguishers9 saffold9 spotter9 uthority from the &eaprtment of Main !oads -/olie to lose roads
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F8!M FT'IS WMS IS SIT: S/:+IFI+ WMS 6& MAST 1: /!:/!:& 1:F8!: 6; PR+SCRI9+/ ACTI0IT' +8MM:6+:S.
PART 1 :'; Ci)il Contra%tor" Pty Lt# > Work Method Statement
/!:S+!I1:& +TILIT;
COMPAN' /+TAILS Insert !elevant /ersons +ompany 6ame9 ddress9 T.+ ARRAN,+M+NTS Insert relevant training for /hone 6umber here FOR APPROPRIAT+ presribed ativity and howTRAININ, S-P+R0ISION supervision will be arried
out
A9N Insert !elevant /ersons +ompany 16 .I,. RISK WORK CLASS %ist lass of any high risk here e.g. person arrying out work work here
SIT+ A//R+SS Insert work site address here
PR+SCRI9+/ Insert name of /resribed tivity or /AT+ WMS /+0+LOP+/ Insert &ate ))-))-))ACTI0IT' &emolition Work e.g. !emoval of )
/+MOLITION WORK s"uare metres of bonded asbestos9 0+RSION N-M9+R Insert Lersion 6umber &emolish wooden bridge
PR+SCRI9+/ ACTI0IT' Insert !elevant +ertifiate 6umber LINKS Insert links here e.g. otherC+RTIFICAT+ N-M9+R WMS9 3SJs
'8W +86T!8% M:SA!:S !: T8 1: M86IT8!:& 6& !:LI:W:&Insert how ontrol measures will be monitored and reviewed9 by whom and when e.g. ontrol measures will be monitored by
employees and site supervisor and reviewed during pre start heks-tool bo2 talks daily
Plant @+uipment
1akhoe
+rane
&o7er :2avator
Crader
%oader
!oad !oller Sraper
Skid Steer
Waste 1ins
&ouble thikness plasti ir testing e"uipment ir monitoring e"uipment
%ights
%adders
Signage Lauum Water
Li%en%e"
lass liense DFriable sbestosE 1 +lass liense D1onded
sbestosE Ceneral Safety Indution
D1lue +ardE
1akhoe
+rane
&o7er :2avator
Crader
:2plosive /ower Tools
!oad !oller Saffold
Sraper
Skid Steer
Traffi +ontrol
Training@Ti%et"@Permit"
&emolition work &M0
&emolition work &M(
Site Speifi Indution Task Speifi Training
+ert > In +ivil
+onstrution
+onfined Spae
:mergenies
First id
Manual Tasks
Moving /lant
MAT+& /art > %evel 0
MAT+& /art > %evel (
MAT+& /art > %evel >
MAT+& /art > %evel
!isk Managemen
Slips9 Trips9 Falls Working 6earAtilities Working t 'eigh
Appli%a$leLegi"lation@Referen%e"
ACTS D7L/E W'S
&angerous Coods :letrial Safety
R+,-LATIONS D7L/E W'S
&angerous Coods :letrial Safety
CO/+ OF PRACTIC+ Management and ontrol
of asbestos in workplaesNnohs ()0* D())E
Safe removal of asbestos(nd edition Nnohs())(D())E
OT.+R Cuide To Safety
The +ivil+onstrutionIndustry
S (G)0?())0 &emolition of
strutures
Maintenan%eC!e%"
ll :letrial Tools ir monitoring e"uipment
menities Cas Testing :"uipment
/re Start +heks ll /lant ll Signage &aily
//:
PP+
Ot!er
Insert any other re"uirements e.g. disposable overalls9 asbestos removal signs9 demolition in progress9unuathorised entry not permitted
/%+: TI+K I6 18B:S T8 I6&I+T: +8M/A%S8!; !:$AI!:M:6TS T8 1: 1%: T8 +8M/%:T: T'IS +TILIT;
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F8!M CPART 2 :'; Ci)il Contra%tor" Pty Lt# > Work Method Statement
FI%A!: T8 /%6 6& F8%%8W T'IS WMS M; %:& T8 /:!S86S 1:I6C S:!I8AS%; 8! FT%%; I63A!:& 6& /8SSI1%: %:C% +TI86 1:I6C TK:6. /ONT RISK IT&
'8W T': +TILIT; WI%% 1: /:!F8!M:&
Insert how the ativity will be performed here
MaBor Step" In A%ti)ity Potential .a3ar#"Ri" S%ore
1*25Ri" Control Mea"ure"
Re"pon"i$leOffi%er
If developing a WMS from a 3Slooking at the 3S e2trat small stepsfrom olumn titled 4ll Steps In
tivity5 and group into larger steps.Insert steps into this olumn in these"uene the ativity is to beperformed. DReferen%e Page 18 *
WMS ,ui#eline" for t!e Ci)ilCon"tru%tion In#u"tryE
:2trat all the ha7ards that ouldause harm identified in your 3Sthat relate to the ma,or steps inthe ativity and insert into thisolumn
Insert risk sorefrom the 3S intothis olumn
Insert all ontrol measuresidentified in your 3S that relateto the ma,or steps in the ativityand insert in this olumn
Identify persoresponsibleomplying with ontmeasures
&&ITI86% I6ST!A+TI86S-+8MM:6TS
_________________________________________________
/rinipal +ontrators Signature
_________________________________________________ _____________________________
6ame of person signing WMS on behalf of the /rinipal +ontrator &ate
I have reeived training in this WMS and I fully understand the ha7ards and ontrol measures to be implemented as part of this ativ ity.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO 6ame
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
Signature &ate
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F8!M ' :M/%8;:!S W8!K M:T'8& STT:M:6T +':+K%IST
+a%! ti% in t!e R+/ 3one mean" you are le"" liely to $e%ompliant
A//R+SS T.+S+ AR+AS PROMPTL'
+a%! ti% in t!e ORAN,+ 3one mean" you are in%rea"ingyour le)el of %omplian%e
9-T 'O- STILL .A0+ WORK TO /O
+a%! ti% in t!e ,R++N 3one mean" your are more lielyto $e %ompliant
MONITOR AN/ R+0I+W TO CONTIN-ALL' IMPRO0+
+urrent %egislation applying to work method statements not
obtained
'igh risk onstrution ativities not identified nor the risk
ontrolled
+ontrol measures for doing high risk onstrution work-
presribed ativities safely left up to workers
/rinipal +ontrator allows persons to start high risk
onstrution ativity without work method statement
!elevant /erson allows persons to start high risk
onstrution ativity without work method statement
Ceneri work method statements not reviewed and
amended at eah new site
Work Method Statements not amended as soon as possible
when there is a hange in the way the high risk onstrutionwork-presribed ativity is to be performed
/rinipal +ontrator not given a opy of amended work
method statements by !elevant /ersons
!elevant /erson has not ensured eah person affeted by
the amendment of a work method statement is advised of
the details of the amendment-s
Work method statements not kept with onstrution safety
plan
Work method statements not signed and dated by /rinipal
+ontrator
+urrent %egislation for work method statements obtained
'igh risk onstrution work-presribed ativities identified
and some work method statements developed
%imited involvement of workers in developing work
method statements
/rinipal +ontrator or !elevant /erson monitors some
persons to whom the work method statement applies
System developed but not maintained for reviewing and
updating work method statements as re"uired bylegislation
Some work method statements kept with onstrution
safety plan
/rinipal +ontrator or !elevant /erson signs and dates
some work method statements
Ceneri work method statements are reviewed but not
always amended at eah new site to reflet site speifiha7ards
Work method statements are easy to follow
Work method statements for high risk onstrution work -
presribed ativities developed not always followed in dayto day operations
Work Method Statements for other high risk ativities
identified but not developed
Work method statements for high risk onstrution work -
presribed ativities developed and followed
+ontrol measures in work method statements ontain all
urrent re"uirements alled up in legislation
Workers involved in developing work method statements
/rinipal +ontrator-!elevant /erson monitors persons to
whom the work method statement applies to
System implemented and maintained for reviewing and
amending work method statements
Ceneri work method statements amended at eah new
site and inlude site speifi ha7ards
ll people likely to be affeted by hanges advised of
amendments to work method statement
/rinipal +ontrator-!elevant /erson has signed and
dated work method statements
Work method statements easy to understand and follow
/rinipal +ontrator has opies of all work method
statements
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Work method statements kept with onstrution safety
plan
Work method statements are readily available for
inspetion
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FORM I +MPLO'++S WORK M+T.O/ STAT+M+NT C.+CKLIST
This WMS heklist relates to the following ativityOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
&ateOOOOOOOOOOOOOOOOOOOOOOOO
This WMS heklist relates to the following site address OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
Pla%e a ti% ne4t to ea%! %orre%t an"(er
WMS inludes the name of the high risk-presribed onstrution ativity
WMS states the way the ativity is to be performed
WMS inludes ha7ards assoiated with the ativity
WMS inludes ontrol measures to be followed
WMS inludes how the ontrol measures will be monitored and reviewed
WMS inludes any relevant presribed oupations
IF A PR+SCRI9+/ ACTI0IT'
WMS inludes the arrangements for appropriate training P supervision
WMS takes aount of S (G)0 &emolition work
,+N+RAL
WMS has been signed and dated by /rinipal +ontrator
/art 0 of WMS has been ompleted
/art ( of WMS has been ompleted
This WMS inludes site speifi ha7ards related to the above address
I have been trained in this WMS
I understand I am responsible for following this WMS
I have read the above "uestions and have tiked all bo2es where the answers are orret.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOO
6ame Signature &ate
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOO
6ame Signature &ate
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOO
6ame Signature &ate
SIT+ S-P+R0ISORG NO WORK TO COMM+NC+ -NTIL ALL A9O0+ R+7-IR+M+NTS .A0+ 9++N M+T
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