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Overview
Complete
Construction Method Statement Template
Road Realignment / SC-M13-19 / 13 May 2019 / SafetyCulture Staff
Project Name / No.
Road Realignment / SC-M13-19
Contractor
Gregory Dushamel
Contractor's Contact No.
+61 2 9192 0995
Conducted by
SafetyCulture Staff
Date

13th May, 2019

12:16 PM +08

Site Address/Location
38 Illawarra St, Appin NSW 2560, Australia
Inspection
Take or Attach Photo of Site
Photos
Job Title
Site Clearance Works & Topsoil Strip
Description of Work (overview list of planned activities)
This method statement outlines the procedure and methodology for site clearance works and topsoil stripping including removal/demolition of existing buildings, road signage and trees which interfere with the new road alignment.
Supervision of Task
Click '+' and add personnel in charge of task supervision (e.g site supervisor, safety officer, foreman, etc.)
Supervision of Task / Employee
Supervision of Task / Employee / Employee 1
Name
Jeremy Bartlett
Role
Site Engineer
Contact No.
+61 491 570 156
Supervision of Task / Employee / Employee 2
Name
Gregory Dushamel
Role
Contractor
Contact No.
+61 491 570 157
Supervision of Task / Employee / Employee 3
Name
Anika Hughes
Role
Contracts Manager
Contact No.
+61 491 570 158
Employees Involved
Employees Involved / Employee
Employees Involved / Employee / Employee 1
Name of personnel
Brady Worton
Role
Plant Operator
Employees Involved / Employee / Employee 2
Name of personnel
Kenneth Herman
Role
Site Supervisor
Employees Involved / Employee / Employee 3
Name of personnel
Galen Humphrey
Role
General Operatives
Methodology
In this section, provide step-by-step instruction as to how the work activity should be safely carried out and completed
Sequence of Operations
1. All personnel entering the site shall have received a site safety induction and have attended a job toolbox talk. 2. A Permit to dig form shall be issued by the Site Engineer relating to the area where Site Clearance and topsoil stripping is to be carried out. The Section Engineer will consult relevant documentation for details of known services and will ensure that the required protections are in place prior to issuing a Permit to Dig. 3. Access to site shall be via approved access points (Refer to Figure 2 in Appendix A for site access points). Clearance of all shrub shall be completed using a 360deg excavator or similar. The surplus vegetation shall be stockpiled in appropriate piles throughout the site (at locations in accordance with Environmental mitigation shown in this Construction Method Statement). Where appropriate this may involve the use of a dump truck or similar. The surplus vegetation shall then be disposed of appropriately. 4. All works will be executed within the permanent fencing boundary. 5. Goal post protection system to be installed around any ESB & Eircom overhead lines which cross works areas prior to any works in these areas. 6. Site clearance will also take place along the proposed fencing, with works undertaken from within the permanent boundary fencing. Openings between the landowners adjacent to the works will be fenced and left stock proof by the end of each working day unless otherwise agreed with the Landowner.
Plant & Equipment to be used
- 20 T – 60 T 3600 excavators - A25 – A40 all terrain dumptrucks - D65 dozers - Tractor and attachments
Specific Staff Training
- All site personnel shall have FAS Safe Pass certification. - All Excavator, Dumper and Crane drivers shall have CSCS certification. - CSCS certified representative in underground service location
Select the type of hazard associated with the planned activities below
Associated Hazard
Associated Hazard / Associated Hazard 1
Hazard
Moving objects
Control Measures
- Avoid working close to the moving object. - Be vigilant of their surroundings, especially if the object does not have lights or beepers. - Wear Personal Protective Equipment (PPE), such as a high visibility jacket, to ensure they are seen.
Associated Hazard / Associated Hazard 2
Hazard
Material and manual handling
Control Measures
- Provide adequate training for workers - Conduct an audit on material, machinery, equipment before use
Associated Hazard / Associated Hazard 3
Hazard
Other
Please specify
Blasting
Control Measures
- Blasting will be conducted by licensed blasting technicians. - Security arrangements will be put in place for the blast site. The blast site will be secured with staffed barricades and only authorized persons would have access to the site. - Exclusion zones will be established and maintained before blasting - Blast mats will be used to minimize rock fly where necessary
PPE (select the required ppe)
Safety gloves
Hearing Protection
Eye Protection
Other
Please specify
Hi Vis- Vest, Hard Hats, Boots
Emergency Procedures
Name of Person with Health & Safety Responsibility
Jonathan Byers - +61 491 570 158
Emergency Contact Details (include mobile no.)
Nearest Accident & Emergency Hospital: Appin Family Practice 4/77 Appin Rd, Appin NSW 2560, Australia +61 2 4631 2041
First Aid Provision - in the event of an emergency, the following procedures should be executed:
- The named persons in Site's schools policies and procedures will be the appointed operative in emergency first aid, rescue planning & fire precautions. - Emergency fire alarm on this site will be a siren or verbal. On hearing the alarm operatives will proceed immediately to the nearest fire assembly point which is at the main front car park. - On hearing the alarm DO NOT try to fight the fire or return to collect personal belongings. If you believe that a member of staff or student is missing or still on the site, DO NOT return to the location, but DO inform a supervisor immediately who will notify the emergency services. - Emergency rescue plan, including emergency trauma, will have designated people assigned to them outside of the site specific RA
Welfare Requirements
N/A
Services to be Supplied by Others
N/A
Completion
Other Information & Comments
Please update information in the welfare requirements and services supplied by others in the emergency procedures section.
Prepared by (provide name & signature)
Marcus Scherbatsky
13th May, 2019 12:55 PM +08
Reviewed by (provide name & signature)
Kenneth Herman
13th May, 2019 12:56 PM +08
Method Statement Briefing Record
Briefing delivered by
Marcus Scherbatsky
Position
Supervisor
Date

13th May, 2019

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.
Employee
Employee / Employee 1
Name & Signature
Adrian Cruz
13th May, 2019 12:57 PM +08
Employee / Employee 2
Name & Signature
Miles Herman
13th May, 2019 12:57 PM +08
Employee / Employee 3
Name & Signature
Harold Fritz
13th May, 2019 12:57 PM +08
Media summary
1 Media file