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SHIMIZU PHILIPPINE CONTRACTORS, INC.

Architects, Engineering & General Contractor


5/f Kings Court Bldg. -1, 2129 Chino Roces Avenue
Makati, Philippines 1231
Tel: 632-811-2981, Fax: +632-811-2985

Revision History
(Document Review Comments)

Document Title: MS for Unfit Area Conctruction - Mechanical Work Date: 08-Jan-21
Discipline: Mechanical Work Revision No. 01

Reference of the
Item/S Comment Commented by: Response Remark
document/section
Preparatory works : this will include all hauling, work
area preparations such as fabrication area,
1 Mr. Kevin G. Already included
installation area, work at heights preparation and
scaffolding preparation etc.

Fabrication : this will include all types of fabrications;


2 limits and specifications to follow. you can cite detail Mr. Kevin G. Already included
drawings in the appendix for a cleaner MS

Pipe/ Ducting Layout: this will include layout of pipe


Layout Added. Support details and intervals already
3 runs, support details and support intervals per Mr. Kevin G.
included
system

Connection: this will include all the connection


4 process per system specially specialized fittings Mr. Kevin G. Added
(step by step procedure on how to install); limits

5 Testing: this will include all testings per system. Mr. Kevin G. Already included

6 B. No Checklists included in the MS. Mr. Kevin G. Added

10

11

12

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14

15

16

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Doc. Control No. :
METHOD STATEMENT FOR Rev. No.:
EPPI F3 ADDITIONAL STANDPIPE AND
Date :
WATERLINE
Page :

METHODOLOGY FOR F3 UNFIT


AREA CONSTRUCTION

PROJECT : F3 UNFIT AREA CONSTRUCTION


(MECHANICAL WORKS)

LOCATION : LIMA TECHNOLOGY MALVAR, BATANGAS

GEN. CONTRACTOR : SHIMIZU PHILS. CONTRACTORS, INC

EPPI
Facility Safety

SPCI
Civil & Safety M&E
Doc. Control No. :
METHOD STATEMENT FOR Rev. No.:
EPPI F3 ADDITIONAL STANDPIPE AND
Date :
WATERLINE
Page :

Contents
1. Introduction .......................................................................................................................................... 1
2. Scope of Work ....................................................................................................................................... 2
3. Abbreviation and Definition of Terms................................................................................................... 2
4. Organization ..........................................................................................................................................
change typo 3
5. Work Sequence Responsibility Chart .................................................................................................... 5
6. References............................................................................................................................................. 6
7. Tools and Materials ............................................................................................................................... 6
8. Schedule of Work .................................................................................................................................. 8
9. Workflow Chart ..................................................................................................................................... 9
10. Method and Sequence of Work ...................................................................................................... 10
11. Inspection and Test Plan (ITP) ............................................................ Error! Bookmark not defined.
12. Health, Safety and Environment ..................................................................................................... 33
13. Emergency Procedure ..................................................................................................................... 34
14. Hazard Identification and Risk Assessment Control ....................................................................... 35
15. Appendices ...................................................................................................................................... 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 1 of 35

1. Introduction
The F3 Construction of Unfit Area is a miscellaneous project of SHIMIZU Philippine
Contractors Inc. in EPSON PRECISION (PHILS), INC. which is in Lima Technology
Center, Lipa City, Batangas.

This Method Statement will enumerate and detail the working procedures applicable to
the specified works at hand by considering all aspects (Safety & Environmental, Climate
Condition, Manpower, Engineering & Etc.) that might affect quality execution of work. This
guideline shall be followed on site as an instruction especially to workers. Thus,
construction personnel must determine the applicability of this MS. Any changes that will
happen on site must be reported and provided with revised Method Statement as to avoid
safety and quality issues.

Page 1 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 2 of 35

2. Scope of Work
The scope of works of this project includes Supply, Labor, Tools and Materials (SLTM)
for the installation of AirConditioning Units with refrigerant and drain pipes, Outdoor Air
Ducts, Supply Air Ducts, Exhaust Air Ducts, and Compressed Dry Air Pipes and other
materials to be used for the completion of the said works including safety requirements and
quality control documentation up to testing and commissioning. This work shall include
working at heights and will require scaffolding (up to two layers). The Outdoor Air Unit shall
be installed on the roofdeck and will be transported using the service elevator as well as the
Indoor Air Unit. The project shall start from December 2020 and to complete by April 2020.
All mechanical works shall be done by MODAIR MANILA CO., LTD.

Abbreviation and Definition of Terms

AFCD - Approved for Construction Drawing


PPE - Personal Protective Equipment
MS - Method Statement
SPCI - Shimizu Philippine Contractors, Inc.
EPPI - Epson Precision Philippines, Inc.
ACU - Air Conditioning Unit
GI - Galvanized Iron
OA - Outdoor Air
SA - Supply Air
PVC - PolyVinyl Chloride

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Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 3 of 35

3. Organization

1.1. Organizational Chart – SPCI (Shimizu Philippine Contractors, Inc.)

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Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 4 of 35

1.2. Subcontractor’s Organizational Chart – MODAIR MANILA CO. LTD,


INC.

BOYONG MARQUEZ
PROJECT MANAGER
0918-915-9294

HERMINIGILDO REYNOSO
SAFETY OFFICER
0926-021-8668

CJ LOMENTIGAR
PROJECT ENGINEER
0996-756-7310

ABRAHAM BERMUDO
SITE SUPERVISOR

RAMIL MARQUEZ
SITE FOREMAN

Page 4 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 5 of 35

4. Work Sequence Responsibility Chart

Page 5 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 6 of 35

5. References
• SPCI-OPR-MST-029 Rev. 01 Installation of ductworks 01-16-20
• SPCI M&E Standard Details

6. Tools and Materials

Materials / Equipment /
Item Purpose
Tools
1 ACU Indoor & Outdoor Unit For Air-Conditioning System
Copper Pipes (w/ Insulation)
2 For Connection of Indoor & Outdoor Unit
& Fittings
For Fireless Connection of Copper Pipes (Indoor Area
3 Compression Fittings
Only)
4 Sizing Tool and Mounting Kit For Compression Fittings Tools
Copper Pipe Cutter and
5 For Cutting and Modification of Copper Pipes
Reamer
Nitrogen Gas Set c/w
6 For Pipe Flushing and Pressure Leak Testing
Regulator Hose
Vacuum Pump Set c/w Hose
7 For Vacuum of Copper Pipes
and Gauge Set
8 GI Sheet / Duct For Ducting of Airconditioning System
Fabricated Ducts and
9 For Duct Accessories
Volume Dampers
10 Duct Insulation For Insulation of Supply Air Duct
Grinder, Speed Cutter,
11 For Fabrication of Ducts and/or Supports
Nibbler and Riveter
12 Gasket and Sealant For Sealing of Ducts
13 Temporary Filter For Testing of ACU, Ducts and Diffusers
For Covering of Duct Ends (Installation Phase) and
14 Blue Sheet
Floor Protection
Insulated PVC Pipes and
15 For Drain Pipes of Indoor Unit
Fittings (With Insulation)
16 Solvent Cement and Brush For Connection of Drain Pipes
17 GI Pipes and Fittings For Compressed Air Line
Threading and Cutting
18 For Threading and Cutting of GI Pipes
Machine
19 Pressure Washer For Cleaning of GI Pipes
20 Ball Valve For Isolation of Droppings and Pipes
21 Push-Fit Fittings For Hose Connection of Droppings
22 Pipe Wrench For Connection of GI Pipes
23 Teflon Tape For Sealing of Threaded Connections
24 Paint and Primer For Painting of the GI Pipes
25 Arrow and Bindings Sticker For Marking of Utilities

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METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 7 of 35

Flat Bars, Angle Bars, and


26 For Supports of Installed Utilities
Threaded/Hanger Rods
27 Bolts and Nuts For Connection of Various Materials
Tape Measure and Marking
28 For Accurate Measurements
Pen
29 Portable and Electric Drill For Tools at Fabrication and Site
30 Chain Block and Lifting Belt For Lifting of Outdoor Air Unit on the roofdeck
31 Scaffolding For Working Platform
32 Welding Machine w/ Rod For Welding of support
33 Cutting and Grinding Discs For Grinder and Speed Cutter
Hammer, Bar Level, and
34 For Fabrication and Installation Tools
Wrenches
Power Cables, ELCB/GFCI
35 Outlet-weather proof as per For Outlet of Power Tools
Shimizu Standard
36 Workers PPE (Visibility Vest,
Safety Helmet, Googles,
For Body protection
Rubber Gloves, Safety
Shoes)
37 Cleaning Materials For Implementation of 5S

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METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 8 of 35

7. Schedule of Work

Page 8 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 9 of 35

8. Workflow Chart

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METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 10 of 35

9. Method and Sequence of Work

10.1 Storing of Materials

Storing of delicate items like the air-conditioning unit, copper pipes and
insulated drain pipes must be done with care.

1. Air-conditioning units must be placed on a balanced ground and clean area.


If possible, place immediately the indoor unit in a staging area at the site. If
not, place it in a secure and well guarded location.
2. Copper pipes, Insulated PVC (drain) pipes and GI pipes must be stored on a
clean ground with rack or must be elevated. Caps must be in place to
prevent foreign objects from entering. If placed outdoor, cover with blue
sheet and secure with ropes or ties to protect from rain and/or strong wind.
3. GI sheets must be stored in a clean area. Place caution materials on the
edges to warn anyone near it. If placed outdoor, provide barricade around
the area. Cover with blue sheet and secure with ropes or ties to protect from
rain and/or strong wind.

10.2 Hauling of ACU Indoor and Outdoor Unit

Coordinate to EPPI the date and time of hauling of the indoor and outdoor unit.
Elevator will be used to transport the Outdoor Unit from basement to roof, and
the Indoor unit from basement to 2FL. It must be at the time that it will not affect
the production’s usage of elevator. 3-1

Capacity : 1600 Kg

Page 10 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 11 of 35

1. Indoor and Outdoor AC will be hauled from closed van by using forklift.
Transport the Indoor/Outdoor Unit using pallet truck from basement elevator
area to Second floor and Roofdeck area. Watchman must hold a stop/go
signage, Always prioritize passing vehicles at the route.

AC Weight : 280 Kg

Forklift : 2 Ton

2. Inform again EPPI before using the elevator. Have workers standby at the
destination floor of the unit for assistance while exiting the elevator.
3. For the Indoor unit, exit at the 2FL. For the Outdoor unit, exit at the Roof level.
4. For the Indoor unit, transport to designated area or temporary staging area.
5. For the Outdoor unit, after exiting the elevator, place temporarily at a vacant
space nearby. Temporarily remove the Stair and erect scaffolding at both side.
6. Attach the chain block with lifting belt to the scaffolding. Then attach the lifting
belt to the Outdoor Air Unit. (Chain block and lifting belt must be inspected prior
to activity).

Chain Block 2 Tons

4 Inches Pipe Lifting Belt 3 Tons


(Yellow)

AC Weight : 280 Kg

Page 11 of 35
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METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 12 of 35

7. Lift Slowly and push toward the platform.

AC Weight : 280 Kg

8. Place the mount on the machine pad and bolt it.


9. Place the outdoor unit on the mount and bolt and nut it.
10. Make sure delicate openings must be capped or covered to prevent damage to
the unit.

10.3 Preparation and Fabrication Area

1. Prepare all the necessary documents (approved shop drawings, work permit,
safety plan, etc.)
2. Procure and prepare all the required materials as approved.
3. SPCI shall inspect all the materials specially the copper pipes & fittings,
compression fittings, insulated pvc pipes & fittings, and gi sheets/ducts.
4. Prepare all equipment, tools and consumables necessary for the fabrication
(oxy-acetylene gas, drill, welding machine, grinder, etc.).
5. Prepare safety precautions at work area (signages, fire extinguisher, fire
blanket, pail of water, first aid kit, etc.)

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METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 13 of 35

10.4 Fabrication of Copper Pipes

1. Prepare length of copper pipe for connection.


2. For straight pipe runs, pipe should be insulated before connecting. Leave
open on the joint portions with sufficient clearance for compression fittings.
3. Cut and chamfer the copper tube. Use pipe cutter and reamer or scraper.
4. Cover the edge of copper tube with the die matching the outside diameter.
5. Insert the body of the sizing tool into the die and knock in the hammer to the
die.

6. Mark the pipe using the gap-checking gauge according to its size.

7. Insert the copper pipe to the fittings until the “L” shape marking is not showing.

8. Mount the copper pipes on the support kit to ensure straight connection.

Page 13 of 35
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METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 14 of 35

9. Tighten one side at a time. Fasten it until it reaches the center piece. Then
repeat for the other side.

10. Check the gap between the nut and center piece using the gap-checking
gauge. And make sure the “L” shape marking is not showing.

11. Maximize the length of the copper pipes to be hauled into the area to minimize
working at height.
12. Attach cap at the end of stored copper pipes to prevent foreign particles from
entering.
13. Perform 5S at the area before, during and after working hours.

10.5 Fabrication of Ducts


1. Prepare the GI Sheets. Clean and dry the surface and determine the inside
and outside part.
2. Fabricate the duct as per approved shop drawings.
3. Apply sealant on joined parts that is prone to leaks. Place the gasket at the
connector of the ducts.
4. After fabrication, if to be stored, cover the ducts to prevent dust
accumulation.
5. Check the volume dampers for functionality. Handle with care to avoid
damage/s.

Page 14 of 35
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METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 15 of 35

10.6 Fabrication of CDA Pipes


1. Prepare the pipes and approved shopdrawings.
2. All cuts of the pipes must be done by pipe cutter machine.
3. Thread the pipes and inspect the quality. Low quality threads will lead to
irrepairable leaks at site.

4. Prepare the surface of the pipe prior to painting. Make sure that there is no
dust and it is dry.
5. Paint the pipes according to client’s specifications. Use SPCI specifications
if client has none. Stay away from fire hazards while painting.
6. Use air compressor to clean the insides of the pipes. Cap the ends with tape
to prevent foreign objects from entering.

10.7 Installation of Pipes at Pipe Rack of Roof deck

1. Prepare the compression fittings and tools at the working area.


2. Haul the refrigerant pipes and supports from fabrication area to roof deck.
3. Remove temporarily the existing cladding of the refrigerant pipes.
4. Lay the pipes on the existing pipe rack, then connect. Install the supports as
well. (Refer to the procedure 9.4 regarding compression fittings).

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Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 16 of 35

5. For the pipes connecting the roof deck and unfit, connect a long enough pipe
that can pass through the riser to minimize compression fittings connection at
a very high place.
6. Reinstall the cladding of the refrigerant pipes temporarily (for easy removal
while pressure leak testing).
7. Perform 5S at the area before, during and after working hours.

Page 16 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 17 of 35

10.8 Typical Installation of Duct & Pipes at Unfit Area

Ducts Pipes

REFRIGERANT CDA PIPES


PIPES

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Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 18 of 35

10.9 Installation of Pipes Inside Unfit Area

1. Haul the refrigerant pipes and supports from the fabrication area to roof
deck.
2. Erect scaffolding that is high enough to reach the designated elevation of
the refrigerant pipes. Modair, SPCI and EPPI shall inspect and attach green
tag at the scaffolding if it is safe to use. Place hard barricade around.
3. Before entering the scaffolding, a full-body harness with two (2) lanyards
must be worn by the worker/s. Upon reaching the working platform, perform
the three-point checking on the steel structures using voltage tester, then
attach the two (2) lanyards to a secure spot but not on the scaffolding.
4. Install lifeline on planned refrigerant pipeline. After the complete and secure
installation, lanyards can now be attached to it.
5. Install the supports for the refrigerant pipes

6. Place the pipes on the supports and secure with U-bolts. Insulation must be
installed and leave enough portion for the fittings.
7. Connect the pipes using compression fittings.
8. After the completion of refrigerant pipe installation, connect it with the pipe
from the riser.
9. Then connect it to the indoor and outdoor units.
10. After completion of the line, conduct pressure leak testing using nitrogen gas
and fill up to 580psi (4MPa). If there is leak/s, use bubble test (liquid soap)
on all compression fittings and weld joints. Repair if necessary.
11. Reduce the nitrogen inside the pipes to a safe pressure.
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METHOD STATEMENT FOR Rev. No.: 01
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(MECHANICAL)
Page : 19 of 35

12. Complete the insulation along the compression fittings and joints and install
the control wirings also.
13. Flushing and vacuum will be performed if the system is complete and ready
to operate.
14. Perform 5S at the area before, during and after working hours.

10.10 Installation of Drainpipes

1. Haul the Insulated PVC Pipes and supports from the fabrication area to Unfit
Area.
2. Erect scaffolding that is high enough to reach the designated elevation of
the pvc pipes. Modair, SPCI and EPPI shall inspect and attach green tag at
the scaffolding if it is safe to use. Place hard barricade around.
3. Before entering the scaffolding, a full-body harness with two (2) lanyards
must be worn by the worker/s. Upon reaching the working platform, perform
the three-point checking on the steel structures using voltage tester, then
attach the two (2) lanyards to a secure spot but not on the scaffolding.
4. Install lifeline on planned drain line. After the complete and secure
installation, lanyards can now be attached to it.
5. Install the supports.

6. Install the pvc pipes on the above-ceiling level first. Make sure the slope is
as intended.
7. Make sure the cut of the pipes are at a 90deg angle. Use marking or clamps
to ensure accurate cut. File the edges for smoothness and clean afterwards.
8. Insert the pipes deeply through the coupling (without solvent cement). Mark
the end of the coupling on the inserted pipes. Then remove the coupling.
9. Apply solvent cement on the pipes up to the marking and inside the coupling
also.
10. Insert the coupling to the pipe and make sure it reaches the marking.
11. Conduct leak testing by installing cap on the lowest part (before connection
to existing) and filling the line with water. Mark the water level at the highest
point of the pipe. Observe for two (2) hours.
12. If the water level goes down, there is leak. Check along pipeline for leaks
then repair. Then redo the leak testing.

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METHOD STATEMENT FOR Rev. No.: 01
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(MECHANICAL)
Page : 20 of 35

13. If there is no more leak, drain the line.


14. Install the remaining line from the above-ceiling level going to the indoor
units.
15. Connect the pipe to the existing drain line. Make sure to do it on a day
without ACU operation for the affected drain line.
16. Perform 5S at the area before, during and after working hours.

10.11 Installation of Supply Air, Outside Air, and Exhaust Air Duct

1. Haul the ducts and supports from the fabrication area to Unfit Area.
2. Erect scaffolding that is high enough to reach the designated elevation of
the ducts. Modair, SPCI and EPPI shall inspect and attach green tag at the
scaffolding if it is safe to use. Place hard barricade around.
3. Before entering the scaffolding, a full-body harness with two (2) lanyards
must be worn by the worker/s. Upon reaching the working platform, perform
the three-point checking on the steel structures using voltage tester, then
attach the two (2) lanyards to a secure spot but not on the scaffolding.
4. Install lifeline on planned ducting area. After the complete and secure
installation, lanyards can now be attached to it.
5. Coordinate to EPPI the tapping point of Outside Air Duct and Exhaust Air
Duct to existing. The supply fan must be turned-off before tapping. The
schedule should not affect the connected ACU on the line.
6. Dismantle the selected duct to be replaced with “Tee.” Then install
immediately the volume damper after the “Tee” in order to resume the
operation of the supply fan.
7. Install the supports

8. Start installation of the ducts. Install duct clips according to the table below

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(MECHANICAL)
Page : 21 of 35

9. Start installation of the supply air duct from the indoor units to the location of
plenum boxes.
10. Conduct light test using mercury lighting fixture with 500W capacity. This
must be coordinated with EPPI and other subcontractors inside the area to
avoid inconvenience. Lights will be turned off and may affect adjacent areas.

11. Observe the leak of the duct and identify if there is leak. Apply sealant to
leaking parts if there is any. Then redo the light test on the repaired parts.
12. Insulate the supply air duct of the ACU.
13. Install the diffusers if there is ceiling already.
14. Perform 5S at the area before, during and after working hours.

10.12 Testing of ACU

1. Install the central controller or central control panel (ccp) of the ACU system.
2. Using Nitrogen Gas, conduct flushing of refrigerant pipes at 5kgf/cm2
(71psi). Check for cleanliness using white clean cloth placed on the exit.
3. Start the vacuum of refrigerant pipes until it reaches below 500microns.
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4. Charge the refrigerant into the pipes.


5. Install temporary filters to the diffusers and ACU Indoor unit vents.
6. Turn-on the air-conditioning units using CCP.
7. Inform EPPI facilities for the witnessing of the tests.

10.13 Installation of CDA Pipes and Droppings.


1. Haul the pipes and supports from the fabrication area to Unfit Area.
2. Erect scaffolding that is high enough to reach the designated elevation of
the CDA pipes. Modair, SPCI and EPPI shall inspect and attach green tag at
the scaffolding if it is safe to use. Place hard barricade around.
3. Before entering the scaffolding, a full-body harness with two (2) lanyards
must be worn by the worker/s. Upon reaching the working platform, perform
the three-point checking on the steel structures using voltage tester, then
attach the two (2) lanyards to a secure spot but not on the scaffolding.
4. Install lifeline on planned pipeline area. After the complete and secure
installation, lanyards can now be attached to it.
5. Coordinate to EPPI the tapping point of CDA Pipes to existing. The CDA line
must be shut-off before tapping. The schedule should not affect the
production or should be on shutdown day/s.
6. Dismantle the selected pipe to be replaced with “Tee.” Then install
immediately the ball valve after the “Tee” in order to resume the operation of
the CDA Line. Once resumed, immediately conduct bubble (liquid soap) test
for leaks on the “Tee.”
7. Install the supports

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(MECHANICAL)
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8. Place the pipes on the supports.


9. Apply Teflon tapes on the threads of the pipes. Then connect using
couplings. Tighten the connections using pipe wrenches.
10. Install all the pipes up to the ball valves. Make sure to close all valves
including the connection to the existing.
11. Fill the pipeline with air and pressure up to 145 psi (1MPa) for 2 hours.

12. Check the gauge for leaks. If there is, use bubble (liquid soap) test, and redo
the test.
13. If there is no more leak, conduct flushing. Release the pressure inside the
pipeline slowly to avoid generating noise.
14. Coordinate with EPPI the flushing as it will generate continuous high volume
noise and the air to be used will be coming from the existing air
compressors and may affect production if all lines are being used. Conduct
on day/s with minimal production.
15. Using the compressed dry air from the existing line, start flushing. Invite
EPPI for the witnessing of the flushing.
16. Slowly open the isolation valve
17. Make sure to close all but one (1) valve from the droppings.
18. Use ear plugs to minimize noise hazard.
19. After some time, place white clean cloth to the open dropping and check for
dirt. If there is no more, close the valve and then move on the next dropping.
20. Conduct step 17-19 for all the droppings.
21. After flushing, install the push-fit fittings at the valves.
22. Perform 5S at the area before, during and after working hours.

Page 23 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 24 of 35

10. Inspection and Test Plan

Page 24 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 25 of 35

Page 25 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 26 of 35

Page 26 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 27 of 35

11. Forms and Checklists


• Drawing Review Form

Page 27 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 28 of 35

• Material Approval

Page 28 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 29 of 35

• Material Delivery Inspection

Page 29 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 30 of 35

• Daily Attendance Sheet


SHIMIZU PHILIPPINE CONTRACTORS, INC.
Architects, Engineering & General Contractor

5/f Kings Court Bldg. -1, 2129 Chino Roces Avenue


Makati, Philippines 1231
Tel: 632-811-2981, Fax: +632-811-2985

DAILY SAFETY ATTENDANCE SHEET


PROJECT NAME: Start Time: _________________
DATE: End Time: _________________
Ref No.: _________________

ORIENTATION TOOL BOX TRAINING STAND DOWN


SAFETY TOPIC OF THE DAY:

ACTIVITIES:

ANNOUNCEMENT:

NAMES OF ATTENDEES:
Name Company Position Signature
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Conducted By: ________________________ Noted By: ________________________


(SPCI EHS Officer Name & Signature) (SPCI PM/CM Name & Signature)

Page 30 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 31 of 35

• KY Minutes of Meeting
SHIMIZU PHILIPPINE CONTRACTORS, INC.
Architects, Engineering & General Contractor

5/f Kings Court Bldg. -1, 2129 Chino Roces Avenue


Makati, Philippines 1231
Tel: 632-811-2981, Fax: +632-811-2985

KY MINUTES OF MEETING
Kiken (Hazard) Yochi (Prediction) Training
PROJECT NAME: DATE:
CONTRACTOR'S NAME: REF NO.
NO.OF ATTENDEES:
AREA/ LOCATION:
ACTIVITIES TO PERFORM:

HAZARD OF THE ACTIVITY CONTROL MEASURE

NAME OF ATTENDEES:
1. 9. 17.
2. 10. 18.
3. 11. 19.
4. 12. 20.
5. 13. 21.
6. 14. ( Use back of this sheet if additional space is
7. 15. needed)
8. 16.
Conducted By: ____________________ Noted By: ____________________________
(Foreman/ Leadman Name & Signature) (SPCI PIC Name & Signature)

NOTE: KYT Meeting shall be conducted at the exact area of the activity. All persons involved shall be present.

Page 31 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 32 of 35

• Scaffolding Checklist
SHIMIZU PHILIPPINE CONTRACTORS, INC.
Architects, Engineering & General Contractor

5/f Kings Court Bldg. -1, 2129 Chino Roces Avenue


Makati, Philippines 1231
Tel: 632-811-2981, Fax: +632-811-2985

SCAFFOLDING CHECKLIST
SPCI Safety SUBCON
PM/CM Site Engr.
PROJECT : Officer Safety Officer
LOCATION :
OWNER/CLIENT :
WORK AREA :
DATE OF INSPECTION:
Ref. No. : Subcontractor's Name
Subcontractor's Name: Scaffold Tag No.:
Scaffold Location: Time Inspected:
Types of Scaffold: GREEN
Types of Erection: Scaffold Tag YELLOW
No. of Workers: Classification: RED
Hanger Scaffold Light Duty (120 kg/sq. mtr.)
Medium Duty (240 kg/sq. mtr.)
Mobile Scaffold
Heavy Duty (360 kg/sq. mtr.)
Independent Scaffold Special Purpose (367 kg/sq. mtr.)
CHECKLIST PASSED FAILED REMARKS
1. Sole Board (if necessary)
2. Base Plate
3. Ledgers and kicker lift (lift Height)
4. Transom
5. Coupler (swivel / fixed /joint pin etc.)
6. Sway Brace / Ledger Brace
7. Wood Planks space and secured (Tighten)
8. Toe board
9. Mid-rail
10. Guard Rail (standard height)
11. Access Ladder,lashed and angle
12. Outrigger Brace
13. Caster Wheel with safety locks
14. Scaffold materials to be use are clean,
free from dust and rust
15. Minimum power line clearance (10ft.)
16. Scaffold tag is check every day by a
competent scaffolder.
17. Base plates should be covered to provide
protection on the floor.
18. Are outriggers secured and installed
correctly?
19. Riding in a rolling scaffold?

Approved by:
CLIENT CONSULTANT

Date Date

Page 32 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 33 of 35

12. Health, Safety and Environment

1. Proper orientation to all workers concerned shall be made by the safety officer
prior to start of work. A safety officer shall always be present at the area to avoid
accidents.
2. All workers must wear the necessary Personal Protective Equipment (PPE) at all
times.
3. Provision of safety warning signs on all work locations must be implemented.
4. All power tools and extension wires shall be inspected every day to ensure no open
wiring is present as to avoid Electrocution.
5. All workers shall do the daily cleaning and clearing 5 minutes before, during and
after working hours. (5S)
6. Discuss all potential hazards, unsafe act, unsafe conditions, and the counter
measures during toolbox/KY meeting before start of work.
7. Practice proper posture during manual lifting of heavy loads/materials. Always
follow the buddy-buddy system.

Page 33 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 34 of 35

13. Emergency Procedure

Page 34 of 35
Doc. Control No. : 1SPCI-EPPI-MS-2011-071
METHOD STATEMENT FOR Rev. No.: 01
EPPI F3 UNFIT AREA CONSTRUCTION
Date : 11-Jan-20
(MECHANICAL)
Page : 35 of 35

14. Hazard Identification and Risk Assessment Control


Please see “Appendix A”

15. Appendices

• Appendix A: Hazard Identification and Risk Assessment Control

• Appendix C: EPPI - SPCI GUIDELINES ON WORKPLACE DURING


GENERAL COMMUNITY QUARANTINE

Page 35 of 35
SHIMIZU PHILIPPINE CONTRACTORS INC. Reference No.:

5f King's Court Building 1, 2129 Chino Roces Ave., Makati City Project Name: EPPI Misc Project

Tel. No. (02) 811-2981 Fax No. (02) 811-2985 HIRAC Revision No.: 0

HAZARD IDENTIFICATION RISK ASSESSMENT AND CONTOL


Shimizu Philippine Contractors, Inc. November 20, 2020
Contractor : Date Prepared:
Unfit Area Construction Date Approved:
Work Activity
EPPI F3 2FL
Location
Mark James Castaneda/Rachelle Ann Sonon
Edwin Quesea/ Construction Manager/ Prepared by: (REVIEW TEAM)

(Name/ Designation/ Signature) (Name/ Designation/ Signature)


Approved by :
** LEGEND
4- HIGH : Death/ Fatality or Permanent Disability and Significant Environmental Damage Sustained > 1 Year 4- High/ Very Likely/ Very Frequent RISK SCORE & RISK 9-16 4 High
SEVERITY LEVEL LIKELIHOOD LEVEL
3- MEDIUM : Hospitalized for more than 24Hrs. Or 4Days or more Lost workdays and Significant Environmental Damage Sustained < 1 Year 3- Medium/ Likely/ Common Occurrence LEVEL 6-8 3 Medium
2- LOW : First aid treatment or 3Days or less Lost workdays and Localized minor environmental impact 2- Low/ Unlikely/ Rare Occurrence 3-4 2 Low
1- EXTREMELY LOW : First aid treatment not required and Insignificant environmental impact 1- Extremely Low/ Rare Unlikely 1-2 1 Extremely Low

Hazard & Risk Identifications Risk Controls Risk Assessment after Controls Additional Risk Controls
Activities

Significance Level
Occurrence

Likelihood
Site Check

Site Check
Risk Score

Risk Level
Condition

Severity
S/N Hazards/ Aspects RISK Impacts A: Abnormal Existing Controls Measures Additional Control Measures
Main Sub-activities
N: Normal
E: Emergency

Workers working without safety Potential to accident, not familiar to Attend and coordinate to construction site for the Ensure that the workers attend the safety site
1 Workers Mobilization Orientation
orientation construction rules and regulation
Physical injury A
orientation
2 2 4 2 N orientation

Not confirmed/ approved PTW, Stoppage of work & delay to the site Implement PTW system., follow rules and regulation
Preparation of PTW
incomplete requirements/ document schedule
Project delay A Provide PTW before commence of work 1 2 2 1 N required by the site project
2 Work Permits
Remind worker before activity starts daily. Provide
Preparation of JHA Not conforming with approved JHA Stoppage of work & potential accident Project delay A Discuss and follow the approved sequence of work 1 2 2 1 N training as necessary.

Workers prone to construction activity Workers must attend the safety assembly to understand
Absence/ Late during TBM & KY Monitor all workers participation during the morning
3 Morning Exercise Tool Box & KY Meeting
Meeting
and accident. Not getting informed Physical injury A the specific high risk work area to avoid minor and major 1 2 2 1 N and afternoon safety assembly
with the activity. accident. Sign TBM & KY Meeting sheet

Ensure that the warehouseman and workers conduct


Not inspected tools /Substandard Impose potential harm to workers if Immediately removed all damage tools. Ensure that tools
4 Mobilization of material Use of tools
and/or damage tools they use damage/ substandard tools
Physical injury A
are inspected and tagged prior to usage.
2 2 4 2 N daily inspection prior to use.Strictly prohibits the
usage of any damage tool.

Poor work site preparation and Project delay / Physical Ensure the area have proper communication and
Check work area
condition
Slip, trip, fall or weather environment
injury
A
coordination.
2 2 4 2 N Check working schedule. Proper planning.

5 Preparation of work area


Ensure the area have proper communication and
Poor work site preparation and Project delay / Physical Check working schedule. Proper planning. Refer on as
Layout and marking at site
condition
Slip, trip, fall or weather environment
injury
A coordination. Properly check the size and list down all of 2 2 4 2 N built and drawings. Coordinate accordingly.
materials to be fabricated.

Provision of Temporary Installation of Traffic cones with Company reputation,damage to Provide marking for temporary fence installation, provide Coordinate accordingly to EPPI in charge, provide key
6
Fence/Enclosure cone bar
Misleading, Unauthorized entry
property
Work delay/downtime A
clean traffic cones & cone bar prior to installation of fence
2 2 4 2 N plan for temporary fence demarcation.

SPCI-EHS-FRM-062 Rev.00 (2020.05.15)


SHIMIZU PHILIPPINE CONTRACTORS INC. Reference No.:

5f King's Court Building 1, 2129 Chino Roces Ave., Makati City Project Name: EPPI Misc Project

Tel. No. (02) 811-2981 Fax No. (02) 811-2985 HIRAC Revision No.: 0

HAZARD IDENTIFICATION RISK ASSESSMENT AND CONTOL


Shimizu Philippine Contractors, Inc. November 20, 2020
Contractor : Date Prepared:
Unfit Area Construction Date Approved:
Work Activity
EPPI F3 2FL
Location
Mark James Castaneda/Rachelle Ann Sonon
Edwin Quesea/ Construction Manager/ Prepared by: (REVIEW TEAM)

(Name/ Designation/ Signature) (Name/ Designation/ Signature)


Approved by :
** LEGEND
4- HIGH : Death/ Fatality or Permanent Disability and Significant Environmental Damage Sustained > 1 Year 4- High/ Very Likely/ Very Frequent RISK SCORE & RISK 9-16 4 High
SEVERITY LEVEL LIKELIHOOD LEVEL
3- MEDIUM : Hospitalized for more than 24Hrs. Or 4Days or more Lost workdays and Significant Environmental Damage Sustained < 1 Year 3- Medium/ Likely/ Common Occurrence LEVEL 6-8 3 Medium
2- LOW : First aid treatment or 3Days or less Lost workdays and Localized minor environmental impact 2- Low/ Unlikely/ Rare Occurrence 3-4 2 Low
1- EXTREMELY LOW : First aid treatment not required and Insignificant environmental impact 1- Extremely Low/ Rare Unlikely 1-2 1 Extremely Low

Hazard & Risk Identifications Risk Controls Risk Assessment after Controls Additional Risk Controls
Activities

Significance Level
Occurrence

Likelihood
Site Check

Site Check
Risk Score

Risk Level
Condition

Severity
S/N Hazards/ Aspects RISK Impacts A: Abnormal Existing Controls Measures Additional Control Measures
Main Sub-activities
N: Normal
E: Emergency

Provide stop & go when travelling of materials from


Transfer of materials from one area to another specialy inside EPPI premises.
caught/struck/hit by vehicles, fall of Physical injury / Work Provide watchman with stop&go sign prior to transport of
7 Hauling/ Transport temfacil area to work area using caught/struck by moving vehicles
materials. delay
A
materials. Buddy2x system.
2 3 6 3 Y Make Planned route going to work area and discuss all
pushcart/trolley possible/potential risk during travelling of materials.
Maintain physical distancing.

Provision of work sequence and information regarding


Pinch Points, sharp edge, Ergonomic/ Physical injury,Bodily
Awkward position, Caught into/ hazard present with the activity. Wear appropriate PPEs.
Installation of support musculoskeletal, fall of workers/
between, pointed parts,
injury,company reputation, A
Buddy 2x system. Proper use of fall protection and PFAS.
2 2 4 2 N
materials damage to property.
Proper body posture/positioning, proper lifting method.

Provision of work sequence and information regarding


Pinch Points, sharp edge, Ergonomic/ Awkward position, Caught into/ Physical injury,Bodily
hazard present with the activity. Wear appropriate PPEs.
Copper pipes musculoskeletal, fall of workers/ between, pointed parts, Struck by injury,company reputation, A
Buddy 2x system. Proper use of fall protection and PFAS.
2 2 4 2 N
materials materials. damage to property. Conduct KY prior to start of all works, discuss the
Proper body posture/positioning, proper lifting method.
sequence of job/task to be done,make sure that all
members know their role, discuss all possible hazards
Installation of Fireless and provide immediate control measure. All works
8
Connections inside EPPI Factory must be coordinated properly to
Provision of work sequence and information regarding
Pinch Points, sharp edge, Ergonomic/ Awkward position, Caught into/ Physical injury,Bodily avoid overlapping works with EPPI employees.
hazard present with the activity. Wear appropriate PPEs.
CDA pipe s musculoskeletal, fall of workers/ between, pointed parts, Struck by injury,company reputation, A
Buddy 2x system. Proper use of fall protection and PFAS.
2 2 4 2 N Maintain physical distancing. always wear face mask
materials materials. damage to property. and face shield while inside EPPI project premises.
Proper body posture/positioning, proper lifting method.

Provision of work sequence and information regarding


Pinch Points, sharp edge, Ergonomic/ Awkward position, Caught into/ Physical injury,Bodily
hazard present with the activity. Wear appropriate PPEs.
AC drain pipes musculoskeletal, fall of workers/ between, pointed parts, Struck by injury,company reputation, A
Buddy 2x system. Proper use of fall protection and PFAS.
2 2 4 2 N
materials materials. damage to property.
Proper body posture/positioning, proper lifting method.

SPCI-EHS-FRM-062 Rev.00 (2020.05.15)


SHIMIZU PHILIPPINE CONTRACTORS INC. Reference No.:

5f King's Court Building 1, 2129 Chino Roces Ave., Makati City Project Name: EPPI Misc Project

Tel. No. (02) 811-2981 Fax No. (02) 811-2985 HIRAC Revision No.: 0

HAZARD IDENTIFICATION RISK ASSESSMENT AND CONTOL


Shimizu Philippine Contractors, Inc. November 20, 2020
Contractor : Date Prepared:
Unfit Area Construction Date Approved:
Work Activity
EPPI F3 2FL
Location
Mark James Castaneda/Rachelle Ann Sonon
Edwin Quesea/ Construction Manager/ Prepared by: (REVIEW TEAM)

(Name/ Designation/ Signature) (Name/ Designation/ Signature)


Approved by :
** LEGEND
4- HIGH : Death/ Fatality or Permanent Disability and Significant Environmental Damage Sustained > 1 Year 4- High/ Very Likely/ Very Frequent RISK SCORE & RISK 9-16 4 High
SEVERITY LEVEL LIKELIHOOD LEVEL
3- MEDIUM : Hospitalized for more than 24Hrs. Or 4Days or more Lost workdays and Significant Environmental Damage Sustained < 1 Year 3- Medium/ Likely/ Common Occurrence LEVEL 6-8 3 Medium
2- LOW : First aid treatment or 3Days or less Lost workdays and Localized minor environmental impact 2- Low/ Unlikely/ Rare Occurrence 3-4 2 Low
1- EXTREMELY LOW : First aid treatment not required and Insignificant environmental impact 1- Extremely Low/ Rare Unlikely 1-2 1 Extremely Low

Hazard & Risk Identifications Risk Controls Risk Assessment after Controls Additional Risk Controls
Activities

Significance Level
Occurrence

Likelihood
Site Check

Site Check
Risk Score

Risk Level
Condition

Severity
S/N Hazards/ Aspects RISK Impacts A: Abnormal Existing Controls Measures Additional Control Measures
Main Sub-activities
N: Normal
E: Emergency

Provision of work sequence and information regarding


Pinch Points, sharp edge, Ergonomic/ Awkward position, Caught into/ Physical injury,Bodily
Indoor & Outdoor AC pipe hazard present with the activity. Wear appropriate PPEs.
connection
musculoskeletal, fall of workers/ between, pointed parts, Struck by injury,company reputation, A
Buddy 2x system. Proper use of fall protection and PFAS.
2 2 4 2 N
Conduct KY prior to start of all works, discuss the
materials materials. damage to property.
Proper body posture/positioning, proper lifting method. sequence of job/task to be done,make sure that all
members know their role, discuss all possible hazards
Installation of Fireless and provide immediate control measure. All works
8
Connections inside EPPI Factory must be coordinated properly to
avoid overlapping works with EPPI employees.
Provision of work sequence and information regarding Maintain physical distancing. always wear face mask
Pinch Points, sharp edge, Ergonomic/ Awkward position, Caught into/ Physical injury,Bodily and face shield while inside EPPI project premises.
hazard present with the activity. Wear appropriate PPEs.
Air duct installation musculoskeletal, fall of workers/ between, pointed parts, Struck by injury,company reputation, A
Buddy 2x system. Proper use of fall protection and PFAS.
2 2 4 2 N
materials materials. damage to property.
Proper body posture/positioning, proper lifting method.

Make sure all duct connections/ joints are properly checked


Awkward position, Caught into/
Electric shock,Short circuit,fall from Physical injury,Bodily prior to testing,make markings on connection/joints for
between, pointed parts, Struck by
Light testing heights,eye strain,fall of
materials, electrical power
injury,company reputation, A identification in case a leak occurred,coordinate to EPPI 2 2 4 2 N
materials/equipments. damage to property. facility prior to conducting testing,provide two way radio for
interruption. Provide all necessary testing files/documents prior to
easy communication/coordination. buddy system.
conduct testing, coordinate to all affected factory
systems in charge. Conduct KY meeting prior to work
start, designate all members accordingly and discuss
their role. Provide necessary/special permits for
Make sure all pipe joints are properly checked prior to testing. Maintain physical distancing.
Physical injury, company testing,make markings on welded joints for identification in
9 Testing and Commissioning Water flooding to EPPI factory due to
Leak testing water surge,water leakage
leaks, Caught/struck by pipe
reputation,damage to A case leak occurred,coordinate to EPPI facility prior to 2 2 4 2 N
property, first aid. conducting testing,provide two way radio for easy
communication/coordination. buddy system.

SPCI-EHS-FRM-062 Rev.00 (2020.05.15)


SHIMIZU PHILIPPINE CONTRACTORS INC. Reference No.:

5f King's Court Building 1, 2129 Chino Roces Ave., Makati City Project Name: EPPI Misc Project

Tel. No. (02) 811-2981 Fax No. (02) 811-2985 HIRAC Revision No.: 0

HAZARD IDENTIFICATION RISK ASSESSMENT AND CONTOL


Shimizu Philippine Contractors, Inc. November 20, 2020
Contractor : Date Prepared:
Unfit Area Construction Date Approved:
Work Activity
EPPI F3 2FL
Location
Mark James Castaneda/Rachelle Ann Sonon
Edwin Quesea/ Construction Manager/ Prepared by: (REVIEW TEAM)

(Name/ Designation/ Signature) (Name/ Designation/ Signature)


Approved by :
** LEGEND
4- HIGH : Death/ Fatality or Permanent Disability and Significant Environmental Damage Sustained > 1 Year 4- High/ Very Likely/ Very Frequent RISK SCORE & RISK 9-16 4 High
SEVERITY LEVEL LIKELIHOOD LEVEL
3- MEDIUM : Hospitalized for more than 24Hrs. Or 4Days or more Lost workdays and Significant Environmental Damage Sustained < 1 Year 3- Medium/ Likely/ Common Occurrence LEVEL 6-8 3 Medium
2- LOW : First aid treatment or 3Days or less Lost workdays and Localized minor environmental impact 2- Low/ Unlikely/ Rare Occurrence 3-4 2 Low
1- EXTREMELY LOW : First aid treatment not required and Insignificant environmental impact 1- Extremely Low/ Rare Unlikely 1-2 1 Extremely Low

Hazard & Risk Identifications Risk Controls Risk Assessment after Controls Additional Risk Controls
Activities

Significance Level
Occurrence

Likelihood
Site Check

Site Check
Risk Score

Risk Level
Condition

Severity
9 Testing and Commissioning
S/N Hazards/ Aspects RISK Impacts A: Abnormal Existing Controls Measures Additional Control Measures
Main Sub-activities
N: Normal
E: Emergency

Conduct KY meeting prior to work start, discuss to all


Coordinate to EPPI in charge and SPCI in charge prior to
members the works to be done and make sure all
Water flooding to EPPI factory due to Physical injury, company flushing, provide sufficient bucket/drum to hold the flushed
members are fit for the job,designate all members
System Flushing water surge,water leakage leaks,caught/struck by valve due to reputation,damage to A water,use of two way radio for easy 2 2 4 2 N accordingly. Provide additional bucket/drum in case of
flushing. property, first aid. coordination/communication during flushing to avoid over
overflow of water from flushing. Maintain physical
surge of water. Buddy system.
distancing.

SPCI-EHS-FRM-062 Rev.00 (2020.05.15)


SHIMIZU PHILIPPINE CONTRACTORS INC. Reference No.:

5f King's Court Building 1, 2129 Chino Roces Ave., Makati City Project Name: EPPI Misc Project

Tel. No. (02) 811-2981 Fax No. (02) 811-2985 HIRAC Revision No.: 0

HAZARD IDENTIFICATION RISK ASSESSMENT AND CONTOL


Shimizu Philippine Contractors, Inc. November 20, 2020
Contractor : Date Prepared:
Unfit Area Construction Date Approved:
Work Activity
EPPI F3 2FL
Location
Mark James Castaneda/Rachelle Ann Sonon
Edwin Quesea/ Construction Manager/ Prepared by: (REVIEW TEAM)

(Name/ Designation/ Signature) (Name/ Designation/ Signature)


Approved by :
** LEGEND
4- HIGH : Death/ Fatality or Permanent Disability and Significant Environmental Damage Sustained > 1 Year 4- High/ Very Likely/ Very Frequent RISK SCORE & RISK 9-16 4 High
SEVERITY LEVEL LIKELIHOOD LEVEL
3- MEDIUM : Hospitalized for more than 24Hrs. Or 4Days or more Lost workdays and Significant Environmental Damage Sustained < 1 Year 3- Medium/ Likely/ Common Occurrence LEVEL 6-8 3 Medium
2- LOW : First aid treatment or 3Days or less Lost workdays and Localized minor environmental impact 2- Low/ Unlikely/ Rare Occurrence 3-4 2 Low
1- EXTREMELY LOW : First aid treatment not required and Insignificant environmental impact 1- Extremely Low/ Rare Unlikely 1-2 1 Extremely Low

Hazard & Risk Identifications Risk Controls Risk Assessment after Controls Additional Risk Controls
Activities

Significance Level
Occurrence

Likelihood
Site Check

Site Check
Risk Score

Risk Level
Condition

Severity
S/N Hazards/ Aspects RISK Impacts A: Abnormal Existing Controls Measures Additional Control Measures
Main Sub-activities
N: Normal
E: Emergency

Ensure the proper handling of materials, use lifting aids as


Provide signage and barricade at temporary staging of
necessary, Use of proper PPE during activity. Perform with
Hauling out of materials Moving equipment Hit & struck by Physical injury E
buddy system, do "STOP & Go" during hauling and control
2 3 6 3 Y material before it is return for storage. Maintain
physical distancing.
traffic coordination going down and out the factory.

11 Housekeeping

Remind workers to complete their daily activities must


Obstruction on the access way area / Potential accident to equipment / Ensure workers conduct clean up before, during & after
Unnecessary materials / debris
poor housekeeping workers passing thru
Physical injury A
activity
1 2 2 1 N be conduct housekeeping and acknowledge by SPCI
staff. Maintain physical distancing.

SPCI-EHS-FRM-062 Rev.00 (2020.05.15)


SHIMIZU COVID-19 COMMUNICATION FLOW CHART
WITHOUT JAPANESE
REPORTING OF
SUSPECTED CASE SPCI HEAD OFFICE
(02) 811-2981
SUSPECTED ANDREW VENTULAN
General Manager SPCI-EPPI SITE OFFICE
COVID-19 0917-812-6348
PATIENT 0918-902-7634

EPPI TRUNKLINE
EPPI MANAGEMENT
043-981-2000
LAWRENCE CALALO EMERGENCY HOTLINE
MA.MORENA D. TADAS Fac. Supervisor LOCAL LINE 1111
Nurse 0917-504-4476
0998-841-6306 EDWIN QUESEA
Const. Manager JOEL GUADINES
MARK JAMES CASTANEDA 0998-966-7341 Safety Manager
Safety Officer 0917—576-0448
0998-966-7331 RHODA NATIVIDAD
Admin Manager
RACHELLE SONON 0918-911-7876
Safety Officer
0920-910-4985

LIPA CITY HEALTH


OFFICE
(043) 981 -2014
0917-389-8051
OTHER EMERGENCY LINES:

If contact person is not METRO LIPA MEDICAL CENTER


available during the (043) 756-0549
LIMA TECHNOLOGY LIPA MEDIX MEDICAL CENTER
course of accident
CENTER OFFICE BRGY.BUGTONG NA PULO (043) 756-2342
inform the next person (043) 981-4444 HEALTH CENTER MARY MEDIATRIX MEDICAL
avaiable indicated on CENTER
the emergency line. (043) 773-6800
AS OF MAY 27,2020
SHIMIZU PHILIIPNES CONTRACTORS INC .
5F King’s Court Building 1, 2129 Chino Roces Ave., Makati City
Tel. No. (02) 811 2981 Fax No. (02) 8112985

CLIENT/VISITOR CONTACT TRACING FORM


Full Name (Last,Given,Middle): Date of Visit (MM/DD/YY):
Complete Current Address (House No.,St.Brgy.,Municipality/City,Province):

Time of Visit:
Mobile/Phone Number:
Seating/Table No/Location:
E-mail Address:
I hereby authorize Shimizu Philippines Contractors, Inc., to collect and process the data indicated herein for the purpose of contact tracing effecting control of the
COVID-19 transmission. I understand that my personal information is protected by RA 10173, Data Privacy Act of 2012 and that this form will be destroyed after
30 days from the date of accomplishment, following the National Archives of the Philippines protocol.

_____________
Signature/Lagda

SHIMIZU PHILIIPNES CONTRACTORS INC .


5F King’s Court Building 1, 2129 Chino Roces Ave., Makati City
Tel. No. (02) 811 2981 Fax No. (02) 8112985

CLIENT/VISITOR CONTACT TRACING FORM


Full Name (Last,Given,Middle): Date of Visit (MM/DD/YY):
Complete Current Address (House No.,St.Brgy.,Municipality/City,Province):

Time of Visit:
Mobile/Phone Number:
Seating/Table No/Location:
E-mail Address:
I hereby authorize Shimizu Philippines Contractors, Inc., to collect and process the data indicated herein for the purpose of contact tracing effecting control of the
COVID-19 transmission. I understand that my personal information is protected by RA 10173, Data Privacy Act of 2012 and that this form will be destroyed after
30 days from the date of accomplishment, following the National Archives of the Philippines protocol.

_____________
Signature/Lagda

SHIMIZU PHILIIPNES CONTRACTORS INC .


5F King’s Court Building 1, 2129 Chino Roces Ave., Makati City
Tel. No. (02) 811 2981 Fax No. (02) 8112985

CLIENT/VISITOR CONTACT TRACING FORM


Full Name (Last,Given,Middle): Date of Visit (MM/DD/YY):
Complete Current Address (House No.,St.Brgy.,Municipality/City,Province):

Time of Visit:
Mobile/Phone Number:
Seating/Table No/Location:
E-mail Address:
I hereby authorize Shimizu Philippines Contractors, Inc., to collect and process the data indicated herein for the purpose of contact tracing effecting control of the
COVID-19 transmission. I understand that my personal information is protected by RA 10173, Data Privacy Act of 2012 and that this form will be destroyed after
30 days from the date of accomplishment, following the National Archives of the Philippines protocol.

_____________
Signature/Lagda

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