SAFE WORK METHOD STATEMENT DOCUMENT

Document Title (to be completed by the Contractor / Service Provider

Project: Lot 349 SWMS No: AJ 0002
This SWMS will be reviewed: 17th July 2017____ (Date)
SWMS Title: Wash Trough 6 months maximum OR earlier if conditions and/or circumstances
change that introduce new hazard/s.
Contractor / Service Provider: Aneka Jaringan Sdn Bhd
Document Status (to be completed by MBSB)
Rev Contractor MBSB MBSB
Date Comments
No review by review by verification by

MBSB Review, Verification & Endorsement

REVIEW
I have reviewed all aspects of this SWMS and am satisfied to the best of my knowledge that it meets all MBSB acceptance criteria.

Package Manager / Engineer : …………..……………………………….….... Signed: ……………………………… Date: ….…/….…/….…

VERIFICATION
I have verified all aspects of this SWMS and am satisfied to the best of my knowledge that it meets all MBSB acceptance criteria.

ESH Mgr / SHO : ………………………………………………………………. Signed: ……………………………… Date: ….…/….…/….…

ENDORSEMENT
I have verified all aspects of this SWMS and am satisfied to the best of my knowledge that it meets all MBSB acceptance criteria.

Project / Construction Leader : ………………………………………………… Signed: ……………………………… Date: ….…/….…/….…

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A SWMS REVIEW CHECKLIST (to be completed by MBSB)
NOTE:
 Each Contractor / Service Provider, before commencing work, must provide written Safe Work Method Statement/s (SWMS) for the work to be
carried out. The following checklist is to be completed and reviewed by MBSB, and assessed to have met the MBSB acceptance criteria in
compliance with the requirements outlined in the checklist and any relevant ES&H Legislation, Codes and Specifications.
 This SWMS must be reviewed on a regular basis. When new information on ES&H risks surface, changes occur or after any inspection, incident /
accident that impact on the agreed method of work, the SWMS must be revised accordingly.
Section 1: Compliance Checklist
Check
SWMS Criteria Remarks
Yes No
1. Sets out step by step how the work activity will be carried out.
2. Identifies the aspects/hazards associated with each step of the work activity.
3. Assesses the impacts / risks associated with each step of the work activity.
4. Defines the controls to manage risks associated with each step of the work activity based
on the hierarchy of controls – Eliminate, Substitute, Isolate, Engineer, Administrate and
PPE.
5. Provides a description of the plant / equipment that will be used in carrying out the work
activity (including equipment maintenance and inspection requirements, certification by
qualified person and / or registration, etc.).
6. Describes the qualifications and training of personnel carrying out the work activity,
including supervisors’ experience, competency, licenses, operators’ certification, etc.
7. Refers to and confirms compliance with relevant ES&H Legislation, Standards, Codes,
Regulations and / or MBSB ES&H Requirements.
8. Includes design requirements, engineered details or certification for both temporary and
permanent structures, platforms or access ways / ladders.
9. Where PPE is nominated, the type of PPE is specifically listed and when it is required.
10. Defines who is responsible to ensure that the work activity is monitored and carried out in
accordance with the SWMS.
11. Defines the process and frequency of reviews and methods for ensuring the work
complies with the SWMS controls.
12. Identifies where any Contractor / Service Provider will be used, who is responsible to
monitor and supervise the works, and how impacts/hazards arising from interaction
between trades will be communicated and managed (e.g. induction into more than 1
SWMS).
13. For complex or high risk work activities (where appropriate), uses photos / diagrams /
sketches / summary to enhance the SWMS.
14. Includes the name and signature of the person who developed the SWMS, a current date
and revision number.
15. The SWMS includes specific ES&H controls for key high risk activities.

Where an exclusion zone is required, the SWMS must clearly state the detail of the required exclusion zone,
including the person responsible for implementation and supervision.

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B APPLICATION (to be completed by Contractor / Service Provider)
Section 1: Scope of Works
Tasks / Activities:

Work Location (Attach Site Plan): Refer Attachments Duration: From 18/01/2017 (Date) to 18/02/2017 (Date)

Remarks:
- Nil

Section 2: Plant / Machinery / Equipment (Attach Inspection Certificates)

Type of Plant / Machinery / Equipment Is this equipment inspected? Remarks
1 Excavator AJ 04 BKU 3276 Yes No

2 Yes No

3 Yes No

4 Yes No

5 Yes No

6 Yes No

7 Yes No

8 Yes No

Section 3: Key Personnel / Qualified Persons (Attach Training Qualification Certificates)

Name Appointment / Designation Remarks
1 Khoo Teok Seng Excavator Operator

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C RISK ASSESSMENT (to be completed by Contractor / Service Provider)

Section 1: General Information

PREPARED BY: REVIEWED / APPROVED BY:

Name: Jeganathan Nair Signed: Name: Kevin Che Kam Seng Signed:

Designation: Safety and Health Officer Date: ……20…. /…1……. /……17…. Designation: Project Manager Date: …20……. /……1…. /…17…….
Applicable Environment, Safety & Health (ES&H)
Risk Assessment Team Approved Code of Practice (COP) and/or CSR
Legislation
Name Designation Signature

 Chan Ten Song  Construction Manager  ________________________

 Ayavu A/L Nagappan
 ________________________
 ________________________
 ________________________
 ________________________
 Senior Supervisor
 ________________________
 ________________________
 ________________________
 ________________________
 ________________________
 ________________________ FMA- Act139, OSHA- Act514 & DOSH Regulations
 ________________________
 ________________________
 ________________________

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Consequence Table
Very Small - 1 Small - 2 Medium - 3 Large - 4 Very Large - 5
Unlikely injury or ill-health, or Offsite medical treatment. Lost Time Injury or Permanently Disabling Injury Fatality due to Injury or
onsite first aid treatment. Onsite and/or offsite Occupational Illness. or Occupational Illness. Occupational Disease.
Onsite environmental impact environmental damage Onsite and/or offsite Onsite and/or offsite Evacuation of employees
IMPACT with straightforward clean-up taking 0-3 months to clean environmental damage environmental damage due to threat of fatality.
or remedy with available site up or remedy. taking 3-6 months to clean taking 6-12 months to clean Irreversible onsite and/or off-
equipment and controls. No regulatory notification up or remedy. up or remedy. site environmental damage;
No regulatory notification required. Regulatory notification may Regulatory notification or clean-up or remedy from
required. Some community concerns be required. compulsory but no public damage lasting > 12
raised but no impact. Limited impact on investigation likely. months.
community with minor Major impact on local Regulatory notification
concerns raised. community leads to compulsory with public
LIKELIHOOD community protests. investigation likely.
Impact on local community
leads to community outrage.
5 (Very High) - A Very High Likelihood:
1) Almost certain to occur; 2) Almost certain to re-occur due to past trends Minor Moderate Significant Significant Critical
from reported incidents / issues; 3) Quantified very high exposure to the risk
without any controls in place.
4 (High) - A High Likelihood:
1) Strong evidence to likely occur; 2) Highly likely to re-occur due to past Minor Minor Moderate Significant Significant
trends from reported incidents / issues; 3) Quantified high exposure to the risk
without any controls in place.
3 (Medium) - A Medium Likelihood:
1) May occur or known to occur; 2) Infrequent number and regularity of Minor Minor Moderate Moderate Significant
reported incidents / issues; 3) Quantified moderate exposure to the risk without
any controls in place.
2 (Low) - A Low Likelihood:
1) Could occur at some but not expected; 2) One or two reported incidents / Negligible Minor Minor Minor Moderate
issues to date; 3) Quantified low exposure to the risk without any controls in
place.
1 (Very Low) - A Very Low Likelihood:
1) Highly unlikely to occur; 2) No evidence of reported incidents / issues in the Negligible Negligible Minor Minor Minor
past; 3) No quantified and known exposure to the risk without controls in place.

Risk Index Action

Critical Operation not permissible; management attention and consultation with HOD Safety & Health required.
Significant Operation not permissible; risk must be reduced by all possible means (not by interim risk control measures); management attention and consultation with HOD Safety & Health required.
Further risk reduction required where possible; remedial action to be taken immediately; 7 day (max) review needed to ensure risk level assigned is accurate and does not increase over time;
Moderate
management attention required.
Risk tolerable subject to demonstration that risk level is as low as reasonably practicable; remedial action to be taken at appropriate time to further reduce risk level; 30 day (max) review needed to
Minor
ensure risk level assigned is accurate and does not increase over time.
Negligible Risk acceptable; discretionary remedial action to be taken.

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Section 2: Risk Assessment
Unless stated otherwise in this document, ALL WORKERS, will wear (at all times during this activity):-
MANDATORY PPE:- Safety Helmet, Safety Shoes (High Ankle), Safety Glasses, High Visibility Vest & Gloves.

NO Job Steps Hazard Risk Risk Control / Control Measures L I Risk Accountable Person
Rating
1 Delivery of Reinforcement and Formwork, Lorry Crane Uncontrolled Major injury due to Designated & Trained Traffic controllers to be assigned. 2 4 Moderate Supervisor
to Work Site Traffic/Vehicle Traffic controller to be equipped with whistle, high visibility clothing & batons/ flags
contact with moving
Movement Proper signage to be placed to warn the public
vehicles or machineries

2 Unload Reinforcement, Formwork Material Dropping Major Injury due to material Minimum 2 workers to unload materials from low levels 2 3 Site Supervisor
dropping Ensure workers not lifting weight greater than 20kg on each lift

3 Mobilization of Excavator to excavation zones Uneven access and Excavator toppling over and Ground must be checked for level and stability by competent person 2 4 Site Supervisor/Excavator
unstable ground Major Injury due to hit Work zone to be barricaded and no workers to be in the barricaded zone Operator

4 Excavation and Cart Away of spoil Uncontrolled swinging Major Injury due to hit by Excavator shall only be operated with the guide of banks men 2 4 Site Supervisor and banks men
of the bucket swinging boom/bucket Work area must be fully barricaded to prevent unauthorised entry

5 Levelling of excavation, installation of base rebar and Concrete burns, Injury Minor injury to hands and feet, Wear proper PPE Site Supervisor
concrete pouring due to rebar Trips and Fell Ensure timber walkway to prevent trips and falls
installation, Poor
housekeeping

6 Installation of formwork and rebar for wash trough Material droppings, Major injury due to collapse of Minimum two workers handling the installation of formwork, Concreting done from Site Supervisor and Concrete
walls and concreting Poor housekeeping and formwork, Trip and fell outside by competent pump operator only Pump Operator
collapse of formwork

7 Delivery and Installation of steel beams and metal Material droppings, Major injury due to contact with To use competent operator 1 4 Lifting Supervisor
grille and pump and gen sets Unsafe lorry crane and load or machinery during lifting Crane to be inspected & with valid fitness certificates
lifting operation operation Crane to use 1m x 1m steel plate for out riggers
Out riggers to be fully extended
Wheels to be slightly above the ground
Crane to be balanced -refer level meter / water leveller on the body
Barricade the work area
Unsafe Slinging Major injury due to material fall To use competent rigger 1 4 Lifting Supervisor
To use tested and certified slings & lifting gears
To lift using designated lifting points only
No overhead lifting or standing under suspended load

D SAFE WORK PROCEDURES (to be completed by Contractor / Service Provider)

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Section 1: Safe Work Procedures
Unless stated otherwise in this document, ALL WORKERS, will wear (at all times during this activity):-
MANDATORY PPE:- Safety Helmet, Safety Shoes (High Ankle), Safety Glasses, High Visibility Vest & Gloves.
Job Steps / Sequence Of Works
- Safety PreStart
Delivery of Reinforcement and Formwork to
Work Site
Unload Reinforcement, Formwork
Mobilization of Excavator to excavation zones
Excavation and Cart Away of spoil
- Levelling of excavation, installation of base
rebar and concrete pouring
Installation of formwork and rebar for wash trough
walls and concreting
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Safe Work Procedures
Additional Equipment / Hold Point
WHO – WHAT – HOW - WHEN Permits Required
PPE Responsible
(include images / sketches if required for further clarity)
All workers and operators need to be briefed into this SWMS and signatures recorded prior
to commence work on daily basis Safety PreStart Safety
Any deviation of activity/method of work from this SWMS needs to be discussed and Forms Personnel
approval obtained from MBSB. Work need to be stopped until the approval is obtained.
Ensure a designated and trained Traffic Controller assigned at the entrance to manage
trucks / machineries coming into site and the traffic at public road. Site
Traffic controller to be equipped with whistle, high visibility clothing & traffic control batons / Supervisor
flags
Work area needs to be barricaded to prevent unauthorised entry using hard barriers
Site
Truck needs to be level and in stable condition
Supervisor
Each item to be unloaded to have minimum 2 workers
Work area needs to be barricaded to prevent unauthorised entry using hard barriers
Site
Excavator needs to be in level and stable condition
Supervisor
Workers need to be outside the barricaded area at all time
Ensure excavator beacon light is functioning at all time
Site
Spoil is located at minimum 1 meter away from the edge of pit
Supervisor
Excavated pit to be barricaded with hard barriers and ladders installed for access into pit
At least two workers to transfer materials from outside pit to inside pit
Two workers to install the rebar and do housekeeping inside the pit
Ensure designated and trained traffic controller assigned at the entrance to guide the
concrete mixer truck to work zone
Site
Trucks needs to be parked on levelled and stable ground condition
Supervisor
Truck mixer operator to manage concrete discharge into pit
No workers shall be allowed inside the pit during concreting process
Workers then allowed to go inside the pit for concrete levelling works shall wear proper
rubber boots with steel toe and rubber gloves
At least two workers to transfer materials from outside pit to inside pit Site
Two workers to install the rebar and formwork and do housekeeping inside the pit Supervisor
Ensure proper strutting of formwork to be checked and confirmed by competent personnel
Ensure designated and trained traffic controller assigned at the entrance to guide the
concrete mixer truck to work zone
Trucks needs to be parked on levelled and stable ground condition
Truck mixer operator to manage concrete discharge into pit wall formwork
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Delivery and Installation of steel beams and
metal grille and pump and gen sets by lorry
crane
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The pit to be covered with timber working platform to allow workers access on top
Workers shall wear proper rubber boots with steel toe and rubber gloves
Lifting supervisor with the truck mounted crane operator to check the crane and all slings and
lifting equipment / lifting gears. Inspection to be recorded and kept at work area and filed
upon completion of work.
Work area to be barricaded to prevent unauthorised entry using hard barriers.
Outriggers to be fully extended and steel plates used as padding.
Truck to be levelled and stable condition.
Load being lifted should not be more than 80% of the crane’s maximum capacity along the
lifting radius and unloading point (locations to be predetermined and verified by the Lifting Lifting
Crane and Lifting
supervisor to confirm this) Supervisor
Equipment Inspection
and Incharge
Lifting of material then shall be done by competent operator (competencies to be verified Checklist
Person
prior to lifting by the Lifting Supervisor) of lorry crane and shall be assisted by lifting
supervisor and 2 riggers.
Loads to be hooked to a designated and engineered lifting point only.
Total load distribution to the slings should not be more than 80% of its capacity. Total loading
to the sling need to be also based on the number of slings and method of slinging.
All Lifting hooks must be fitted with safety latch.
To ensure the workers are standing behind the barriers doing this activity
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Section 2: Instruction & Communication
This Safe Work Method Statement has been developed through consultation with the following crew members and has been instructed through induction, read and understood, and signed by all employees undertaking
the works.
Name Designation Remarks / Comments Signature Date
1 Kevin Che Kam Seng Project Manager
2 Chan Ten Song Construction Manager

Section 3: Verification
I have provided, accurate and sufficient information and instructions pertaining to this Safe Work Method Statement - the aspects / hazards associated with each work process and activity, the type of potential impact,
incident or accident, and the risk controls / practicable measures to be taken in the course of work and during an emergency - to ensure its / their safe undertaking.

Instructed by (print name): …………………………………………………………………….. Signed: ………………………………………….. Date: …..../…...../……… Time: .............. am / pm

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