Safe Work Method Statement

(Small Projects)

Description of the Task / Replace Tension Spring on Rollershutter Work Order or

Activity to be performed Door Purchase Order PO4500721652
Number
Standard Bank
Contract / Project Name Project Number
Standard Bank
MIS505080
Service Provider Name Vendor Number
Mushi Integrated Systems
3 Simmonds Street Start Date / Time 11/04/2022
Site Location /Address
Finish Date / Time 11/04/2022
Name and Surname of the Peet Prinsloo Telephone Number 073 725 6323
Company Appointed Section Office:
16. 1 – Owner or Section Cell Phone:
16.2
Name and Surname of the Darren Pigden Telephone Number 061 400 9899
Manager or Supervisor Office:
overseeing the work to be Cell Phone:
performed on site
Name and Surname of the Telephone Number 073 725 6323
SHE Officer / Specialist Peet Prinsloo Office:
Cell Phone:
Personnel Involved Name and ID No. Role / Trade Name and ID No. Role / Trade
(Copy of the ID No. to be Manager
attached, if required for Peet
Access to site permit) 6204065049084
Darren Technician
9612095046085

Document No.: Bidvest Facilities Company Restricted

SharePoint Ver.: Management (Pty) Ltd Document No.: GOV0-4-504
Date: SharePoint Ver.: 1.0
Page 1 of 9
 Safe Work Method Statement
(Small Projects)

Risk Rating Property /

Health, Safety Environmental Matrix
Methodology Business Lost
Catastrophic, Fatality, Loss limb 80% of the damage is 1 day or more 3
3 6 9
irreversible
Severity Lost Time Injury 60% of the damage is 1 day or less 2
2 4 6
irreversible
First Aid Treatment / Near Miss Fully reversible 1 Hour or less 1 1 2 3
Acceptable Risk High Risk (4-9) – Supervision, Competent Workers, Safe Working Procedure, 1 Unlikely 2 Likely 3Certain
Control Level Medium Risk (2-3)– Supervision, Competent Workers and Awareness Probability
Low Risk (1) – Tool Box Talk

Sequence of events (included sketches if required)

Potential Hazard Appropriate Controls

Probability (P)
Risk Rating (S
Sequence No:
Activity / Task

Severity (S)
Job Step/Task Against each step list the [Engineering, Administrative, PPE /
PPW and Training]
Describe the steps required to potential hazards that could Responsibility
List the control measure required to
perform the task in the cause injury/damage to
eliminate or minimise the risk of injury
sequence they are carried out property when the task step
arising from the identified hazard
is performed.
Close the door None 0 0 0 None Darren
1

2 Remove dust and protection Sharp edges- fingers can 2 1 2 Wear Gloves Darren
cover get cut Wear dust mask
Disengage Motordrive Rollershutter door can 9 5 4 Make sure no one is standing under Darren
3 collapse and injur people 5 the rollershutter door whilst
standing underneath it. disengaging the motordrive
Release doormat from shaft Sharp edges fingers can 2 1 2 Wear gloves Darren
4 get cut

Document No.: Bidvest Facilities Company Restricted

SharePoint Ver.: Management (Pty) Ltd Document No.: GOV0-4-504
Date: SharePoint Ver.: 1.0
Page 2 of 9
 Safe Work Method Statement
(Small Projects)

Undo mounting brackets on Sharp edges- fingers can 2 1 2 Wear Gloves Darren
5 shaft get cut

Remove shaft from bracket Heavy weight- can fall onto 2 1 2 Wear safety Boots Darren
6 feet Make sure 2 or more people are
removing shaft

Pre-Requests before work

Document No.: Bidvest Facilities Company Restricted

SharePoint Ver.: Management (Pty) Ltd Document No.: GOV0-4-504
Date: SharePoint Ver.: 1.0
Page 3 of 9
 Safe Work Method Statement
(Small Projects)

commences on site
Permit Required (Mark the item x Hot Work Working at Heights Confined Electrical/ Excavations
with an “X” if applicable) Space Mechanical
Lockout
Vehicles and mobile plant
(Registration Numbers)
Key Materials to be used
Tension spring
Key Equipment to be used
(Access platforms / winches / ladders, ladders
MEWP’s, etc.)
Key Hand Tools & Electrical Drill (if necessary)
Tools to be used Screw driver
Key Personnel Protective Safety boots
Equipment to be worn / Gloves
utilised Dust mask
Incident Management (Mark x First Aid Kit available on site Spillage Kit available on site
the item with an “X” if applicable)
Hazardous Substances to be N/A
used (Attach MSDS)
Safety signage and (i.e. Scaffolding Safe to Use Sign, Unauthorised Entry, Men at work, Orange Netting or Barricading tape, Hording, etc.)
Barricading to be used
Men at work Sign
Statutory required Training (i.e. Scaffolding Erectors & Inspectors, MEWP Operators, Rope Access and Fall Prevention, etc.)
Certificates (Attach records)

Method of Access and (i.e. Ladders, Scaffold, Trestles, MEWP, Rope Access, etc.)
Egress to the area:
(i.e. Fall Protection Systems / Guard Rails / Toe Boards / Safety Mesh, Life Lines; etc.)
Fall Protection Measures
(Where work at height cannot be
eliminated – consider both Personnel
and materials)
Attached the following items Contractual Scope of Work (Technical Specification) X Yes No N/A Available on SHE File

Document No.: Bidvest Facilities Company Restricted

SharePoint Ver.: Management (Pty) Ltd Document No.: GOV0-4-504
Date: SharePoint Ver.: 1.0
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 Safe Work Method Statement
(Small Projects)

(“X” – Compulsory / Notification of Construction Work (Construction Regulation x Yes No N/A Available on SHE File
Mandatory item) 4)
Mandatory Agreement Signed (Section 37.2 Agreement) X Yes No N/A Available in SHE File
Public Liability Insurance Cover X Yes No N/A Verified at Site
Handover. Recorded in
Site Handover Meeting
Minutes
Valid Letter of Good Standing X Yes No N/A Available in SHE File

Task Based Risk Assessment approved by the Project X Yes No N/A Method Statement &
Risk Assessment
Manager Document
Safe Working Procedures e.g. LOTO, Hot Work, Working at X Yes No N/A Available in SHE File
Heights, Mast Recovery, etc.)
SHE Induction X Yes No N/A Method Statement &
Risk Assessment
Document
Legal Appointments (Section 16,2; Construction Supervisor / X Yes No N/A Available in SHE File
Manager; Risk Assessor; Fall Protection Planner; First Aider etc.,)
Technical Staff Competency Records e.g. HVAC, X Yes No N/A Available in SHE File
Electrical, Fire & Access, Plumbing, Carpentry, Welding, etc.
Statutory Training Certificates E.g. Erectors, Yes No N/A Available in SHE File
Inspectors, MEWP Operators, Fall prevention and fall
arrest equipment certificates, etc.
Fall Protection Plan (Construction Regulation 10) Yes No N/A Available in SHE File
Rescue Plan (Construction Regulation 10) Yes No N/A Available in SHE File
Fall prevention and fall arrest equipment Inspection Yes No N/A Available in SHE File
Registers (Include unique numbering)
Material Safety Data Sheets and Training Records Yes No N/A Available in SHE File
Waste Management Register Yes No N/A Available in SHE File
Sketches Yes No N/A Available in SHE File
Certificates of specialised equipment (e.g. Lifting Yes No N/A Available in SHE File
devices, Slings, etc.
Copies of ID’s / Passport for security access to site Yes No N/A Available in SHE File
Medical Certificates of fitness (Construction Regulation 7, 10, Yes No N/A Available in SHE File
22, 23, Annexure 3, Hazardous Chemical Substances, etc.)

Document No.: Bidvest Facilities Company Restricted

SharePoint Ver.: Management (Pty) Ltd Document No.: GOV0-4-504
Date: SharePoint Ver.: 1.0
Page 5 of 9
 Safe Work Method Statement
(Small Projects)

Masts Recovery: Comply with Construction Regulation 7, 8, 9, Yes No N/A Available in SHE File
10, 11, 12, 14, 16, 18, 22, 23, 24, 27, 29, 30, 33, etc .
Other:

DOCUMENT APPROVAL
Contractor Authorised Person Role / Title Date Signature Revision
Technician 11/04/22
Darren Pigden

Approval Bidvest Facilities Management Authority Name Role / Title Date Signature

Approval Bidvest Facilities Management Authority Name Role / Title Date Signature

Document No.: Bidvest Facilities Company Restricted

SharePoint Ver.: Management (Pty) Ltd Document No.: GOV0-4-504
Date: SharePoint Ver.: 1.0
Page 6 of 9
 Safe Work Method Statement
(Small Projects)

SAFE WORK METHOD STATEMENT BRIEFING AND INSPECTION RECORD

Heading Replace tension spring Work Order or Purchase PO4500721658
(Description of the Activity / Task) Order Number
Date 11/04/2022 Start Time
End Tame
Authorised Person on site Darren Position Technician
Briefing delivered by Position

We (the undersigned) have read and understood the attached Method Statement / Risk Assessment and will comply with the specific
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 / Risk Assessment.
Name (Print) Signature Name (Print) Signature

Darren

Register and Inspection of Hand Tools, Ladders, Portable Electrical Equipment and PPE
Legend: Yes – Safe to use, No- Unsafe to use (Prohibited)
Tools, Ladders & Equipment Personal Protective Equipment (PPE)
Description ID Nr. Yes No Name Description Yes No

Document No.: Bidvest Facilities Company Restricted

SharePoint Ver.: Management (Pty) Ltd Document No.: GOV0-4-504
Date: SharePoint Ver.: 1.0
Page 7 of 9
 Safe Work Method Statement
(Small Projects)

Company Authority Name

I confirm that I understand the risks described above and that I am familiar with the health, safety and environmental precautions in place
Name Designation Signature Date

Document No.: Bidvest Facilities Company Restricted

SharePoint Ver.: Management (Pty) Ltd Document No.: GOV0-4-504
Date: SharePoint Ver.: 1.0
Page 8 of 9
 Safe Work Method Statement
(Small Projects)

Bidvest Facilities Management Authority Name

Comments:

I confirm to the best of my knowledge, that the above information is correct and that all the health, safety and environmental precautions have
been taken as indicated
Name Designation Signature Date

Bidvest Facilities Management or Customer Sign-off

Comments:

I, the undersigned, do hereby confirm to the best of my knowledge, that the work was completed satisfactory
Name Designation Signature Date

Document No.: Bidvest Facilities Company Restricted

SharePoint Ver.: Management (Pty) Ltd Document No.: GOV0-4-504
Date: SharePoint Ver.: 1.0
Page 9 of 9