Check list for Method Statement:

Method Statement: Temporary Removal of Obstructions in

Construction of STG Pipe Rack Foundations at Block 2
Checked By Contractor
Checked By SEC/LI when
No. Items Before Submitting for
Received
Approval
Name and detail of person from
1 contractor responsible for the supervision Page-4: Paragraph 5
of works.
Brief Description of the work to be
2 carried out. (detail methodology under Page-3: Paragraph 1
item 12)
Detail Program of work showing timing,
3 sequence and order of activities on daily Page-5: Paragraph 7
basis.
Plant and Resource Utilization (Listing
4 daily usage of Plant and Resource for N/A
the period of works.)
Identification of work Area (sketch,
showing operation area, storage area, Attachements: Obstacles @
5 vehicle and plant movement area). If Pipe Rack Foundations, Block
any crane or lifting equipment are used 2 drawing and EA-679403
Jib radius and lifting plan.

6 Access and egress to work area (sketch N/A

indicating boundaries of work area).
Proposed Method of cordoning and
7 N/A
fencing of the work area (sketch).
Provision of access to Plant Operators
8 and pedestrian through the work area if N/A
required (sketch indicating access
routes).
Provision of reduction of noise, dust,
9 N/A
vibration and other pollutions.

10 Provision of protection of existing plant N/A

and installation from damage from
adjacent construction activities (sketch).
Provision of temporary work at the
necessary calculations for shoring of
11 existing foundation, structure adjacent to N/A
construction works (drawings and
calculations sheets).

12 Detailed description of the Methodology Page-5: Paragraph 8

of carrying out the works.
Emergency and safety plan specific to
13 Page-5: Paragraph 6
the work place.
14 Risk assessment Page-5: Paragraph 7

15 Requirement of all the relevant permits. Page-5: Paragraph 7.1

16 Inspection and test plan. Page-7: Paragraph 9

For Contractor: For SEC/LI:

Name: Mr. Tony Witkowski Name:

Date: January 22, 2011 Date:

Signature: Signature: