site-specific safety program

Client:

Date Prepared:

Project:

Site Address:

- Contact Information:

Local Address:

Office Telephone:

Contact Names / Position:

Contact Telephone

Contact Mobile Tel

-

Purpose:

The purpose of this method statement is to define the safe methods and procedures to be used by -------

------------ and subcontractor personnel for this noted project places the highest priority on

ensuring full compliance with all applicable safety procedures on every project. While jobsite safety is of paramount importance to on an ethical level, it is also apparent that jobs with the best

overall safety records tend to be the most profitable.

This method statement will apply to all persons associated with the works at the referenced site and to all persons who by nature of their involvement with this project interface directly or indirectly with this work.

Safety Responsibilities

· All persons will;

· All Project Management will ensure;

Competent Person:

The term “competent person” is used in many OSHA standards. The definition of a competent person, by OSHA standards, is one who “is capable of identifying existing and predictable hazards in the surroundings or working conditions which are unsanitary, hazardous, or dangerous to employees, and who has authorization to take prompt corrective measures to eliminate them”. (29 CFR 1926.32(f)). While there are specific standards which require a specially trained individual designated to oversee a specific work practice as a “competent person”, all employees must be trained in hazard recognition techniques and all have the authority to stop work in the event of a hazardous situation.

The activities which a designated and DOCUMENTED competent person according to OSHA standards will be assigned are as follows:

·

Responsible Person

Additionally, assigned “responsible” persons will be assigned for the following activities: 1.

These “Responsible Persons” will have documentation that they possess the training, knowledge, skills and abilities to perform the assigned functions.

Logical Sequence of Task:

1.

SPECIFIC SITE SAFETY RULES:

1.

Schedule:

Proposed Start Date:

Duration:

Working Hours:

Overtime Hours:

Access to Work Area:

Resources Required to Undertake Works:

Contractor, Equipment, Materials:



Inspections / Documentation Required:

· .

Personal Protective Equipment (PPE):

All employees and subcontractor employees will use and wear approved PPE as follows :

·

Disposal of contaminated PPE



First Aid, Emergency and Treatment Arrangements:

1.

Medical Facilities Identified for this Project:

Occupational Clinic Name:

Address:

Telephone:

Working Hours:

~ Map~

Emergency Medical Facilities Identified for this Project:

Emergency Hospital Name:

Address:

Telephone:

Working Hours:

~Map~

Monitoring & Compliance

Monitoring and compliance of the work by ---------

Subject

Required

Specific & detailed information / description required for all questions.

List OSHA Standard Number

Yes

No

Compressed Gas:

N/A

Will cylinders be brought on site?

Are there plans for safe use and storage on site?

Will portable torch sets be required?

(All gas cylinders and welding machines must be left outside of excavations and

long enough leads provided.)

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

Ladders:

N/A

Will ladders be required?

(All ladders – min 300 lb. rating.)

The ladder chosen must be long enough to provide access to the work area without necessitating standing

on the top two steps of a stepladder

or the top three rungs of a straight ladder.

Will fall protection be required? List equipment to be used.

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

Fall Protection, Leading Edge Work & Elevated Surfaces:

N/A

Has a Fall Protection Rescue Plan been developed?

Attach and describe plan.

Will fall protection be required? 100% protection > 6 feet.

Are competent/qualified persons identified to perform system and equipment inspections,

identify hazards, and anchor points as needed?

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

Cranes and Rigging:

N/A

Will crane operations be required?

Have all overhead lines been identified and the locations appropriately communicated?

Will any special lifting devices be needed?

Will any Critical Lifts take place?

Has all rigging equipment been inspected?

Is all equipment appropriate for the task(s)?

Have all required safety inspections been completed?

Will traffic control be provided (pedestrian & vehicular)?

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

Confined Spaces:

N/A

Will any confined space work be performed?

**NOTE: Atmospheric testing must be conducted daily prior to entry into a Confined Space.

Will any Confined Space Entry permits be required?

Have affected personnel been trained for confined space entry?

What equipment will be provided for non-entry rescue?

Will external rescue team services to be used?

Please specify the name of the provider.

Have all entry procedures been provided and documented?

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

Excavations (all soil will be classified as type C):

N/A

Will equipment to be brought on site? Please specify type.

Will any work activities involve excavations greater than four ( 4) feet?

Will a trench box/shoring be needed?

Does fencing/barricade need to be installed?

Daily inspections of excavations, adjacent area and protective systems for evidence that result in cave-in, failure of protective systems, hazardous atmospheres or other hazardous conditions must be conducted before the start of work and as needed throughout the shift. Inspections must be

documented.

What will be the MAXIMUM depth(s) of the excavation(s)/trench(s) be on this project?

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

Mobile Equipment / Powered Industrial Trucks /

Lifts / Booms:

N/A

Will any mobile powered equipment be required? Type to be brought on site?

Will you be using any special attachments? ex. jibs, man lifts, etc.

Are operators trained / certified for operations of equipment?

Is there a plan for fuel transfer/storage or battery changes?

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

Caught-In / Struck-By Hazards:

N/A

Are employees familiar with pinching and crushing

points?

Are employees aware of the hazards associated with overhead loads and swing radius?

Are all vehicles equipped with appropriate back- up alarms, horns and lights?

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

Hand and Power Tools:

N/A

Will all grinders, saws and similar equipment provided with appropriate safety guards?

Are power tools used with proper shields, guards, or attachments, as recommended by the

manufacturer?

Power tools must be equipped with a constant-pressure switch or

control that shuts off the power when pressure is

released.

Will all cord-connected, electrically operated tools and equipment be properly grounded or of the

approved double insulated type?

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

Personal Protective Equipment:

N/A

What type of PPE will be used for this project?

Will any special PPE be required, i.e. respirators? What type?

Have portable eye wash stations been set up on the jobsite?

Has personnel received training for special PPE

requirements? NOTE: Hi Vis clothing is required.

Is there verification of medical respiratory protection clearance submitted / attached?

Will respirators be worn on a voluntary use? (Half mask, paper, etc.)

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

Signs, Signals and Barricades:

N/A

Describe site control measures, especially in high public areas such as playgrounds, parks, etc.

Will perimeter barricades be used?

Will any caution/danger signs be needed?

Will flammable gas/liquid labels be needed? Will material labels be needed? GHS

Will traffic control be provided?

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

Additional Work Permits:

N/A

Will any utility interruption permits be required?

Will Hot Work (welding/cutting/grinding/ soldering/electrical) permits be required?

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

HAZARD COMMUNICATION

N/A

Are all employees trained in Hazard Communication / GHS?

Are all Safety Data Sheets provided and a copy easy to obtain at job site? Where are they located?

Are employees trained to handle/use specific materials?

Does storage and use meet all NFPA, Federal and State Regulations?

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

Hot Work:

N/A

Are hot work activities to be performed?

(Any flame or spark producing task.) Briefly describe.

Will any special PPE be required?

Will fire blankets/protective shields/screens be required?

Are fire watch personnel current with actual training?

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

Flammable Gases / Liquids:

N/A

Will any flammable gases and/or liquids be used?

Have provisions for their storage been made?

Will appropriate containers be utilized? Safety cans are

required.

Are secondary containment and spill kits required?

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

Emergency Preparedness:

N/A

Have the appropriate number of fire extinguishers been identified? Inspections will be performed monthly.

Have emergency phone numbers been identified?

Have adequate security measures been identified?

Has an emergency evacuation plan been developed?

Will emergency responders have easy access if needed?

Subject

Required

Specific & detailed information / description required for all

questions. List OSHA Standard Number

Yes

No

Housekeeping and Waste Management:

N/A

All projects are to be maintained clean, sanitary and orderly.

Is there a plan for waste disposal in place?

Are all characterization, containerization, segregation, storage and disposal

requirements understood?

Is there a plan for water/wastewater discharges in place? Describe or attach plan.

Is there a spill plan in place?

JOB HAZARD ANALYSIS (JHA) – LIST AT LEAST 3 ACTIVITIES

1. Contract Number:

2. Contractor Name:

3. Date prepared:

4. Title/Activity Performed:

5. Start Date

6. Estimated Date of Completion:

7. PRINCIPAL STEPS

8. POTENTIAL HAZARDS

9. RECOMMENDED CONTROLS

· Form and pour columns

·

·

·

·

·

·

10. EQUIPMENT TO BE USED

11. INSPECTION REQUIREMENTS

12. TRAINING REQUIREMENTS





13. Prepared by (Signature and Date):

14. Safety Officer Review (Signature and Date):

15. AHA Discussed at Preparatory Meeting Held On (Signature and Date):

Acknowledgement:

Person Drafting this Method Statement

Name:

Position:

Date:

Acknowledgement of Project Team

I confirm that I have read the above method statement and fully understand the work to be carried

out:

Sign:

Print:

Date:

Sign:

Print:

Date:

Sign:

Print:

Date:

Sign:

Print:

Date:

Sign:

Print:

Date:

Sign:

Print:

Date:

Sign:

Print:

Date:

Sign:

Print:

Date:

Sign:

Print:

Date:

Sign:

Print:

Date:

I CONFIRM THAT THE APPROPRIATE CONTROLS ARE IN PLACE. I HAVE INCLUDED ONLY ACTIVITIES AND CONTROLS THAT ARE RELEVANT TO THIS ASSESSMENT

SIGNATURE OF MANAGER/SUPERVISOR:

…………………………………………………………………

PRINT NAME: DATE:

………………......