Lesotho Highlands Water Project – Phase II

Contract – Method Statement (MS)

Contractor: Contract No. Contract Name:

Developed by: Date: Signature:

Task name should correspond with the title of the

Task: TRA.
Method Statement No.
Brief description
of activity/work: TRA No.
00
Part 1
SWP / SOP
Ref. Task steps in sequence (If applicable, these should align with any
Exist? Develop? Referen Potential Hazards Controls
# associated SWP/SOP to enable cross-referencing)
(Y/N) (Y/N) ce

 Work areas to be identified

and risks assessed
 Tasks to be identified and
Failure to do DSTI will
risks assessed
Daily Safety Task Instruction (DSTI) should be done every Safety lead to accidents where
1. Y N  Required machinery and
day before the work commences. File hazards could be
identified and controlled. equipment to be identified
and risks assessed
 Risk Assessments to be
reviewed
 Supervisor to ensure that
Not wearing correct PPE. all employees being issued
Personal Protective Equipment. LHWP
Hand and feet injuries. with the required PPE
2-
2. Y N Overall, Safety boots,
SWP1
safety gloves, reflective
6
vest.

3. Offloading rebar from truck. Poor lifting procedure.  All employees must ensure
Injuries, Pinch point and that they do not stand

LHWP2-SHEQ-Form 8.1 Page 1 of 4

Lesotho Highlands Water Project – Phase II

Contract – Method Statement (MS)

below an overhead load

and banks man are to
ensure that the load is
properly balanced and
secure.
 Supervisor to ensure all
workers involved in the
offloading are wearing
hand injuries.
safety gloves and DSTI are
to be conducted.
 Stacking supervisor must
ensure that all offloaded
reinforcing is immediately
demarcated and neatly
stacked to ensure no
protruding steel is on the
outside of the demarcated
area.

 Steel fixers must wear eye

Fixing steel Failure to use correct protection when fixing
4. Y N SOP PPE. steel above their heads to
Hands, eye injuries. prevent eye injuries,

5.

6.

7.

8.

9.

10.

11.

LHWP2-SHEQ-Form 8.1 Page 2 of 4

Lesotho Highlands Water Project – Phase II

Contract – Method Statement (MS)

12.

Part 2
Training, qualifications and experience (other than in SWPs/SOPs) required to
Inspections and tests required
complete this Task

Note: The records of qualifications and experience are held in local files
Engineering certificates/permits/approvals Equipment / Machinery / Tools / Vehicles
Codes of Practice, legislation, standards which apply to this Task
required for this Task required for this Task
Labour Code Order 1992 Approved Method Statement

OSHA 1993

LHWP2 SHEQ Framework

Person(s) responsible for supervising work: (Inspecting and approving work areas, work methods, protective measures, plant, equipment, power tools, etc.)

Name: ________________________________________________________
Position: ___________________________________________________

Name: ________________________________________________________
Position: ___________________________________________________

Note: For a list of names and signatures of staff instructed in this MS see local training records.
Part 3
Contractor Responsible Person - Name Signature Date

LHWP2-SHEQ-Form 8.1 Page 3 of 4

Lesotho Highlands Water Project – Phase II

Contract – Method Statement (MS)

Project Manager ___/___/20___

LHDA Responsible Person - Name Signature Date

Site Supervisor ___/___/20___

LHWP2-SHEQ-Form 8.1 Page 4 of 4