Safe Work Method Statement

Project Name: ServiceNow Address: Hyderabad

Company Name: Vayucon Systems Pvt. Ltd. Activity/Trade: Unloading and shifting Material through Forklift
Address: B-9, Raheja Mindspace, Hitec City, Hyderabad, TS-81 Office Contact No: Nil
Prepared by: Mr. Raviteja Contact No: 7997598829
Procedure (in steps) Possible Hazards Risk Control Measures Contr Person who will
Rating (Describe what action or procedure will be taken to eliminate or minimise the risk of injury or olled ensure this
(Break the job down into steps. (Identify the hazards associated with each step. Examine each to (See damage. Use the Hierarchy of Controls below as a guide Risk happens
Each step should accomplish some find possibilities that could lead to an accident or potential harm below) 1. Eliminate the Hazard Score
major task and be in logical arising.) 2. Substitute the material or equipment
sequence.) 3. Isolate the hazard
4. Implement Engineering control
5. Implement Administrative control
6. PPE

 Standard Operating Procedures (SOP) must be followed as per State / M

Most common symptoms:
Union Govt directions
 Fever VSPL – EHS
 Medical Examination to be done for all the employees (staff, workers,
 dry cough Team and
visitors, drivers etc.)
 tiredness PM
 Ensure Body Temp. Screening & recording at the time of gate entry/
 Less common symptoms: exit (temp should be less than 98 degree C).
 aches and pains  After Screening, eligible employees must be allowed to work at site
 sore throat  Ensure Social distancing (min 6ft person to person) in all the
 diarrhoea movements (During site Entry/ Exit, Stores, security check post, Rest
 conjunctivitis & Dining, Work place, while travelling, TBT, Training sessions etc.)
Covid Precautions  headache H
 PPE's must wear all times: (Nose Mask)
 loss of taste or smell  Ensure Frequent Hand wash/ hand Sanitization
 a rash on skin, or discoloration of  COVID19 Awareness Posters must be displayed in site premises
fingers or toes  Must be displayed Emergency Contact no’s and Nearest COVID
 Serious symptoms: treatment hospital details
 difficulty breathing or shortness of  Initial Disinfection to be done at site all the locations (like stores,
breath materials, tools & tackles etc.)
 chest pain or pressure  Incoming Materials has to disinfect in the designated location
 loss of speech or movement  COVID19 awareness training to be conducted for all the employees
 Only Vaccinated person should be allowed to site.

E - Extreme Risk: The hazard has the potential to kill or permanently disable a person H - High Risk: The hazard has the potential to cause a LTI ≥ 7 days
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (ie: Nil LTI)
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 Safe Work Method Statement

Procedure (in steps) Possible Hazards Risk Control Measures Contr Person who will
Rating (Describe what action or procedure will be taken to eliminate or minimise the risk of injury or olled ensure this
(Break the job down into steps. (Identify the hazards associated with each step. Examine each to (See damage. Use the Hierarchy of Controls below as a guide Risk happens
Each step should accomplish some find possibilities that could lead to an accident or potential harm below) 1. Eliminate the Hazard Score
major task and be in logical arising.) 2. Substitute the material or equipment
sequence.) 3. Isolate the hazard
4. Implement Engineering control
5. Implement Administrative control
6. PPE

Project Engineer &

1. Park the vehicle Vehicle may hit someone while moving M Make sure the drive way is safe and clear for truck to drive L Safety Officer
where material has to in. through.
unloaded. Obstructing other vehicle human Identify/demark the parking are where vehicle has to be
movement. unloaded
Muscle or tendon strain getting on and Do not jump off the truck, use the provided “Steps” or use a
off the vehicle. ladder.
Project Engineer &
2. Handling of the Injury from curtain buckles when M Secure curtain in windy conditions. L Safety Officer
material to be lifted opening of vehicle curtains. Use cut/abrasive resistant gloves, pad up the uneven surface.
Material may have sharp edges and Ensure that the hand/finger does not get jammed in between
splinters. material and vehicles sides by carrying material with hands
Material does not adequate side inside the maximum width of the item carried.
clearance for lifting. Ensure that you get additional support of personal before lifting.
Material in odd shape to carry. Use the material trolley.
Using PPE’s (Hard Hat, Safety shoes, Hi Visibility jackets, Hand
Gloves, Goggles, Mask/face shield).

E - Extreme Risk: The hazard has the potential to kill or permanently disable a person H - High Risk: The hazard has the potential to cause a LTI ≥ 7 days
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (ie: Nil LTI)
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 Safe Work Method Statement

Procedure (in steps) Possible Hazards Risk Control Measures Contr Person who will
Rating (Describe what action or procedure will be taken to eliminate or minimise the risk of injury or olled ensure this
(Break the job down into steps. (Identify the hazards associated with each step. Examine each to (See damage. Use the Hierarchy of Controls below as a guide Risk happens
Each step should accomplish some find possibilities that could lead to an accident or potential harm below) 1. Eliminate the Hazard Score
major task and be in logical arising.) 2. Substitute the material or equipment
sequence.) 3. Isolate the hazard
4. Implement Engineering control
5. Implement Administrative control
6. PPE

H Ensure all workers, including the truck driver are well clear before Project Engineer &
3. Unloading Material Falling materials, crush injuries to truck L Safety Officer
from trucks by forklift. driver and/or other workers. positioning forklift arms under load.
Maintain visual sight of truck driver at all times. If the forklift operator
Load falling off forklift arms, potential cannot see the truck driver, unloading is to stop immediately.
crush injuries to other workers. Ensure load is lowered as far as possible before travelling with load.
Untrained operator. If load obstructs the forward view operates the forklift in reverse.
Damage to material by loading Ensure all workers are well clear of the forklift and load. Forklift operator is
improperly. to stop if obstructions or workers are in close proximity to travel route.
Where required, barricading and signage must be positioned to warn
Overloading. pedestrians and drivers of the forklift activity.
Pinching hands between the truck and Adequate quantity of diesel to be there for the fork lift.
other objects. Suitable forklift arrangements shall be previously made so
Injury to other personnel’s. that the pallets are safely unloaded from the truck to a trolley or to the
Damage to other equipment’s. storage areas on the UB.
Only License holder operator to use forklift.
Tilt the mast slightly forward and align the forks with the base of the load.
Proceed slowly and insert the forks into the base of the load and ensure that
at least 2/3rd the length of the fork enter the base of the load.
Lift forks approximately 8 inches for the load to clear the floor.
Tilt mast back in preparation for traveling.
Position the truck at the desired location.
If stacking loads, adjusts the height of the load not more than 1 meter from
ground level.
Tilt the mast forward to place the forks parallel to the ground.
Once the load is set, slowly back away from the load.
When clear of the load, place the forks at the proper height for traveling.
Using PPE’s (Hard Hat, Safety shoes, Hi Visibility jackets, Hand Gloves,
Mask/face shield).

E - Extreme Risk: The hazard has the potential to kill or permanently disable a person H - High Risk: The hazard has the potential to cause a LTI ≥ 7 days
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (ie: Nil LTI)
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 Safe Work Method Statement

Procedure (in steps) Possible Hazards Risk Control Measures Contr Person
Ratin (Describe what action or procedure will be taken to eliminate or minimise the risk of injury or olled who will
(Break the job down into steps. (Identify the hazards associated with each step. Examine each g damage. Use the Hierarchy of Controls below as a guide Risk ensure this
Each step should accomplish to find possibilities that could lead to an accident or potential (See 1. Eliminate the Hazard Score happens
some major task and be in harm arising.) below 2. Substitute the material or equipment
logical sequence.) ) 3. Isolate the hazard
4. Implement Engineering control
5. Implement Administrative control
6. PPE

Project
4. Shifting materials Back injury and muscle strain. M Take correct body use and positioning before handling L Engineer &
on pallets trolley Pinch points between material and materials. Safety
Officer
through at stand vehicle. Check the vehicle for any falling or loose material that may fall
location by Lift. Hit by pallets trolley to someone. on your foot.
Fall of materials on someone foot due Use cut resistance hand gloves.
to over loading of materials. Check the walk path before carrying the material
Check the pallets before use and pallets hydraulic should be in
good working conditions.
Make sure the load should be as per the capacity of pallet.
Only trained and inducted workers shall be responsible for
shifting and handling the pallets.
Do not overload the material on pallets.
Using PPE’s (Hard Hat, Safety shoes, Hi Visibility jackets, Hand
Gloves, Mask/face shield).
Project
5. Unloading material Lifting beyond the capacity of the M Find out the feasibility of lifting the material without placing L Engineer &
using pallets. person may lead fall on the foot and hand below the material Safety
Officer
muscle, back strain. Try to take assistance if the weight of the material is beyond
25Kgs
Do not make single person manual lift if the weight of the
material is beyond 25Kgs
Make use of the trolley to shift any loose material
Using PPE’s (Hard Hat, Safety shoes, Hi Visibility jackets, Hand
Gloves, Mask/face shield).

E - Extreme Risk: The hazard has the potential to kill or permanently disable a person H - High Risk: The hazard has the potential to cause a LTI ≥ 7 days
M - Medium Risk: The hazard has the potential to cause a LTI < 7 days L - Low Risk: The hazard has the potential to cause a minor injury that will not disable a person (ie: Nil LTI)
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 Personnel Summary
SUPERVISOR’S DETAILS
Supervisors Name & Qualifications: Name: Akhil
Experience: 3years
Qualifications: BE
Supervisor’s Responsibilities: In addition to the above, the supervisor is to provide training in the use of this WMS, issue PPE and provide training in the same, supervise the work,
ensure conformity with this WMS, amend the WMS when additional hazards are found (and if applicable, ensure all workers receive a tool-box talk
to discuss the control measures for the additional hazards).

DESCRIPTION OF TRAINING THAT HAS BEEN GIVEN TO PEOPLE INVOLVED WITH THE WORK

H&S GENERAL INDUCTION: All workers must have successfully completed industry induction training

WORK ACTIVITY TRAINING: All workers need to have been trained in the activities outlined in this safe work method statement.

SITE INDUCTION: All workers are to be site inducted by the Principal Contractor, prior to commencing work on site.

OTHER: (List other training undertaken by workers): (eg: Confined Space, Manual Handling, Traffic Control etc)

TICKETS, PERMITS or LICENCES REQUIRED to undertake this work (ie. Certificates of Competency, Confined Spaces etc):
N.B. - Copies of the above must be shown to the Principal Contractor during site induction.

LEGISLATION, CODES OF PRACTICE and GUIDELINES applicable to this work

All work to comply with the <insert location> H&S Acts and Regulations and amendments, Workplace Injury Management & Workers Compensation Acts

Additional Codes and Standards applicable to this trade:

 Equipment & Material Summary
PLANT and EQUIPMENT used and MAINTENANCE FREQUENCY:

Serial Plant/Equipment Contractor Government Plant Hazards Maintenance/service records and log books sighted
Registration No. identified and by Principle Contractor prior to equipment being
controlled within used on site?
(Where applicable)
WMS?
Yes No Sign Date

1
2
3

ELECTRICAL EQUIPMENT USED DURING THE WORKS (Attach Electrical Equipment Register if applicable):
Item Tag/Item Testers Name & Signature License Number Test Date Result Test Date Result
Number
____ /____ /____ ____ /____ /____
____ /____ /____ ____ /____ /____

HAZARDOUS SUBSTANCES or DANGEROUS GOODS USED IN THE WORKS and anticipated volumes (Attach MSDS if applicable):
MSDS
Purpose Location & Volume Used Controls
Date on Site Date Left Site Product Name MSDS Date Attached
(ie. Application on site) on Site (& PPE to be worn)
(Y/N)
/ / / / / /
/ / / / / /
/ / / / / /
N.B. - All workers must be trained in the safe use of all chemicals and provided with the PPE required when using and storing these chemicals. Disposal is to be as per the waste disposal methods in
the MSDS. Spillage and leaks are to be cleaned up as per the spill/leak procedures identified in the MSDS.

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We agree that we have been consulted in the hazards and control measures and agree to complete the work in accordance with our Work Method
Statement (WMS).
We have been provided with training in all tasks outlined in our WMS and in the Codes of Practice applicable to our work.

Employee / Worker Signature Date Employee / Worker Signature Date

1. 8.
/ / / /
2. / / 9. / /
3. / / 10. / /
4. / / 11. / /
5. / / 12. / /
6. / / 13. / /

Reviewed by: Signature: Date:

(Principal Contractor’s Representative)

Any changes, additions or deletions made to this WMS are to be covered with the above personnel and the Principal Contractor’s representative at a Toolbox
meeting (Record date and time of Toolbox meeting below):

Date: Time:
Comments:

A copy of the Toolbox Meeting must be attached to this WMS.

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