UCL Estates

METHOD STATEMENT FORM

Description of Work(s):

Specific Location (including address and building number if relevant):

Start
date Estimated
and finished date
time: and time:

Works
Supervisor: Role:

Telephon
e: e-mail:

NOTE: This method statement demonstrates the hazards and risks associated with this activity have been properly
considered and evaluated. It outlines the appropriate risk control strategies required to be implemented to ensure the
health, safety and welfare of staff and others affected by the works. It is based on Risk Assessments already completed for
the tasks, equipment, substances and locations relevant to this activity. This is an activity-specific method statement. It is
based on a generic template but has been developed to consider the unique aspects of this activity, including location and
adjacent works.

1. Personnel Details
(include list of personnel and roles, supervisory structure, people responsible for logistics or safety)

2. Overview of Work
(include description of the works methodology (timings, duration, sequence, locations), what the tasks are, whether
other parties are going to be involved (e.g. sub-contractors), the techniques and methodology to be used, whether the
work is likely to interfere with other operations, protection of existing structure required, environmental considerations,
logistics arrangements)

3. Resources Required
(include any plant, equipment and materials required, logistics resources required, temporary lighting and power, any
time or effort required from parties and how consultation for these resources will be carried out)

4. Risk Assessment
(include reference to relevant risk assessments (including COSHH) for tasks being carried out as part of these works,
specify relevant hazards, consider access/egress, whether members of the public are at risk, hazardous substances,
noise, live working, manual handling, confined spaces, work at height, the working platform, whether a survey of the
building is required, whether service need to be located and/or installed)

5. Control Measures
(include permits, security, special training, edge protection, existing systems of work, Approved Codes of Practice, HSE
Guidance Notes, special precautions (eg electrical isolation, permits to work) requiring authorisation and who will
authorise them, how persons out of hearing distance or out of sight of each other will effectively communicate, how
other contractors be informed about the work, traffic management)

6. Personal Protective Equipment

(include personal protection (e.g. ear defenders, breathing apparatus, protective clothing) to be used, and any training
required to be given on its use, how it is to be maintained)

1
UCL Estates
METHOD STATEMENT FORM

7. Emergency Arrangements
(include rescue arrangements, special first aid arrangements or other special emergency arrangements such as
emergency drills, fire wardens, and extra first aid cover, names of first aiders and fire wardens, location of first aid
supplies and nearest medical facilities)

8. Temporarily Amended Systems

(include whether any fire systems, security systems or access arrangements will be affected temporarily and how this
will be managed)

9. Information and Communication

(include who information has or will be submitted to, how checking, review and update of Method Statement and Safe
Systems of Work will occur, who will need to receive copies of the Safe System of Work, confirmation of the operatives
briefing, what notification procedures are required for completion of high risk activities.)

10. Monitoring and Compliance

(include how compliance with the method statement is going to be monitoring and any digressions addressed.)

Prepared by: Position:

Signature
Date:
:

Reviewed by: Position:

Signature
Date:
: