Work Method Statement Form
Please provide detailed information about the work method, associated hazards, and safety controls for this task.
Project or Job Name
*
Location of Work
*
Description of Task/Work to be Performed
*
Step-by-Step Work Procedures
*
Identify Potential Hazards (select all that apply)
*
Working at heights
Electrical hazards
Manual handling
Hazardous substances
Slips, trips, and falls
Noise
Other
Control Measures to be Implemented
*
Name and Position of Person Preparing Statement
*
First Name
Last Name
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Method Statement
Should be Empty: