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
*
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Month
-
Day
Year
Date
Submit Method Statement
Should be Empty: