Waterway Safety Work Method Statement
Document and assess safe work practices for activities in or near waterways.
Project Name
*
Work Location (Specify waterway and site details)
*
Date of Work
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Person Responsible for Work (Full Name)
*
First Name
Last Name
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Description of Work to be Performed
*
Personnel Involved (List all team members)
*
Identify Potential Hazards (Select all that apply)
*
Drowning risk
Slips, trips, and falls
Strong currents or tides
Exposure to hazardous substances
Weather conditions
Other
Control Measures Implemented (Describe steps taken to reduce risks)
*
Personal Protective Equipment (PPE) Required (Select all that apply)
*
Life jackets / buoyancy aids
Protective footwear
Gloves
High-visibility clothing
Helmet
Other
Emergency Procedures (Describe actions in case of incident)
*
Environmental Considerations (e.g., pollution prevention, wildlife protection)
Signature (Responsible Person)
*
Submit Statement
Submit Statement
Should be Empty: