SAFE WORK METHOD STATEMENT DOCUMENT

Document Title (to be completed by the Contractor / Service Provider

Project: Lot 349 SWMS No: AJ 0003
This SWMS will be reviewed: 17th July 2017____ (Date)
SWMS Title: Hoarding Gate 6 months maximum OR earlier if conditions and/or circumstances
change that introduce new hazard/s.
Contractor / Service Provider: Aneka Jaringan Sdn Bhd
Document Status (to be completed by MBSB)
Rev Contractor MBSB MBSB
Date Comments
No review by review by verification by

MBSB Review, Verification & Endorsement

REVIEW
I have reviewed all aspects of this SWMS and am satisfied to the best of my knowledge that it meets all MBSB acceptance criteria.

Package Manager / Engineer : …………..……………………………….….... Signed: ……………………………… Date: ….…/….…/….…

VERIFICATION
I have verified all aspects of this SWMS and am satisfied to the best of my knowledge that it meets all MBSB acceptance criteria.

ESH Mgr / SHO : ………………………………………………………………. Signed: ……………………………… Date: ….…/….…/….…

ENDORSEMENT
I have verified all aspects of this SWMS and am satisfied to the best of my knowledge that it meets all MBSB acceptance criteria.

Project / Construction Leader : ………………………………………………… Signed: ……………………………… Date: ….…/….…/….…

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A SWMS REVIEW CHECKLIST (to be completed by MBSB)
NOTE:
 Each Contractor / Service Provider, before commencing work, must provide written Safe Work Method Statement/s (SWMS) for the work to be
carried out. The following checklist is to be completed and reviewed by MBSB, and assessed to have met the MBSB acceptance criteria in
compliance with the requirements outlined in the checklist and any relevant ES&H Legislation, Codes and Specifications.
 This SWMS must be reviewed on a regular basis. When new information on ES&H risks surface, changes occur or after any inspection, incident /
accident that impact on the agreed method of work, the SWMS must be revised accordingly.
Section 1: Compliance Checklist
Check
SWMS Criteria Remarks
Yes No
1. Sets out step by step how the work activity will be carried out.
2. Identifies the aspects/hazards associated with each step of the work activity.
3. Assesses the impacts / risks associated with each step of the work activity.
4. Defines the controls to manage risks associated with each step of the work activity based
on the hierarchy of controls – Eliminate, Substitute, Isolate, Engineer, Administrate and
PPE.
5. Provides a description of the plant / equipment that will be used in carrying out the work
activity (including equipment maintenance and inspection requirements, certification by
qualified person and / or registration, etc.).
6. Describes the qualifications and training of personnel carrying out the work activity,
including supervisors’ experience, competency, licenses, operators’ certification, etc.
7. Refers to and confirms compliance with relevant ES&H Legislation, Standards, Codes,
Regulations and / or MBSB ES&H Requirements.
8. Includes design requirements, engineered details or certification for both temporary and
permanent structures, platforms or access ways / ladders.
9. Where PPE is nominated, the type of PPE is specifically listed and when it is required.
10. Defines who is responsible to ensure that the work activity is monitored and carried out in
accordance with the SWMS.
11. Defines the process and frequency of reviews and methods for ensuring the work
complies with the SWMS controls.
12. Identifies where any Contractor / Service Provider will be used, who is responsible to
monitor and supervise the works, and how impacts/hazards arising from interaction
between trades will be communicated and managed (e.g. induction into more than 1
SWMS).
13. For complex or high risk work activities (where appropriate), uses photos / diagrams /
sketches / summary to enhance the SWMS.
14. Includes the name and signature of the person who developed the SWMS, a current date
and revision number.
15. The SWMS includes specific ES&H controls for key high risk activities .

Where an exclusion zone is required, the SWMS must clearly state the detail of the required exclusion zone,
including the person responsible for implementation and supervision.

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B APPLICATION (to be completed by Contractor / Service Provider)
Section 1: Scope of Works
Tasks / Activities: Installation of new sliding gate replacing old gate at site hoarding

Work Location (Attach Site Plan): Refer Attachments Duration: From 18/01/2017 (Date) to 18/02/2017 (Date)

Remarks:
- Nil

Section 2: Plant / Machinery / Equipment (Attach Inspection Certificates)

Type of Plant / Machinery / Equipment Is this equipment inspected? Remarks
1 Excavator AJ 04 BKU 3276 Yes No

2 Crawler Crane Liebherr Yes No WP PMA 20446

3 Yes No

4 Yes No

5 Yes No

6 Yes No

7 Yes No

8 Yes No

Section 3: Key Personnel / Qualified Persons (Attach Training Qualification Certificates)

Name Appointment / Designation Remarks
1 Khoo Teok Seng Excavator Operator

2 Lee Kien Meng Crawler Crane Operator

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C RISK ASSESSMENT (to be completed by Contractor / Service Provider)

Section 1: General Information

PREPARED BY: REVIEWED / APPROVED BY:

Name: Jeganathan Nair Signed: Name: Kevin Che Kam Seng Signed:

Designation: Safety and Health Officer Date: ……20…. /…1……. /……17…. Designation: Project Manager Date: …20……. /……1…. /…17…….
Applicable Environment, Safety & Health (ES&H)
Risk Assessment Team Approved Code of Practice (COP) and/or CSR
Legislation
Name Designation Signature

 Chan Ten Song  Construction Manager  ________________________

 Ayavu A/L Nagappan  Senior Supervisor  ________________________
 ________________________  ________________________  ________________________ FMA- Act139, OSHA- Act514 & DOSH Regulations
 ________________________  ________________________  ________________________
 ________________________  ________________________  ________________________
 ________________________  ________________________  ________________________

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Consequence Table
Very Small - 1 Small - 2 Medium - 3 Large - 4 Very Large - 5
Unlikely injury or ill-health, or Offsite medical treatment. Lost Time Injury or Permanently Disabling Injury Fatality due to Injury or
onsite first aid treatment. Onsite and/or offsite Occupational Illness. or Occupational Illness. Occupational Disease.
Onsite environmental impact environmental damage Onsite and/or offsite Onsite and/or offsite Evacuation of employees
IMPACT with straightforward clean-up taking 0-3 months to clean environmental damage environmental damage due to threat of fatality.
or remedy with available site up or remedy. taking 3-6 months to clean taking 6-12 months to clean Irreversible onsite and/or off-
equipment and controls. No regulatory notification up or remedy. up or remedy. site environmental damage;
No regulatory notification required. Regulatory notification may Regulatory notification or clean-up or remedy from
required. Some community concerns be required. compulsory but no public damage lasting > 12
raised but no impact. Limited impact on investigation likely. months.
community with minor Major impact on local Regulatory notification
concerns raised. community leads to compulsory with public
LIKELIHOOD community protests. investigation likely.
Impact on local community
leads to community outrage.
5 (Very High) - A Very High Likelihood:
1) Almost certain to occur; 2) Almost certain to re-occur due to past trends Minor Moderate Significant Significant Critical
from reported incidents / issues; 3) Quantified very high exposure to the risk
without any controls in place.
4 (High) - A High Likelihood:
1) Strong evidence to likely occur; 2) Highly likely to re-occur due to past Minor Minor Moderate Significant Significant
trends from reported incidents / issues; 3) Quantified high exposure to the risk
without any controls in place.
3 (Medium) - A Medium Likelihood:
1) May occur or known to occur; 2) Infrequent number and regularity of Minor Minor Moderate Moderate Significant
reported incidents / issues; 3) Quantified moderate exposure to the risk without
any controls in place.
2 (Low) - A Low Likelihood:
1) Could occur at some but not expected; 2) One or two reported incidents / Negligible Minor Minor Minor Moderate
issues to date; 3) Quantified low exposure to the risk without any controls in
place.
1 (Very Low) - A Very Low Likelihood:
1) Highly unlikely to occur; 2) No evidence of reported incidents / issues in the Negligible Negligible Minor Minor Minor
past; 3) No quantified and known exposure to the risk without controls in place.

Risk Index Action

Critical Operation not permissible; management attention and consultation with HOD Safety & Health required.
Significant Operation not permissible; risk must be reduced by all possible means (not by interim risk control measures); management attention and consultation with HOD Safety & Health required.
Further risk reduction required where possible; remedial action to be taken immediately; 7 day (max) review needed to ensure risk level assigned is accurate and does not increase over time;
Moderate
management attention required.
Risk tolerable subject to demonstration that risk level is as low as reasonably practicable; remedial action to be taken at appropriate time to further reduce risk level; 30 day (max) review needed to
Minor
ensure risk level assigned is accurate and does not increase over time.
Negligible Risk acceptable; discretionary remedial action to be taken.

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Section 2: Risk Assessment
Unless stated otherwise in this document, ALL WORKERS, will wear (at all times during this activity):-
MANDATORY PPE:- Safety Helmet, Safety Shoes (High Ankle), Safety Glasses, High Visibility Vest & Gloves.

NO Job Steps Hazard Risk Risk Control / Control Measures L I Risk Accountable Person
Rating
1 Delivery of hollow section to entrance of Uncontrolled Major injury due to Designated & Trained Traffic controllers to be assigned. 2 4 Moderat Supervisor
hoarding Traffic/Vehicle contact with moving Traffic controller to be equipped with whistle, high visibility e
Movement vehicles or machineries clothing & batons/ flags
Proper signage to be placed to warn the public

2 Unload the hollow sections inside nearby Material Dropping Major Injury due to Minimum 2 workers to unload materials from low levels 2 3 Site Supervisor
entrance material dropping Ensure workers not lifting weight greater than 20kg on each lift

3 Dismantling of the existing hoarding gate Material Dropping Major Injury due to hit Ground must be checked for level and stability by competent 2 4 Site Supervisor/Excavator
using crawler crane and swinging person Operator
Work zone to be barricaded and no workers to be in the
barricaded zone
Signalman guiding the crane operation

4 Fabrication of new sliding gate 4.5mx3.0 Cutting and Eye Injury, Burn Injury Wear proper PPE and protective clothing 2 4 Site Supervisor and
Welding Barricade the fabrication area to prevent unauthorized entry banks men
Fire and spark Welding set must have flashback arrestor
hazard Cylinder shall be in upright position in cage
Electrical set must be properly grounded
No combustible material nearby
Fire Extinguisher standby

5 Installation of new pole left and right and Hand Injury, Minor injury to hands At least 2 workers bury and concrete the pole 1 4 Site Supervisor
concreting Falling of pole and feet, Temporary support for pole
Major injury for head
injury

6 Welding of loop ear on pole for new gate Fire and spark Eye Injury, Burn Injury Wear proper PPE and protective clothing Site Supervisor and
installation hazard Barricade the fabrication area to prevent unauthorized entry Concrete Pump Operator
Welding set must have flashback arrestor
Cylinder shall be in upright position in cage
Electrical set must be properly grounded
No combustible material nearby

7 Lifting and installing the new gate Material Major injury due to To use competent operator 1 4 Lifting Supervisor
droppings, Unsafe contact with load or Crane to be inspected & with valid fitness certificates
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 crawler crane and machinery during lifting Out riggers to be fully extended
lifting operation operation Wheels to be slightly above the ground
Crane to be balanced -refer level meter / water leveller on the
body
Barricade the work area
Unsafe Slinging Major injury due to To use competent rigger 1 4 Lifting Supervisor
material fall To use tested and certified slings & lifting gears
To lift using designated lifting points only
No overhead lifting or standing under suspended load

D SAFE WORK PROCEDURES (to be completed by Contractor / Service Provider)

Section 1: Safe Work Procedures
Unless stated otherwise in this document, ALL WORKERS, will wear (at all times during this activity):-
MANDATORY PPE:- Safety Helmet, Safety Shoes (High Ankle), Safety Glasses, High Visibility Vest & Gloves.
Safe Work Procedures
Job Steps / Sequence Of Works Additional Equipment / Hold Point
WHO – WHAT – HOW - WHEN Permits Required
PPE Responsible
(include images / sketches if required for further clarity)
- Safety PreStart All workers and operators need to be briefed into this SWMS and signatures recorded prior
to commence work on daily basis Safety PreStart Safety
Any deviation of activity/method of work from this SWMS needs to be discussed and Forms Personnel
approval obtained from MBSB. Work need to be stopped until the approval is obtained.
- Delivery of hollow section to Work Site Ensure a designated and trained Traffic Controller assigned at the entrance to manage
trucks / machineries coming into site and the traffic at public road. Site
Traffic controller to be equipped with whistle, high visibility clothing & traffic control batons / Supervisor
flags
- Unload the hollow sections inside nearby Park lorry at stable ground Site
entrance Hollow section unloaded from lorry by at least 2 worker Supervisor
- Dismantling of the existing hoarding gate Gate to be properly tied with crane hook in order to be uplifted high before lowered again
using crawler crane once its out of lock
All lifting gear must be checked to make sure in proper condition before usage Site
Lifting of material then shall be done by competent operator (competencies to be verified Supervisor
prior to lifting by the Lifting Supervisor) of crawler crane and shall be assisted by lifting
supervisor
- Fabrication of new sliding gate 4.5mx3.0 Welding must be done by competent welder only Site
The working area shall be barricaded surroundings with proper fire resistance barriers Supervisor

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 No combustible material should be in the designated welding area
Worker must wear the proper PPE and protective clothing
Cylinder must be in upright position
Flashback arrestor must installed properly on hose
Adequate fire extinguisher shall be on standby at all time
- Installation of new pole left and right and At least 1 meter hole dug in put in the pole
concreting 2 workers transfer the pole to hole and stand it in the hole Site
Pole supported from side to make sure it doesn’t fall down Supervisor
Hole concreted and backfilled
Welding of loop ear on pole for new gate Welding must be done by competent welder only
installation The working area shall be barricaded surroundings with proper fire resistance barriers
No combustible material should be in the designated welding area
Site
Worker must wear the proper PPE and protective clothing
Supervisor
Cylinder must be in upright position
Flashback arrestor must installed properly on hose
Adequate fire extinguisher shall be on standby at all time
Lifting and installing the new gate Lifting supervisor with the truck mounted crane operator to check the crane and all slings and
lifting equipment / lifting gears. Inspection to be recorded and kept at work area and filed
upon completion of work.
Work area to be barricaded to prevent unauthorised entry using hard barriers.
Outriggers to be fully extended and steel plates used as padding.
Truck to be levelled and stable condition.
Load being lifted should not be more than 80% of the crane’s maximum capacity along the
lifting radius and unloading point (locations to be predetermined and verified by the Lifting Lifting
Crane and Lifting
supervisor to confirm this) Supervisor
Equipment Inspection
and Incharge
Lifting of material then shall be done by competent operator (competencies to be verified Checklist
Person
prior to lifting by the Lifting Supervisor) of lorry crane and shall be assisted by lifting
supervisor and 2 riggers.
Loads to be hooked to a designated and engineered lifting point only.
Total load distribution to the slings should not be more than 80% of its capacity. Total loading
to the sling need to be also based on the number of slings and method of slinging.
All Lifting hooks must be fitted with safety latch.
To ensure the workers are standing behind the barriers doing this activity

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Section 2: Instruction & Communication
This Safe Work Method Statement has been developed through consultation with the following crew members and has been instructed through induction, read and understood, and signed by all employees undertaking
the works.
Name Designation Remarks / Comments Signature Date
1 Kevin Che Kam Seng Project Manager
2 Chan Ten Song Construction Manager

Section 3: Verification
I have provided, accurate and sufficient information and instructions pertaining to this Safe Work Method Statement - the aspects / hazards associated with each work process and activity, the type of potential impact,
incident or accident, and the risk controls / practicable measures to be taken in the course of work and during an emergency - to ensure its / their safe undertaking.

Instructed by (print name): …………………………………………………………………….. Signed: ………………………………………….. Date: …..../…...../……… Time: .............. am / pm

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