Contractor’s Method Statement Form

This Method Statement is to be completed by the sub-contractor prior to commencement of works on any IDAMA FM sites.

SECTION 1: CONTRACTOR DETAILS

Company Name: MULTILINE Company Address: P.B. 111362, DUABI - UAE

Name of SHERJI Contact No: 0552067443

Engineer:

SECTION 2: WORK DETAILS

Facility Name: DIFC Exact Location: Dubai

Brief Description Off loading and shifting of Cables

of Work

Planned Start Date: 08/11/2024 Time: 10 PM Planned End Date : 09/11/2024 Time: 6 AM

Working Hours: 8 hrs. No of Workers: 30

SECTION 3: MANAGEMENT
Details all persons who have responsibility on site including Supervisor, Manager, Director
Name Job Title Contact Number

ESSAKKI PROJECT MANAGER 0552346179

VIJESH SITE SUPERVISOR 0554410571

Who is responsible for authorising Name Contact Number

changes to the planned work? MANOJ 0553064300

SECTION 4: PERSONNEL DETAILS

Names of personnel to be employed on site

Name Job Title Name Job Title

1. VIJESH SUPERVISOR 6. GANGADHAR INSULATOR

2. CHERIYAN SUPERVISOR 7. RAMJAN ALI TECHNICIAN

3. CHANTHU DUCTMAN 8. ROY ELECTRICIAN

4. SUKESH TECHNICIAN 9. CHANDRALAL PLUMBER

5. ESSAKKI DURAI FIRE WARDEN 10.

 Contractor’s Method Statement Form

SECTION 6: PERSONAL PROTECTIVE EQUIPMENT (PPE)

List of Personal Protective Equipment that will be provided to workers

 SAFETY SHOES  HAND GLOVES

 HELMET  GOGGLES

 WELDING SHIELD  HIGH VISIBILITY JACKET

SECTION 7: METHOD OF WORK
Provide site information and site specific description of the working method to be used.

Introduction
This document has been prepared to provide brief outline of the method of works that will be carried
out for safe and smooth execution and completion of offloading and shifting of electrical cable drum to innovation
one entrance area to P1 parking. This method statement will be appended with further individual method statements
for the scope of works as may be varied, required or instructed

Responsibilities and supervision

Project Manager shall have the overall responsibility of the project for execution, quality and safety.
He shall maintain the planning Progress and co-ordination of works.
• Project/ Site Engineer(s) shall be responsible for monitoring of the day-to-day activities on site, for
materials, drawings, testing & commissioning and allocation of resources to work areas on site. He shall
report to the Project Manager.

Supervisor/ Charge Hand shall be directly responsible for the day- to-Day job at site, for coordinating
of work with skilled and unskilled labor or any other staff assigned in his area.
• QA/QC Department will be overseeing the quality requirements and quality control measures for the
project in coordination with Project/Site Engineer(s).
• Safety Officer shall be responsible for the health & safety aspects on site as per the Main contractor
and safety Manual.

Pre-installation check
Ensure that all safety requirements are in place in accordance with Project safety plan.
• Ensure that the correct revision of the approved shop drawing is being used.
• Ensure that all supervision staff (Project Manager, Engineers, Technicians and Foremen) are fully
aware of all procedures and work sequences shown in this document.
 Contractor’s Method Statement Form

Ensure that all technicians and helpers are aware of using the correct materials, handling and
installation procedure to ensure best quality of workmanship.
Ensure that all the hidden conduits or electrical cables are de terminated from the proposed area.

Site survey
ML engineering team will survey site conditions, required levels, access, material proposal, material
shifting methods and setting out the area for coring, preplanning for hoarding and erection of scaffolding. Also
find out the logistics way and mode according the site condition. If any hot work shall be conducted for
particular items removal, then arrange special team for fire watch.

Floor protection
Before starting the work, temporary floor protection will be laid on the existing floor or building floor
with 4 mm thick MDF/ Plywood board for the material shifting from the yard to the work place.

METHOD

Preparation:

Operate the forklift

 The vehicle should be positioned in a safe location, clear of traffic/vehicles/pedestrians during

equipment delivery and materials removal (deploy physical barriers, caution signs as necessary)
 Do not park illegally
 Identify and obey all safety-related signage (check site entry requirements)
 If loading/unloading/setting-up roadside – comply with local laws and permits
 Barricading controls are implemented and authorized as part of the safe work system to protect
persons from hazards
 Establish exclusion zones to stop people from entering the area
 Signage in place to caution persons not to enter
 Forklift to be operated by qualified, authorized personnel, holding a high risk work license for
fork lift operation.
 The first forklift operator to use the forklift (each day or each shift where more than one shift per
day) will carry out a full pre use visual inspection to identify any damage, leaks etc. with details
of the inspection to be recorded
 Do not place hands or any parts of body through the mast
 Do not stand between the mast and the load
 Do not stand on the tynes and / or load
 Do not exceed safe weight limit
 Do not operate with unstable loads
 Do not use damaged pallets
 Do not lower load when other workers are in the immediate vicinity
 Operate forklift with load and tynes as low as possible to increase operators field of vision
 Contractor’s Method Statement Form

 Operate forklift within nominated speed limits

 Where practical operate in a forward direction
 Maintain a safe distance from other plant
 Operate steering and brake smoothly when load is elevated
 Ensure all safety devices are working correctly
 Remove key from forklift when unattended or not in use
 Do not allow passengers to ride on forklift
 Do not operate forklift in proximity of overhead power cables
 Only palletized loads to be shifted with the fork lift. Do not pace items directly on the fork arms.
They are liable to slide off. Use pallets at all times.

ACCESS / EGRESS:

Access is gained by using the service road infront of innovation one main entrance near revolving door.

No other point of entry to the project is permitted.

Lift dimension and SWL of service lift to be considered before any Delivery is made.

Access to working areas will be gained by using the approved access points agreed with DIFC any
changes to access routes occurring during the duration of the work will be identified and relayed to the
workforce during daily site briefings.

Any vehicle access for deliveries will be agreed in advance with the ML site manager and manager
delivered via the doors specified.

FIRE SAFETY ARRANGEMENTS:

In the event of a fire, or fire alarms sounding all personnel will make their way to the closest rendezvous
point by the safest route as detailed during site induction.

SECTION 8 : PLANT AND EQUIPMENT

EQUIPMENT & PERSONNEL - provide details of Plant and Equipment to be used on the works and provide details of personnel trained and
competent to operate plant/equipment
Plant / Equipment Test Certification Provided Operator Name Competency

Fork Lift YES

Hydraulic Palette YES

YES

SECTION 9: MATERIALS
 Contractor’s Method Statement Form

CHEMICALS - Pprovide details of chemicals to be used during the work.

COSHH assessment to be provided in separate Form
Governmental
Chemical Name MSDS Specific Safety Requirements
Approval/Authorisation

NA

MATERIALS - Provide details of other materials to be used during the work

Material Name Quantity
Mild Steel Pipes, Rubber insulation, MI fittings, Vapour Barriers,
Lot
Adhesives, Black Tapes, Canvass cloth. Communication cables
Lot

SECTION 10: WASTE DISPOSAL

WASTE - Provide details of how waste material will be removed from work area and disposed of
Material / Chemical Disposal Method
MS pipe fittings, Support channels, threaded rods, Nut & All waste generated will be removed on a regular
Washers, basis and disposed off in accordance with local laws
Rubber insulation and regulations. This will be done by utilizing
mechanical means wherever practicable to reduce
manual handling.

SECTION 11: OTHER ARRANGEMENTS

EMERGENCY ARRANGEMENTS - Provide details of specific Emergency Procedures required

In case of emergency all works will stop and materials will be removed from the access and all people
come to the emergency assembly point. Coordinate with Interim Management. First Aid Medicine
available in site.

FIRST AID - Provide details of First Aid arrangements in place

A FIRST AID Kit shall be available all time at site during the project until completion.

WELFARE - Provide details of welfare facilities provided (i.e. washroom, food/drink provision)
 Contractor’s Method Statement Form

Wash room and drinking water facilities are available at contractors facility at B2-CP-05.

SECTION 12: SUPPLEMENTARY INFORMATION

SECTION 13: PREPARATION AND APPROVAL

Details of person preparing Method Statement Approval (to be approved by contractor’s management)

Name: SREEDHAR Name: RANJAN

Job Title: SAFETY OFFICER Job Title: PROJECT MANAGER

Signature: Signature:

Please note that all pages of this document must be stamped and signed by the contractor to be admitted for
approval upon review.
 Contractor’s Risk Assessment Form

Date Review
07/11/2024 07/11/2024 Account/Site DIFC Company Name MULTILINE
Issued Date

Off loading and shifting of Electrical Cable Drum

Task Description

1. Palette Jack
List of Equipment

1.
List of Chemicals NA

*L= Likelihood or probability rating of the hazard or consequence occurring *S = Severity rating of hazard or consequence if it occurs

*Risk rating & level or Residual Risk(s) rate= Likelihood rating (L) X Severity rating (S) eg: 3 x 3 = 9(as shown below)

Please refer to the Risk Matrix Table below and note that the ratings are ranked from 1-5 based on subjective assessment of risks associated to
the activity to be carried out

Risk Residual
Accumulated Hazards, Risk and Further Action(s)
Sr.# Activity/Step L S Rating & Current Control measures L S Risk(s)
Consequences Required/Remarks
Level Rate
Competent persons, Proper
Materials Cuts/ bruises/ minor sufficient time supervision
loading and injury All materials shall be would be
moving organized well in good ensured.
1. 3 3 9 1 2 2
order and securely tied
and stacked on bundles
before
loading/offloading
 Contractor’s Risk Assessment Form

Access / Egress to Slip/ Trip / Fall / Crush / 2 3 5 Before entering the

Site Run Over Site all personnel to
undertake an
Induction by the
main contractor
which will highlight
the correct access &
egress routes to the
2. 1 2 2
site. These must be
adhered to at all
times to minimize the
risks of operatives
work interfering with
Unit Staff & any
unauthorized access
to restricted areas.
Damaged tools Injury to the Ensure the condition of the
Improvised tools person/persons hand tools is good, when
3 3 3 9 1 2 2
Sharp edges obtaining from the stores.

Use of Electrical Electric shocks while Operatives will be Proper

operated Tools operating the electrical advised of the risk of supervision
appliances electric shock, burns and would be
fires associated with ensured.
4. 3 3 9 parts of system being 1 2 2
energized.
Work will only carried
out by qualified
competent persons.
 Contractor’s Risk Assessment Form

Supervised by an
experienced competent
person.
Use suitable Gloves
along with safety shoes,
helmet and coveralls
Faulty / damaged 4 5 20 All portable electrical 4 1 4 Supervision of
equipment. Electrocution. equipment will be Competent
Site Environment. Fire. individually identified and Person
Trailing leads. Injury. subject to planned
Fatality. maintenance. Equipment
supplied will be fit for
purpose with regard to
voltage, power and
environmental conditions.
Visual inspection of
5. equipment will be carried
out before use. All
equipment found to be
defective will be switched
off and removed from site
immediately. Leads and
extension cables are to be
routed so as to minimize
the likelihood of damage
and trip hazards.
Slipping of tools Hand tools shall not be Supervision of
6. 3 3 9 kept on walkways. 1 2 2 Competent
Person
 Contractor’s Risk Assessment Form

Hand tools shall be kept in

tool boxes whenever not in
use. All tools shall be
inspected for any damages
on daily basis and at
regular intervals.
Tie off tools with a rope to
prevent its fall while
working at height or near
edges.
Don’t keep any tools
unattended at the height
after the work.
Store keeper will inspect all
the new tools before
issuing to site.
Ensure that no
homemade/make shift
tools are used at site

Hand Tools Eye injury, Injury to Hands, All tools provided must Supervision of
Handling & Feet & Body, Fall-over be assessed to ensure Competent
Operation tools that they are fit for Person
purpose and environment
in which
7.
3 3 9 they are to be used and to 1 2 2
be in good condition.
Visual checks must be
completed by operatives
on tools prior to their use.
Suitable tools should be
 Contractor’s Risk Assessment Form

used for the particular

work as required. Eye
protection is to be
provided and used
whenever work is done
using cold chisels, drills,
grinders or other tools
where there is risk of
flying particles or other
pieces of the tools
breaking off. Insulated
tools must be used where
there is possibility of live
electrical work. All tools
should be kept clear of
unnecessary grease,
moisture or dust.
Any movable or
adjustable parts should
be lightly oiled to
protect against corrosion
and to prevent
misalignment.
Tools should not be left
lying around, to avoid
someone falling over it
and getting injured.
Disconnection of Cuts/ bruises/ minor Competent persons, Supervision of
8. cables injury 3 3 9 sufficient time 1 2 2 Competent
Person
 Contractor’s Risk Assessment Form

All cables shall be handle

with care
Use of Mobile Falls from height cuts, Inspection of Mobile Supervision of
Tower Scaffold / fatality fractures, falling Scaffold every 7 days. Competent
Work at Height materials, Fracture; TBT with regard Person
Crushing; Hand & feet Erection & Dismantling
Injuries of Scaffold
9. 3 3 9 1 2 2
The working platform
must have railing system.
Provide Proper Access to
the Scaffold.
Use of Proper PPE.
10 Inappropriate Lift Lift Truck operator, Staff, 3 3 9 Appointment of a responsible 1 2 2
Truck operations students, public in vicinity of person in each company /
Lift Truck operations department to coordinate Lift
Truck operations.
11 Inappropriate driving / Lift Truck operator, Staff, 3 3 9 Lift Trucks are driven only
operation of Lift public in vicinity of Lift Truck by operators, appointed in
Truck operations writing following attendance
of an approved training
course. Periodic re
assessment carried out by 1 2 2
company / department. Lift
Trucks are securely parked
with ignition keys removed
12 Pedestrian crush injury Staff, Workers, public in 3 3 9 with audible/visual warning
vicinity of Lift Truck operations alarms fitted to Lift Truck. 1 2 2
Hi Visibility clothing is worn
by all persons involved in
Lift Truck operations.
13 Operator crush injury Lift Truck operator 3 3 9 Lift Trucks are not operated 1 2 2
on unacceptably uneven
surfaces and are fitted with
‘fall out protection’ seat
belts.
 Contractor’s Risk Assessment Form

14 Passenger crush injury Lift Truck passenger 3 3 9 Passengers are not allowed to 1 2 2
ride on Lift Trucks.
15 Impact injury from Lift Truck operator / banks-man 3 3 9 Lift Truck forks are not
falling objects overloaded, loads are
transported at low speeds
with forks in lowered
position. Operation of Lift
Trucks on uneven ground is 1 2 2
avoided. Head protection
required to be worn by staff
involved in Lift Truck
operations where there is a
risk of falling objects.
 Contractor’s Risk Assessment Form

1.1.1. HSE Risk Matrix Tables

1.1.2. Severity Scale

5 5 10 15 20 25
Low HSE Risk
1-4 Green Acceptable Risk
4 4 8 12 16 20 (No more controls required)
Severity

Medium HSE Risk

3 3 6 9 12 15 5-12 (Controls are required but may be effected by other
Yellow Tolerable Risk
factors like, e.g. cost/benefits, availability of items,
2 2 4 6 8 10 manpower, etc.)

1 1 2 3 4 5 15-25 High HSE Risk

Red Unacceptable Risk
(Controls must be applied immidately)
1 2 3 4 5
HSE
Likelihood

1.1.3. Likelihood Scale:

Rank Hazard exposure likelihood scale

1 Very Low Almost certain it will not occur
2 Low Not expected to occur
3 Medium It could occur
4 High Expected to occur
5 Very High Almost certain it will occur
 Contractor’s Risk Assessment Form

1.1.4. Severity Scales:

Rank Potential Severity Scale

 First aid injury (one person), and/or
1 Very Low
 Negligible other occupational incident.
 First aid injury (more than one person), and/or
2 Low
 Minor other occupational incident without violating legal requirements
 Hospitalization injury (one person) and no more than 3 days lost, and/or
3 Medium
 High other occupational incident without violation of legal requirements
 Hospitalization injury (more than one person) and/or more than 3 days lost, and/or
4 High
 High risk other occupational incident, causing a violation of legal requirements
5 Very High  Fatality or permanent disability injury (one or more person).

Name Designation Signature Date

Prepared By AKSHAY MOHAN HSE 07/11/2024

Approved By MANOJ PROJECT MANAGER

Please note that all pages of this document must be stamped and signed by the contractor to be admitted for approval upon
review.