Safe Work Method Statement (SWMS) - : Incorporating Job Safety Analysis

SAFE WORK METHOD STATEMENT (SWMS) Incorporating Job Safety Analysis
Description of Activity to be carried out:
Work Location:
ASSEMBLING & ERECTION OF FLARE
Dolphin Onshore Facilities Project
Risk Assessment Log Section:
Step
1.0
Name:
Position: JGC HSE Manager
Signature:
Date:
Activity Guidelines used:
Critical Steps in this Activity:
Transportation of material
(Loading / offloading of
material using Trailer, Crane,
Forklift etc.)
JGC approve the use of this MSJSA :
Potential Hazards:
Improper loading of material

Falling Object / material hazard
Failure of lifting gears
Crane failure
Fire hazard
Struck against (Fork lifter)
Personnel Injury due to slip / trip, struck
against, struck by and fall from height
Road Traffic Accidents
Material fall during transportation
Roll down of material
Damage of material during shifting
Environmental Hazard due to leakage of oil
from equipment
HSE Controls to be Implemented:
Tool box talk will be conducted by Supervisor.

Supervisor will be responsible to complete safe activity prechecklist sheet daily before start of work.
Loading of material will be done under proper supervision.
Ensure that overloading is prevented
Secure all material properly
Only Third party certified and color coded lifting gears will
be used
Banksman will be 3rd party certified and will wear high
visibility Vest for identification.
Barricade the loading / offloading area& use hard barriers
wherever required.
3rd party certified operator will operate the crane / fork lifter.
Double Tag line to be used.
Banksman with vest to guide all vehicle maneuvering.
Highlight any protruding load.
Use proper signboards
Fork lifter and crane to be used as per size, shape and
weight of load
Suitable edge protection to be used

Step
Potential Hazards:
Safe access to be provided in case of requirement.

Position the crane on solid and level ground,
Outriggers fully extended on approved pads
No un-authorized person allowed in the area
Supervisor / Approved Riggers to assess each lift i.e., crane
position, location away from edges of excavation or weak
ground
For the lifting operation, wind speed should be less than 25
knots. The total lift weight should not exceed 75 % of crane
chart capacity (SWL)
Daily inspection of crane and lifting gears to be done and
checklist to be filled.
In case of sand storm / less visibility lifting operation should
be reviewed with HSE personnel.
Descon activities to be integrated into JGC transport and
traffic management plan
Check and protect any overhead or under ground services.
Fire extinguisher to be available with crane and fork lifter.
No smoking in the crane cabin.
Avoid standing at the edge of the trailer while loading /
offloading
No passenger allow to travel on the back of the trailer
Ladder will be used to go up on trailer
Ensure nobody comes under the suspended load
Ensure reverse horn of fork lifter / crane working
All drivers / operators to have valid driving license
No standing at the back of Trailer.
Road traffic signs to be followed.
Speed limits to be followed
Use dunnage and wedge blocks to prevent material from
rolling.
Proper House Keeping will be carried out and waste
management will be done as per JGC Waste Management
Procedure RLO-0000-FPR-50126.
Management of spills will comply with the measures stated
in the Spill Contingency, Procedure RLO-0000-FPR-50128.

Step
Potential Hazards:
2.0
Assembling of flare blocks on

ground (Max. 25 meter)
Poor planning
Unsafe / Improper scaffold
High wind speed
Falling hazard
Falling object Hazard
Heat stress
Slip / trip hazard
Poor housekeeping
Follow safety precautions regarding Rigging & Lifting as

described in Step # 1.0
JGC Working at Height Procedure (S-000-1654-114 Section
4.22) to be used as guideline for working at height.
Ensure that the scaffolds are weekly inspected and tagged
and are safe as per the JGC Scaffolding Procedure S-0001654-125
Also follow applicable safety precautions in Safe Work
Method Statement for Scaffolding Job.
Supervisor to ensure that tool box talk is conducted before
start of job conveying job related hazards and preventive
measures.
Safe activity pre-checklist sheet to be filled in daily before
start of job by supervisor.
Area Engineer to plan before start of activity
Only relevantly trained & skilled manpower to do the job
Provide safe access / egress including ladder / scaffold with
valid inspection & tag
Wear and anchor full body harness with lanyard while
working above 2.0 meter
Inspect fall arresting equipment before each use
Dont use faulty fall arresting equipment
Never try to overreach
Use of lifeline where applicable
No material / tools / equipment to be thrown or dropped
Extra care to be taken in windy conditions
All material / tools / equipment to be properly stacked &
secured
Good housekeeping to be maintained all the time
Use of toe board where applicable
Proper illumination for jobs at night
No walk along unguarded portions to get access to working
platform
Area to be properly barricade and post safety signs
Proper illumination for jobs at night
Ensure availability of cold water at job site in summer
Drink water frequently to avoid dehydration in summer

Step
Potential Hazards:
3.0
Flare Blocks assembling &

Erection using scaffold /
safety nets for working at
height (Max. 141 meter)
Improper Scaffolding
Falling object hazard
Improperly stored / scattered scaffold
material
4.0
Use of ladder / Lightweight

Staging for working at height
during
Flare
Block
Assembling on ground (Max.
25 meter)
Improper selection of ladder / stepladder /

lightweight staging
Improper / unsecured use of ladder /
stepladder / lightweight staging
Excessive use of ladder / stepladder /
lightweight staging
Position of ladder / stepladder / lightweight
staging on Soft or unleveled surface
Falling Hazard
Overloading
Improper angle
Ensure availability of heat stress shelter at job site in

summer
Act as per instructions against each flag color to prevent
yourself from heat stress in summer
Ensure availability of 1st aider, 1st aid kit and list of 1st aiders
and emergency numbers at job site
Only trained & experienced scaffolders will erect / alter /
dismantle scaffolds.
Ensure that the scaffolds are weekly inspected and tagged
and are safe as per the JGC Scaffolding Procedure S-0001654-125
Also follow applicable safety precautions in Safe Work
Method Statement for Scaffolding Job.
4.22.5 b) will be used as guideline for erection & use of
safety nets.
JGC Ladder & Lightweight Staging Procedure (S-000-1654114 Section 4.13) to be used as guideline for working at
height.
All ladder / stepladder / lightweight staging should be of
approved type
Select & use appropriate ladder as per job nature and
height
Physical inspection before each use
Secure properly before each use
Minimize use of ladder / stepladder / lightweight staging
Position ladder / stepladder / lightweight staging on a stable
and level surface
Mobile towers should be provided with locking system.
No over stretching / over reaching

No overloading
Dont use boxes, stool to level up ladders
Ladder inclined at an angle of 75
Three point contact to be made all the time while climbing
or coming down on ladder / stepladder
No tools / material carrying in hands while climbing or
coming down on ladder / stepladder
Wear and Anchor fall protection equipment when working at
height more than 2.0 meter
Secure all joints, steps, and fittings of lightweight staging

Step
5.0
Use of MEWP i.e. Mobile

Elevated
Work
platforms
(Telescopic or Scissor Lift) for
Flare Blocks Assembling on
Ground (Max. 25 meter)
Potential Hazards:
Improper Planning
Use of equipment without valid & current
inspection
Uncertified operators
Overloading (Exceeding SWL)
Improper guards / barriers
Equipment on Soft or unleveled surface
Slippery surfaces under MEWP
Improper barricade & Signs
Poor supervision
Exceeding maximum gradient during MEWP
operation
Poor condition of control panel of MEWP
MEWP on slippery floor
Unguarded / open sides on MEWP
By-passing dead man handle of MEWP
MEWP without Emergency Stop Device
Struck against / Struck by
Unstable hoist ways
Unguarded moving parts
Falling from Height
Falling objects
overreach
High wind speed
Fire Hazard
Environmental hazard- leakage f oil
Movable parts of lightweight staging should operate freely

Rungs to be kept oil / grease free
Platforms free of cracks / warped
Additional securing for long ladders

Plan the job properly covering all aspects before start of
activity
measures.
Only 3rd party certified MEWP with Valid & current JGC
inspection to be used
3rd party certified operators to operate the MEWP
SWL & maximum number of passengers to be clearly
marked on MEWP and never overload or exceed these
limits
All sides of MEWP to be covered by a top rail & mid rail
Inside moving and self closing door for MEWP
Always position MEWP on a solid, level and stable surface
capable withstanding intended load
Barricade area properly and use safety signs
Full time supervision by a competent person for critical jobs
Control levers and buttons of dead man type
MEWP control panel with Emergency Stop Device
Reverse alarm for MEWP
Proper guarding on moving parts
Fall arrest equipment (Full body harness and lanyard) to be
worn all times and anchored by passengers on MEWP
Never try to overreach by leaning from MEWP platform
Secure material / tools on platform
No use of ladder or boxes etc. on MEWP platform to gain
extra height
No MEWP operation in high wind speed condition
MEWP to be equipped with a portable fire extinguisher
Use of drip tray

Step
6.0
Flare Blocks assembling &

Erection using Man cage (Man
Basket) for working at height
(Max. 141 meter)
Potential Hazards:
Improperly designed / constructed / load

tested
Use of uncertified man cage
Improper lifting machine / equipment for
man cage
Uncertified / untrained operators, banks man
etc
Failure of lifting gear
Overloading man cage
Height phobia personnel on man cage
Swaying of man cage while suspended
Improper Communication / signal
Poor weather condition
Falling hazard
Overreach
Fire hazard during hot job using man cage
fore access
Environmental hazard- leakage of oil from
lifting equipment / machinery
Heat stress

JGC Construction Safe Operating Procedure S-000-1654114 Section 4.10.3 for Man-lift equipment will be used as a
guideline for job involving use of man-cage.
Plan the job properly covering all aspects before start of
activity
measures.
MAN CAGE to be designed, constructed and load tested by
a competent engineer
Only 3rd party certified man cage to be used.
Only Valid & current JGC inspected equipment / man cage
to be used
Inspected / color coded tools / lifting gears to be used
Man Cage Lifting machine to be equipped with dead mans
handle
An additional safety line will be provided and secured to the
cranes main hook for workers to attach their safety
harnesses & persons in the man basket to hook on to that
line all the time.
Standard hand signal to be used for communication and
use radio where hand signals are impractical due to height
or distance.
Man cage not to be used in adverse weather conditions
such as high wind, heavy rain etc.
Passengers riding man cage not to sit or stand on guardrail
of man cage.
Dont use material or tools to gain extra height or reach.
During lifting / lowering man cage, hand & arms to be kept
inside man cage.
Personnel to stay inside the work platform / man basket
Materials, tools, and waste not to be thrown / dropped from
a man cage.
Lifting machine to be properly positioned on solid level
ground with outriggers fully extended and pads in place.

Step
Potential Hazards:
Power controlled lowering of man cage rather than free fall

3rd party certified operators, banks man & rigger
SWL & maximum number of passengers to be clearly
marked on MAN CAGE and never overload or exceed
these limits
Persons having height phobia or other known medical
problems like high / low blood pressure, respiratory problem
and diabetic problems etc. not to ride man cage.
All sides of MAN CAGE to be covered by a top rail & mid
rail
Always position MAN CAGE on a solid, level and stable
surface capable withstanding intended load
Crane hook should have safety latch
Additional safety line to crane hook for workers to anchor
safety harnesses
At least double tagline to be used to control suspended
MAN CAGE
Barricade area properly and use proper safety signs
Full time supervision by a competent person for critical jobs
Fall arrest equipment (Full body harness and lanyard) to be
worn all times and anchored by passengers to safety line
on MAN CAGE
Never try to overreach by leaning from MAN CAGE
platform
Use standard hand signals for communication
Use other communication aid (radio etc.) whenever needed
Secure material / tools on platform
MAN CAGE to be equipped with a portable fire extinguisher
when using man cage to perform hot job
Use of drip tray
Ensure availability of cold water at job site in summer
Drink water frequently to avoid dehydration in summer
Ensure availability of heat stress shelter at job site in

Step
Potential Hazards:
7.0
Refueling of Equipments e.g.

Generators, Man Lifts, Cranes,
etc
Environmental hazard due to Spillage of oil

during refueling.
Fire Hazards during refueling.
Personal injury due to slip / trip
Inadequate hose connection
Over fueling
Act as per instructions against each flag color to prevent

yourself from heat stress in summer
Ensure availability of 1st aider, 1st aid kit and list of 1st aiders
at job site
List of emergency numbers to be made available
Management of spills will comply with the measures stated

in the Spill Contingency, Procedure S-000-1654-128.
Trained personnel for refueling
Stay near your equipments fueling point when refueling.
Ensure a safe access to the equipment to be refueled
Wearing of appropriate PPES at all time during refueling
Switch off equipment before starting refueling
Never overstretch refueling hose
Never overfill or top the fuel tank
Refueling to be done at slow rate to reduce the potential for
spillage and static ignition buildup
Let the fuel dispenser shut off automatically and leave the
nozzle in the tank for six to eight seconds so the fuel can
settle down and any fuel in the nozzle can drip down into
fuel tank
Ensure drip tray under the equipment to be refueled.
Hose and refueling assembly should be in good condition
Refueling to be done only by refueling vehicle and trained
person.
If fuel is needed to be taken on site in cane, use the
recommended jerry cane
Ensure the availability of fire extinguisher near refueling
point
No ignition source /smoking near refueling point
Switch off mobile phone before starting refueling

HSE Information / Requirements
Resources and Competency
Does the Work Team have the necessary capacity, capability, experience & authority to avoid, minimize, monitor and control the risks (Training / Awareness / Equipment, etc.)?
Detail minimum expected requirements:
Workforce Will be trained relevant to the job they have to perform. Working at Height and Heat stress training will be given to
workforce. Supervisor to conduct tool box talk daily before start of work. Equipment to be inspected and certified by JGC
Communications / Workforce Consultation
Have all members of the Work Party attended the Toolbox Talk, and have they been made fully aware of the risks that they are taking (Residual risks)?
TBT Record No.
Yes
Supervisor to conduct tool box talk daily before start of work explaining the hazards involved in the job and Preventive
Measures to be taken.
External Risk
Has an assessment been conducted to identify all external (to the activity) hazards and potential risks (3rd parties such as other workforce teams or other adjacent parties)? What is the
result?
Risk Assess. No.
Job Safety Analysis has been carried out keeping in view all external Risks / Hazards. No simultaneous activities will be carried out
in the barricaded area by any other party.
H&S Training
Employees should be trained in the proper interaction with equipment, and the proper response to incidents involving this equipment. List the training your employee(s) has received.
Workforce Will be trained relevant to the job they have to perform. Scaffolding and Man cage Use will be given to workforce as per
their job natures.
Specialist Training
Will the workforce require any specialist training?
YES / NO (IF YES, list the specialist training required for the job):
YES
Workforce Will be trained relevant to the job they have to perform. Specialist training for Scaffolding & 3 rd party certification for
Man-lift Operators and Rigger.s Training will be given to workforce as per their job natures.
High Potential Risks

Does the task require special access / egress / heavy lifting / entry into confined spaces or work at height / in excavations?
(IF YES, a separate Risk Assessment needs to be completed).
YES / NO
Risk Assess. No.
YES
Working at Height
Other Impacts
Are there any other ways in which the work will be affecting and/or protecting the Health and Safety of the team members?
YES / NO (If so, please describe below):
YES
Heat Stress, Height Phobia
PTW / Isolations: Other Certificates / Permits
What other precautions (e.g. electrical isolation, permits to work) are required and who will authorize them?
PTW / Cert. Nos.
YES
Permit to work will be obtained wherever applicable.
Contingency / Emergency Response

Should special emergency procedures be instituted, e.g. Emergency Drill, providing Fire Wardens, extra First Aid cover, etc.?
YES / NO (If so, please describe below):
YES
AVAILABILITY OF 1ST AIDER, 1ST AID KIT, LIST OF 1ST AIDERS AND EMERGENCY NUMBERS AT JOB SITE.
Air Emissions
Will the work you perform produce or cause the release of any air emissions?
No
Water Discharges
YES / NO
(If YES, list air emissions and method for preventing impact to the environment):

Will the work you perform produce or cause the release of any wastewater?
YES / NO (IF YES, how will the wastewater be handled?):
No
Materials
What materials (chemicals, oils, etc.) and/or equipment will you be handling or bringing on-site to perform the contracted work?
Diesel as a fuel for equipments.

Environmental Training
Have employees been trained in the proper handling of materials and equipment, and the proper response to incidents involving these materials? List the training your task employees
have received.
Safe Refueling, Use of Drip tray and Spill Control training will be given to workforce as per their job nature.
Waste Generation
Will the work you perform result in any wastes? YES / NO (IF YES, list the disposal location, as well as amounts and types of wastes expected and the proposed disposal method):
YES
Waste will be disposed off as per JGC Waste Management Procedure S-000-1654-126.
Energy
Will the work you perform consume energy (electricity, compressed air, natural gas, steam, etc.)? YES / NO (IF YES, explain what type of energy will be consumed, and how you will
minimize consumption):
Yes, Diesel fuel will be used in MEWP, cranes, generators etc. Equipment will be stopped if it is not needed to reduce fuel consumption
Other Impacts
Are there any other ways in which the work will be affecting and/or protecting the environment?
No
YES / NO (If YES, please describe below):
Environmental Monitoring
Describe any environmental monitoring to be performed, including sampling methods, frequency, analytical requirements and laboratory to be used:
Environmental legal requirements given in JGC Environmental Monitoring Procedure S-000-1654-129 will be followed.
Legal requirements
Identify environmental legal requirements applicable to the work that has not already been addressed by the Project.
Not Applicable

Training modules required to complete Activity:
List Codes of Practice, Legislation, Standards which apply to this Activity:
JSA will be used as a training module
Standard
Codes
ASTM-1599
ASME B31.3
ASME B16.5
List Plant / Equipment / PPE required for this Activity:
Crane, power generator, welding machines,

compressor.
List Equipment / Maintenance

Checks required for this Activity:
Pre job equipment check

will be done before starting
the job
PPEs:
Safety Helmet
Engineering Certificates / Permits / Approvals required for this Activity

(e.g. RLC Permit Road closure, Utility isolation, Special Waste license, etc.)
No
Type
Reference/Documents
Safety Shoes
Safety Glasses
Coverall
As per job requirement:

Safety Gloves
Dust Masks
equipment
Ear Plugs
Fall protection
Person(s) Responsible for Supervising / Inspecting Work:

Person(s) responsible for supervising the work, inspecting and approving work areas, work methods, protective measures, plant equipment and power / other tools:
NB: List of qualifications/experience is held in local JGC files see JGC HSE Group for details.
Name: .
Position:
Name: .
Position:
Signature: .................................................................
Signature: .................................................................
For a list of names and signatures of staff instructed in this Safe Work Method Statement and JSA, see JGC training records.
Copy 1 - To be posted at the Worksite / Supervisor at the Worksite

Copy 2 - To be retained by JGC HSE Group (24 months)

Copy 3 - To be held by the subcontractor (24 months)
SAFE ACTIVITY PRE-CHECK (SAP) SHEET

Company:
DESCON ENGINEERING QATAR L.L.C.
Date:
Foreman (print
name):
Task Description:
Location:
Assembling & Erection of Steel Structure
MUSTER / ASSEMBLY POINT LOCATION:

IS YOUR DESIGNATED PLACE OF WORK TIDY? - YES or NO (If "NO" housekeeping must be performed prior to work commencing).
PERMIT TO WORK REQUIREMENTS
YES
(tick box)
NO
N/A
Excavations
Access Only
Plant & Equipment
Electrical
Key Task Related Hazards
Falling Hazard
Falling Object Hazard
Injury to personnel (Slip / trip, Struck Against / Struck by etc.)
Fire Hazard
Heat stress
Spillage of oil
Key Preventative Control Measures
Confined Spaces
Isolations
Lock Out / Tag Out
Hot work
Instrumentation
Pre / Commissioning / START-UP
EXCAVATION
YES
NO
N/A
Skilled manpower & Use of appropriate PPES

Safe working platforms
Secured material / tools/ equipment
Proper housekeeping & availability of fire extinguisher
Use of drip trays
3rd party certified crane operators, man-lift operators and banks-man
YES
NO
N/A
HOTWORK (Non PTW controlled)
SHORED / SLOPED / BENCHED
FIRE EXTINGUISHER
LADDERS PROVIDED
FIRE BLANKET
BURIED SERVICES IDENTIFIED
CYLINDERS UPRIGHT & SECURED
VEHICLE STOP BARRIERS / BOARDS
COMBUSTIBLES REMOVED
EXCAVATION INSPECTED
CONFINED SPACES
FIRE WATCH (Safety Passport check)
YES
NO
N/A
SPECIAL PPE (VISORS, GLOVES, etc)
STANDBY MAN
EMERGENCY COMMUNICATIONS
VENTILATION
WORK BELOW RESTRICTED
PERMIT to WORK
BARRIERS / SIGNS POSTED
GAS TEST COMPLETED
FLAME ARRESTORS FITTED
TALLY BOARD or similar
WELDING CABLES IN GOOD CONDITION
EMERGENCY ACCESS
CHEMICALS
COMMUNICATIONS
MSDS REVIEWED / AVAILABLE
SAFETY HARNESSES
SKIN / EYE / THROAT IRRITANT
SUITABLE (Ex.) LIGHTING
SHOWER or EYEWASH AVAILABLE
SCAFFOLDING
YES
NO
N/A
CONTAINERS LABELLED PROPERLY
INSPECTION SCAFTAG POSITIONED & IN DATE
SIGNS POSTED
SAFE ACCESS / EGRESS PROVIDED
RISK ASSESSMENT CONDUCTED
TOEBOARDS, KICKPLATES IN ORDER
HAZARDS COMMUNICATED
HANDRAILS SECURED
GROUNDING
HARNESS & LANYARDS INSPECTED
CONTAINMENT REQUIRED / PROVIDED
PLANT & EQUIPMENT
N/A
YES
NO
N/A
YES
NO
N/A
ABSORBENT AVAILABLE IN SITU.
YES
NO
N/A
PORTABLE TOOLS
PLANT & EQUIPMENT INSPECTED
TOOLS, APPLIANCES INSPECTED
LIFTING GEAR, RIGGING INSPECTED & CERTS.

BANKSMAN / COMPETENT PERSON
IDENTIFIED
LIFTING PLAN / CALCS & M/S CHECKED
DEFECTS REPORTED
OPERATOR CERTIFIED
OPERATORS CERTIFIED
CABLES, HOSES INSPECTED
PPE REQUIREMENTS IDENTIFIED
PORTABLE APPLIANCES INSPECTED

EXTENSION CABLE CHECKED & TAGGED
FLAGMEN TRAINED / POSITIONED
OCCUPATIONAL HEALTH
NO
SPECIAL PPE AVAILABLE AS PER MSDS
SCAFFOLD INSPECTED
STATIC LINES - TIE OFF POINTS
YES
GUARDS POSITIONED
YES
NO
N/A
PPE
SAFE ACTIVITY PRE-CHECK (SAP) SHEET

FIRST AIDER / FIRST AID KIT
HARD HAT
HEAT STRESS
BOOTS
DUST
GLASSES
HYGIENE (FOOD / WATER) CONTAINERS
COVERALLS / HIGH-VISIBILITY VESTS
NOISE
FACE MASKS
VIBRATION
GENERAL WORK GLOVES
YES
ELECTRICITY
NO
N/A
SPECIALIST PPE
PTW REVIEWED (COMPETENT PERSON)
WELDERS, FIRE RETARDANT GLOVES
SYSTEM LOCK OUT
ELECTRICAL RUBBER GLOVES
SYSTEM TAGGED OUT
EAR DEFENDERS / PLUGS
JSA / METHOD STATEMENT IN PLACE
HARNESSES / LANYARDS
SYSTEM DISCONNECTED
WELDERS SCREEN
SYSTEM TESTED
YES
NO
N/A
YES
NO
N/A
YES
NO
N/A
FACE MASK (DUST - FUMES)
MANUAL HANDLING
YES
NO
N/A
RESPIRATORS
WORKER(S) TRAINED (Safety Passport check)
SELF CONTAINED BREATHING APPARATUS
LIFTING, PULLING
FIRE RETARDENT CLOTHING
STRETCHING
ENVIRONMENTAL CONSTRAINTS
SHARP OBJECTS, PINCH POINTS
ENV. STUDY REPORT COMPLETED
(TROLLEYS, FORKLIFTS, etc) available
ENV. HAZARDS IDENTIFIED IN MS
SOUND GROUND / UNDERFOOT CONDITIONS
WORK AREA CHECKED (R&E SPECIES)
GENERAL
YES
NO
N/A
WASTE CONTAINERS / AREA IDENTIFIED
FLYING PARTICLES
SPILL CONTAINMENT
CABLES SECURED ABOVE HEAD HEIGHT
ENV. MONITOR INFORMED / AVAILABLE
VOIDS / HOLES COVERED & SECURED
SITE PLANT & VEHICLES
BARRIERS & TAPE PROVIDED
SAFE DISTANCE - VEHICLES & PEDESTRIANS
ALL HAZARDS COMMUNICATED
SIGNS ERECTED AND VISIBLE
OTHER WORKERS SAFETY CONSIDERED
NOISE / EXHAUST HAZARDS IDENTIFIED
Foreman
/ Supervisor: I have discussed the above potential hazards involved in the task, reviewed the SAFE
ACTIVITY PRECHECKLIST SHEET Card with the employees under my control, and implemented suitable and sufficient
controls to minimize the risks involved.
Name (print)
Signature
Employees: I / WE ACCEPT THE RESPONSIBILITY FOR THE SAFE BEHAVIOUR OF MYSELF AND MY CO-WORKERS
DURING THE TASKS IDENTIFIED ABOVE:
EMPLOYEE NAME
SIGNATURE
EMPLOYEE NAME
1.
10.
2.
11.
3.
12.
4.
13.
5.
14.
6.
15.
7.
16.
8.
17.
9.
18.
SIGNATURE

Safe Work Method Statement (SWMS) - : Incorporating Job Safety Analysis

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SAFE WORK METHOD STATEMENT (SWMS) Incorporating Job Safety Analysis

Description of Activity to be carried out:

ASSEMBLING & ERECTION OF FLARE

Dolphin Onshore Facilities Project

Risk Assessment Log Section:

Position: JGC HSE Manager

Activity Guidelines used:

Critical Steps in this Activity:

JGC approve the use of this MSJSA :

Improper loading of material

HSE Controls to be Implemented:

Tool box talk will be conducted by Supervisor.