Method Statement (Non-Construction)

Project / Task Details

Company Name: [COMPANY NAME] ABN: [ABN] Job Reference Number: [REF NUMBER] Date of Preparation: [DATE]

Task Description: [BRIEF DESCRIPTION OF THE WORK TO BE UNDERTAKEN]

Location of Work: [SITE ADDRESS OR SPECIFIC LOCATION WITHIN A FACILITY]

Date and Time of Work: [START DATE] to [END DATE] [WORK HOURS]

Personnel: Name: [SUPERVISOR NAME] | Role: [SUPERVISOR ROLE] Name: [WORKER 1 NAME] | Role: [WORKER ROLE] Name: [WORKER 2 NAME] | Role: [WORKER ROLE]

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1. Hazards and Risks

Hazard	Who is at Risk	Potential Consequence	Initial Risk Rating (L/M/H)
[HAZARD 1, e.g. Use of chemicals]	[WHO, e.g. Operator, nearby staff]	[CONSEQUENCE, e.g. Chemical burn, respiratory issue]	[RATING]
[HAZARD 2, e.g. Moving vehicles]	[WHO]	[CONSEQUENCE]	[RATING]
[HAZARD 3]	[WHO]	[CONSEQUENCE]	[RATING]

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2. Control Measures

[Describe the measures taken to control the risks listed above. Refer to the Hierarchy of Controls.]

Hazard 1: [NAME]

• Elimination: [Can it be removed?]
• Substitution: [Can something safer be used?]
• Engineering: [Guards, barriers, ventilation]
• Administrative: [Training, signage, permits]
• PPE: [Gloves, respirator, goggles]

Hazard 2: [NAME]

• [List controls as above]

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3. Step by Step Method / Sequence of Work

Step 1: Preparation

• Action: [Describe setup, e.g., Barricading the work area]
• Risk: [Associated risk]
• Controls: [Safety measure]

Step 2: [Activity Name]

• Action: [Describe the specific action]
• Risk: [Associated risk]
• Controls: [Safety measure]

Step 3: [Activity Name]

• Action: [Describe the specific action]
• Risk: [Associated risk]
• Controls: [Safety measure]

Step 4: Cleanup and Demobilisation

• Action: [Describe cleanup, e.g., Removing waste, removing signs]
• Risk: [Associated risk]
• Controls: [Safety measure]

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4. Plant and Equipment

Item	Inspection Date	Next Due Date	Operator License/Competency
[EQUIPMENT 1]	[DATE]	[DATE]	[LICENSE NUMBER OR 'COMPETENT']
[EQUIPMENT 2]	[DATE]	[DATE]	[LICENSE NUMBER OR 'COMPETENT']

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5. Personal Protective Equipment (PPE)

[ ] High Visibility Vest/Shirt [ ] Safety Helmet [ ] Safety Glasses/Goggles [ ] Safety Boots (Steel cap/composite) [ ] Gloves (Specify type: [TYPE]) [ ] Hearing Protection [ ] Respiratory Protection (Specify type: [TYPE]) [ ] Dust Mask [ ] Other: [SPECIFY]

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6. Emergency Procedures

Nearest First Aid Kit Location: [LOCATION] Emergency Assembly Point: [LOCATION] Fire Extinguisher Location: [LOCATION]

Emergency Contacts:

• Site Supervisor: [NAME] - [PHONE NUMBER]
• Emergency Services: 000
• Poisons Information Centre: 13 11 26
• Local Hospital: [NAME] - [PHONE NUMBER]

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7. Sign Off

I acknowledge I have read and understood the contents of this Method Statement. I agree to follow all safety controls and procedures listed.

Worker 1: ____________________ Date: ______ Worker 2: ____________________ Date: ______ Worker 3: ____________________ Date: ______

Supervisor / Manager: ____________________ Date: ______