ࡱ> Y[TUVWXu Abjbj s]dddd44444hl46@ @ :z z z 5555555$6855ddz z P@ dz hlz 544dddd5n3 J,5z 44f5<Method Statement Title: Pipe Burst Method Statement No: Enter MS No. HereCatchment Area: Enter Scheme No. HerePrepared By: Position: Company: Signed:Date:Checked By: Position: Company: Signed:Date:Approved By: Position: Signed: Date: Accepted for use By: Position: Signed: Date: Accepted for use By: Position: Signed: Date: Issued By: Position: Document ControllerIssue: Revision A0Status: For ConstructionDate: Issued To:Position:Please acknowledge receipt of your copy of this MS, by signing and returning the transmittal note:Transmittal Date:Project Office (orig)Site File (copy) 1. Introduction 1.1This method statement outlines initial proposals for this activity. Where it is identified that there is a need to change the method of work due to unforeseen circumstances for example, then revision, authorisation and issue will follow the same procedure as the original. 1.2This Method Statement details the site set-up, construction works, and the procedures to construct the chambers and associated pipe-work.2. Scope of Works 2.1Renew by pipe bursting method existing [Insert Dia and sewer type]. Construction of new sewers, and associated manholes, flow turning.2.2The working area plan and access route drawing is attached at Annex A.3. Responsible Persons in Charge 3.1Name:Position:Mobile:3.2The David Lewis Agent is responsible for the satisfactory completion of the works.4. Equipment and Plant. 4.101 no Komatsu 130 wheeled excavator4.111 no JCB 4CX4.12Small Tools4.131 no 20T Lorry4.142 No JC Box4.152 No 4 Hydraulic pump - super silenced4.161 No 6T Dumper4.1750m Heras fencing4.18Trench barriers4.19Trench sheets and frame4.20Hydraulic pipe bursting rig4.21Welfare Facilities5. Induction/Training/Permits 5.1All site personnel to be inducted records available at the [Please Enter Address of Site Here.]5.2All site personnel will then be familiarised with the site and made aware of any hazards. 5.3A Permit to Excavate will be issued by the David Lewis Designated Person prior to any works commencing.5.4A Permit to Enter Confined Spaces will be issued where entry into Category A and B confined spaces are required.6. Procedure/Method of Work 6.1Site Set-up6.1.1Prior to commencement of any works the Site Engineer will mark out the working easement, traffic management will be erected in accordance to Chapter 8 and with the approval of highway authority.[Enter name of highway authority here] 6.1.2The Site Engineer will mark out the location of any existing services in the close vicinity of the work area.6.1.3For compound on verge the topsoil will be stripped and stored within one side of the compound. Terram will be laid over the stripped ground, then a layer of stone will be placed and rolled to form the compound base. The operator of the roller will hold the relevant certification. Signage will be fixed to the compound fencing detailing contact numbers, PPE and access requirements etc. 6.1.4Access for deliveries will be via site entrances. These will be clearly sign posted. Material lorries arriving on site will be guided by a banksman during unloading procedures. He will be responsible for opening the entrances into the site and ensuring that the entrances are closed and secure after deliveries. The entrances must be kept closed at all other times. During break times it will be necessary for one person from the gang to supervise and maintain security on the site, by ensuring that all accesses are closed and secure.6.1.5Welfare facilities will be provided in the form of an all in one unit, comprising of a toilet, canteen, drying room and storage area. An integral silenced generator will power the unit. The compound will also have a storage container. All pumps and static plant will be situated within drip trays.6.1.6Once the working area is fenced with Heras fencing, compound set up and existing services marked out, a permit to dig will be issued thereby allowing bulk excavation to begin. All personnel involved in the works described here must be trained in accordance with this method statement and subsequent risk assessments. 6.2Excavation6.2.1Prior to excavation works for the pits proceeding, the Site Engineer will mark the location of any buried services within the area. The service drawing provided will be consulted.6.2.2The road, the surface will be cut using a road saw, the operator of which will wear goggles and ear protection as specified in the attached risk assessment. Dust suppression will be by use of a water reservoir supplying water to the cutting blade6.2.3Only when all known buried services have been located will a mechanical excavator, be used. When a machine is being used a banks man will be in attendance to alert the driver of any danger.6.2.4Existing tarmacadam will be broken out by the use of a machine-mounted breaker. The breaker will be operated by a trained person, who will be under the supervision of a banksman. It should be noted that all personnel in the immediate vicinity of the breaking operation will require eye and ear protection.6.2.5Due to the depth of the proposed pipeline it will be necessary to install a trench support system during the excavation process. The temporary works system is detailed on the attached drawing and should be adhered to at all times. Should an adaptation of this system be required proposals should be made to the temporary works designer who will agree changes. Sheet piles will be utilised where crossing services may create a problem. They will be lowered into the excavation by the use of the excavator. All straps, chains and shackles will have current test certificates. A nominated person will bank the machine during the lifting operations and whenever a movement is required. Trench boxes will be utilised where possible.6.2.6Once the bulk excavation is completed and all necessary temporary works are in place, entry will be gained to the workplace by means of a ladder access. This ladder will be in a suitable condition, tagged and dated with next inspection due. The ladder is to be placed where there is no risk of damage from plant or materials being lowered into the excavation, and shall be either tied at the top or footed by a secondary party.6.2.7Barriers will be provided around the top perimeter of the excavation. These will be a minimum of 910mm high. Where possible, this will be done by utilising the temporary works system, which will protrude above ground level. All vehicle movements within the vicinity of the works area will be under the supervision of a banksman.6.2.8Temporary works, material aggregate and pipes will be lowered into the excavation by the use of the excavator. All straps, chains and shackles will have current test certificates. A nominated person will bank the machine during the lifting operations and whenever a movement is required.6.2.9The material from the excavation will either be removed from site and taken to a tip licensed tip. 6.2.10Clear access will be maintained at all times and on completion of each working day the excavation will be fenced and secured.6.3Flow diversion at Manholes 6.3.1A Permit to Enter Confined Spaces will be issued where entry into Category A and B confined spaces are required. Works within live sewers will be conducted in accordance to the confined space procedures detailed in section 6.5.6.3.2Prior to any flow turning operations a long-range weather forecast will be acquired to ascertain the feasibility of dealing with the sewer flows, during the flow turning operation. 6.3.3Set up over pumping of existing [insert diameter here] sewer by setting up pumps in manhole upstream and down stream chambers. Via a trelleburge stopper system.6.3.4Super silenced pumps are to be used to minimise noise levels. 6.3.5A stand by pump and the necessary pipe work will be available no site as a contingency in the event of breakdown.6.3.6Once the pipe bursting operation is complete it is proposed to return the flows back into the newly installed line, it is therefore anticipated that no over pumping will be carried out over night or weekends 6.4Pipe Welding6.4.1The pipe to used on this project is polyethylene, therefore the proposed method of jointing is butt-fusion. The welding procedures is as follows: Check site is suitable and level and there is a tent to cover the fusion operation in the event of adverse weather. Check the fusion machine is complete and in good working order and as a current calibration certificate. Check the generator as a full tank of fuel. The machine will be switched on and the correct pipe size and SDR rating shall be set. The pipe will be placed on rollers to prevent drag.Covers will be placed over the end of the pipes to prevent draught. The pipes shall be loaded and clamped into the machine using safe lifting practices. The auto trim button on the control box shall be pressed and the trimming cycle will commence. The clamps will automatically open when the trimming cycle is complete and the swarf or trimmings will be cleared from the carriage. The control box will automatically close the clamps and check pipe alignment. On successful alignment the control box will automatically engage the heater plate and the heating cycle will commence. The control box will automatically open the clamps, lift the heater plate and the machine will commence with the jointing mode. The control box will not instruct the clamps to open until the joint proves successful and sufficient time as lapsed and the pipe joint cooled. At this stage a joint bead sample may be taken for future reference. 6.4.2Pipe bursting6.4.1An excavation will be made at the extremities of the length of sewer to be burst this will be manhole-to-manhole. Temporary works due to the depth and ground conditions at each location.  6.4.2When over pumping has been established, a section of the existing sewer will be taken out; the base of the excavation will be levelled so that the pipe-bursting rig sits level and flush with the existing pipe to be burst. The pipe-bursting rig is then lowered into the pit by means of the excavator, all straps, chains and shackles will have current test certificates. A nominated person will bank the machine during the lifting operations and whenever a movement is required.6.4.3The pipe-bursting rig will then be connected to the power pack and bursting rods will be inserted up the sewer line until they reach the reception pit. An expander and splitting head will be connected to the rods along with the new pipe to be installed.6.4.4The rod gripping mechanism is reversed and the rods are then pulled back, in doing so the splitting head and expander breaks and displaces the existing pipeline pulling in the new pipe as it progresses.6.4.5The bursting operation continues until the splitting head, expander and new pipe is exposed in the starting pit. The bursting rig is then removed along with the bursting accessories to leave the newly installed pipe exposed; this is then connected to the original pipe or a new or existing manhole. 6.4.6Manholes will be constructed using 1200 or 1050 dia manhole rings. A concrete base will be poured and rings used, to construct the chamber. Manholes constructed prior to the breaking out of sewer connections will be conducted under a category C confined space, as they will be newly constructed and not live. Access and egress will be good, with only LOW RISK of carbon monoxide from nearby plant filling chamber (area will be well ventilated). A gas monitor is to be used to monitor the atmosphere.6.4.7Works involved with the breaking of the sewer and connection of flows will be conducted under a CATEGORY A confined space. This due to the presence of sewage, the restricted room (physical dimensions) and poor access & egress. As these chambers are live there is a HIGH RISK of : explosion or suffocation due to ingress of gasses, lack of oxygen due to available oxygen being consumed by operatives, lack of oxygen due to chemical reaction. risk of drowning due to flooding of the chamber from excessive flows. To minimise the risk of the above if possible all connection works are to be carried out prior to the cover slab being placed over the manhole. This will increase ventilation, decrease the risk of gasses being trapped in a small space, and also provide a better access into the chamber.6.4.8Confined space trained personnel and procedures will be employed for this work. Personnel are to be trained to NVQ level 2 or City & Guilds.6.5Confined Space ProceduresCategory A6.5.1Inspect all confined space equipment and PPE before commencing works for damage, corrosion, fatigue, calibration, suitability for job in hand.6.5.2If there is a possibility of encountering hypodermic needles within the confined space a pair of anti-syringe gloves will be obtained from the stores along with cotton liners. A sharps box will also be collected in to which any syringes found shall be placed. On completion of the work the gloves will be returned to the stores. Any used sharps boxes will also be returned to the stores for disposal as controlled waste.6.5.3Remove cover on access hole and at least one cover upstream and downstream ensuring that all openings are adequately guarded to prevent anyone falling in. 6.5.4Visually inspect chamber for excessive standing water and/or high flow rates, as entry may be impractical.6.5.5Check the weather conditions for the catchment of the asset for the previous four hours and the forecast for the duration of the work as flash flooding or increased flows may occur even if it is not raining where you are entering.6.5.6Where possible all assets must be isolated by the use of valves, stop logs or any other mechanical means and locked off by use of chain and padlock. The turning of valves, etc., shall only be carried out with the permission of Welsh Water.6.5.7Having ventilated the asset for at least 15 minutes a gas detector should be lowered by rope in to the opening in peak reading format for 10 minutes. Slowly withdraw the gas detector and check the readings looking for extreme readings and record on the Permit to Enter. The Permit to Enter confined spaces will be authorised by Marc Griffiths (Senior Engineer). Tel: 07801 663016. 6.5.8Should forced ventilation be deemed necessary this shall be installed on initial opening and again left for a minimum of 15 minutes prior to performing the initial atmospheric checks.6.5.9If whilst performing the initial atmospheric check a gas alarm is recorded the entry will be abandoned and the Supervisor responsible for the work informed immediately giving the details of the alarm. NOTE: Any gas alarm is a reportable occurrence.6.5.10If no harmful gases are detected work may proceed.6.5.11Set up the tripod and winch over the entrance and re lower the gas detector in to the asset. The gas detector is to be stationed at chest level of working height. (An additional gas monitor may be worn by the operative entering the confined space).6.5.12Personnel entering the confined space must at least wear suitable safety footwear, hard hat, High visibility clothing, full body harness and BA set. Other PPE to include waterproof clothing, waterproof gloves, safety goggles and face mask where appropriate. No one should enter if they have an open wound.6.5.13Any person entering the confined space may be lowered by the top man (winch man) whilst connected to the winch at all times. The first man into the confined space must visually check the structural condition of components and where there are ladders or step irons physically test by applying firm pressure with their feet. Verbal contact must be maintained between personnel in the confined space and the top man at all times. 6.5.14At all times one man within the confined space must be connected to the rescue winch.6.5.15If contact is lost with the person in the asset, the top man will raise the person using the tripod and winch.6.5.16Should a gas detector alarm whist works are ongoing then personnel will don their BA sets and evacuate the confined space, being attached to the rescue winch. When the confined space is clear the alarming gas detector(s) will be checked and the Supervisor informed immediately giving full details of occurrence. Work must not proceed until the cause of the alarm is ascertained and the confined space has been rechecked the appointed supervisor has been notified and the all clear has been given.6.5.17Should the person in the confined space pass out and the crew are unable to winch him to the surface then no one should attempt to enter the confined space to rescue that person and emergency procedures should be deployed.6.5.18The top man must not leave the top of the confined space whilst a person is in the confined space and shall possess a form of communication should an emergency arise.6.5.19Once work has been completed the manhole/chamber must be made safe by replacing the covers.6.5.20Report any accidents, cuts, lacerations etc. that occurred within the confined space immediately to the Supervisor and Safety Co-ordinator.Category C6.5.21Chambers classified as low risk can be entered once gas monitoring has taken place. The monitor must remain whilst work continues6.6Reinstatement6.6.1Upon completion and commissioning of the new sewer, all works materials will be removed and the area will be reinstated. 6.6.2The road areas will be reinstated to HAUC specification.7. Quality Assurance 7.1Air testing of the pipelines will be required. 7.2All works to be carried out within the David Lewis quality procedures.7.3The Inspection Test Plan is to be checked by the Catchment Agent at the end of all operations specific to these works.8. Contingency Plans 8.1In the event of any incident requiring the attendance of the Emergency services, raise the alarm by dialling 999. The caller should be prepared to give their name, location and nature of the emergency. Then contact the main site office using the hand held radios or by telephoning on: Enter Site No.8.2First Aid kits are available in the Site Cabins and with the appointed First Aiders, and in Site Engineers cars.8.3No extra contingency plans are deemed necessary for the work being carried out under this method statement.9. Special Conditions 9.1No special conditions apply for the work being carried out under this method statement. Should any conditions be imposed they shall be briefed to the necessary operatives by means of toolbox talks.9.2Only those people with confined space qualifications (NVQ Level 2 or City and Guilds) are to work in confined spaces. 10. Approvals 10.1This method statement is only valid when the person who has prepared it and the persons who have authorised it have signed the front sheet accordingly.10.2This method statement should also be distributed to the persons on the method statement Tracking and content sheet for approval status and/or comment.11. Risk Assessments 11.1See the appended risk assessment references 1 to 28 1Pipe-BurstingContact with rat infested waterWeils DiseaseFatality Major injuryS4S3S12Good hygiene Issue PPE & train in use Tool box talks Welfare facilities COSHH assessmentS4S1S42Pipe-BurstingContaminated WaterWater bourne Polutants / bacteria etc.Fatality Major injury PathelogicalS4 E3S3 E4S12 E12Good hygiene Issue PPE & train in use Tool box talks Welfare facilities COSHH assessment Water testing regime Suitable clothingS4 E3S1 E1S4 E33Pipe-BurstingLiquid leakagesSpills. Poorly maintained plant. Damaged containers.Destruction of waterbourne life forms. De-oxygenation of water courses. Contamination of natural watercourses.S3 E3S3 E4S9 E12All hazardous liquids to be placed in secure bunded areas. No re-fuelling of plant within river boundaries. Or over/adjacent to gullies. PPM scheme on all plant. Spill response kit on site. Spill response procedures in place. All washing out of equip. away from site.S3 E3 S1 E1S3 E3 4Pipe-BurstingBacterial infectionBad personal Hygiene, touching Face/mouth with Dirty hands, infection Through open woundsSerious illness and possible deathS4S3S12Wash thoroughly after exit from contaminated areas(both equipment and body), do not touch face, wear protective clothing e.g. gloves and overalls, use barrier cream and cover abrasions with sterile waterproof dressing.S3S1S35Manhole ConnectionsWork to be carried out in live chambers or those with live connections. Exposure to sewer gas and CO from plant. AsphyxiationSuffocation caused by inhalation and absorption into the blood stream. Symptoms often unnoticeable until loss of consciousness and death. S4 E1S3 E1S12 E1Access into a confined space will require recognised confined space training. NVQ Level 2 or City and Guilds Categorisation of Confined space to be carried out by competent person. A safe system of work (method statement) prepared detailing the procedure for works in the designated confined space. Works to be carried out according to this procedure. All operatives involved to the briefed on works procedure and signed on to the method statement. Gas detection prior to entry and whilst work is in progress. Rescue system in place with observers in contact with workers at all times. Rescue equipment to be in good working order, certified and checked before use.S4 E1S2 E1S8 E1 6Pipe-BurstingFalling and tripping Falls into open manholes.Serious injury or death due to fall from height. Falling onto sharp or awkward objectsS4 E1S3 E1S12 E1Solid barrier to physically prevent falling into open manhole. Use of signs to warn of open manhole beyond barriers. Provide substantial covering to possible fall hazard.S4 E1S2 E1S8 E17Pipe-BurstingFalling objectsObjects falling onto operatives from existing ground level.Serious injury from impact and possible death.S4 E1S3 E1S12 E1Good house keeping to work area. Ensure operatives wear head protection.S4 E1S2 E1S8 E18Pipe-BurstingGeneral public and local residents, children.General public gaining access to the site causing injury to themselves.Possible death or injury due to falling, tripping and other accidents due to ignorance of the danger on construction sites.S4 E2S4 E4S16 E8Take all practicable measures to ensure that access cannot be gained to the work area during day or night. Provide signs to highlight the dangers present.S4 E2S2 E2S8 E49Pipe-BurstingTrafficCollision.Serious Injury and possible death.S4 E2S3 E3S12 E6Traffic management schemes and use of high visibility clothing for all personnel.S3 E2S1 E1S3 E2 10Connection to existing sewerPresence of explosive gases such as methane in confined spaceExplosionSerious injury and possible deathS4 E2S3 E3S12 E6Use of gas detectors, and intrinsically safe equipment whilst in confined space. Use of fan blowers to maintain ventilation if required. Access into a confined space will require recognised confined space training. NVQ Level 2 or City and Guilds Categorisation of Confined space to be carried out by competent person. A safe system of work (method statement) prepared detailing the procedure for works in the designated confined space. Works to be carried out according to this procedure. All operatives involved to the briefed on works procedure and signed on to the method statement.S4 E2S1 E1S4 E211Pipe-BurstingUnderground ServicesExcavation in the vicinity Electric cables Gas Mains etc.Fatality serious injuryS4S3S12Permit to dig system following examination of service drawings and liason with stats. CAT scan of area. Trial holes as necessaryS4S2S812Pipe-BurstingNoiseOperating plantEar damage Environmental impactS3S4S12Silenced plant Correct PPE issue and trainingS3S1S3 13Pipe-BurstingPlant, Vehicle movementCollision with operatives and other plant. Working in restricted access areas.Serious injury, crushing possible fatality. Damage to plant and equipment.S4S3S12PPE High visibility clothing Use of trained banksman/signallers CTA trained plant operatives. Designed vehicle routes for deliveriesS4S2S814Pipe-BurstingCrushing due to trench collapsePoor ground conditions Adverse weather conditions causing ground rotation Ingress of ground water causing underminingCrushing and /or burial of operatives at the work face. Possible ingress of plant and other operatives due to the surface effect. Usual effect of collapse S4S3S12Use of suitable temporary works as detailed on the temporary works drawings attached to method statement. Regular inspection of temporary works. Stockpile horisons away from excavation Avoid plant excavation.S4S2S815Pipe-BurstingEating and drinkingIncrease contact with contaminant during meal breaksIngestion due to direct contact via hand to mouthS3S4S12Provision of suitable welfare to include siting of wipes, skin safety cradle and appropriate disposal arrangementsS3S1S3 16Pipe-BurstingEnvironmental storagePoor storage of contaminated material including disposable overallsRun off of contaminated material from spoil heap and mobilisation around site and pollution of adjacent watercoursesS3 E2S4 E3S12 E6Dedicated storage area segregated away from other waste Bunding of sensitive areas Cover contaminated material Dedicated bins for disposable overallsS3S1S317Pipe-BurstingJack hammers Heavy breakers Noise/Vibration caused by hammer action, and flying debrisDamage to hearing from prolonged use. Vibration injuries. Eye damage from flying debrisS4 E2S4 E3S12 E6Avoid using hand held tools where possible. Use of machine mounted breakers in preference to hand tools. Concrete drilling and cutting operation in preference to hand tools. Ensure adequate ear protection. Eye protection. The use of gloves for breaking operation. Adequate signage around site.S3S1 S318Pipe-BurstingUse of vibrating toolsHAVS, Damage to ears, eyes(from flying debris)Vibration white finger, eye injury, damage to hearingS3s3S9Low vibration tools to be ordered where possible, operatives to wear gloves and keep hands warm (to aid circulation), rotation of operation between operatives to reduce time using vibrating tools. Appropriate PPE must be worn during such operations (i.e. ear defenders, goggles, dust mask, gloves.)S32S6 19Pipe-BurstingLifting operationsUncontrolled lifting of loads causing failure of lifting appliances or equipmentDropping of load in an unsafe manner uncontrolled slewing causing collision with plant or operativesS4S3S12Regularly tested appliances and equipment with test certificates, to be used. Trained banksman to control lifts.S4S2S820Pipe-BurstingMoving/Lifting of loadFailure of lifting equipmentLoad falling Fatality Crushing/Injury DamageS4S3S12Only approved lifting appliances and equipment to be used.S4S1S421Pipe-BurstingAbrasive WheelsInjury to user and other personnel from flying debris or incorrect use of wheel.Serious injury and possibly death. Damage to eyes and hearing . Prolonged use can cause Vibration White Finger.S4S3S12Use of goggles (to BS2092) Use of ear defenders (E.A.R.Classic or similar). Use of gloves (short rigger type) Ensure all necessary guards are in place. Competent person only to change blade ensuring speed match. Do not use side of blade S4S2S8 22Pipe-BurstingSmall toolsElectrocution of Operator due to faulty equipment. Injury from flying debris. Damage to hearing.Electrocution causing possible death or burns. Damage to eyes. Prolonged use may cause Vibration White Finger. Some small tools may exceed first or second action level db(a)S4S3S12Use of goggles (to BS 2092) Use of ear defenders (E.A.R.Classic or similar). Use of gloves (short rigger type) Small tools to be P.A.T tested prior to use. 110V tools only.S4S1S423Pipe-BurstingAir hoses Hoses blowing from winch/airspannerOperatives struck by hose end fractures head injuriesS3S3S9Correctly fitted hoses Hoses over 20mm to be fitted with whip checks Air supply turned off at tap when charging tools (No manual crimping)S3S1S324Pipe-BurstingConcrete placing and finishing.Poor PPM for working with concreteAlkali burns to exposed skin and eyes.S3S3S9Cover bare skin before working with concrete Use of goggles (to BS 2092). Wear gloves (PVC coated).S3S1S325Pipe-BurstingPipe greasePoor PPMCauses Dermatitis.S3S2S6Wear gloves (PVC coated) Good hygiene before eatingS3S2S6 26Pipe-BurstingDiesel fuelPoor PPMDermatitis and poisoning if ingestedS3S3S9Cover exposed skin and wear gloves (PVC coated).S3S1S327Pipe-BurstingManual LiftingInjury to operativesShort term & Long term injuries Crushing of LimbsS3 4 S12 Ensure that correct lifting procedure is adopted, and that operatives have training in correct manual lifting. Mechanical means of lifting to be used where possible. S4 2 S8 28Pipe-BurstingUse of small toolsInjury to operativesCuts, lacerations and abrasions.S34S12Ensure that tools are fit for purpose. Check tools for any defects, signs of wear and tear, parts missing due to impact etc. Use of correct PPE. Gloves, eye protection, overalls safety footware.S22S3 Method Statement Title: Pipe Burst Method Statement No: Enter MS No. HereIssued By: Position: Document ControllerIssue: Revision A0Status: For ConstructionDate: Induction By: Position: Signature: Date:  The following personnel have been inducted in the procedures required to carry out the operations detailed in this method statement. (Note: please complete the original method statement attendance sheet [to be kept in the on-site master file] and return when induction is complete. Copies of the original method statement are to be distributed to the method statement holders). (Note to Contractor: whenever the method of work changes significantly you must seek agreement from David Lewis before proceeding. Remember to instruct all new starters and get them to sign below). Name:Job Description:Signature:Employer: Control Sheet: Method Statement/Risk Assessment Tracking and Content Name:Position:Consulted:Status*/Comments:Y/NY/NY/NY/NY/N Status*: A Work can proceed as described B Work can proceed when comments are incorporated C Re-submit before work can proceedNoPrompt ListYesNoIn PartN/A1Describes the works/individual tasks/the sequence and method?2Names and titles of key personnel/supervisors responsible?3Resources required eg. equipment, plant, men, materials?4Programme of works and working hours identified?5Interfaces/security of the client/public/other contractor identified?6Specific risk assessment attached and satisfactory? Are all the hazards identified? Have all the risks been evaluated? (see item 7)7High risk or safety critical activities identified/controls specified?8Access/scaffolding requirements clearly set out?9Certificates of competence or qualification of operatives provided?10Certificates for plant/equipment/inspection/examination provided?11COSHH, noise, manual handling issues dealt with?12Personal protective equipment specified?13Permit requirements identified?14Monitoring (checks and inspections) identified?15Any builders work in connection, identified/adequate notice given? 16Temporary protection/support identified (eg. fire, traffic, services)?17Environmental controls/waste disposal identified?18Craneage certificates/checklist/lifting plan in place?19Lifting equipment certificates in place?20Emergency arrangements/first aid/special welfare?21Statement confirming operatives to sign as being inducted?22Statement confirming regular eg. daily briefing of operatives by supervisor?23Toolbox talks to be provided?24Method statement signed on behalf of contractor?25Any other (specify)? Any generic risk assessment must be amended/confirmed as site specific. METHOD STATEMENT Page  PAGE 1 of 20 Rev. A0 Enter Date RISK ASSESSMENT RISK ASSESSMENT FORM ACTIVITY: Pipe Bursting (C) Environmental Consequence (C) Health & Safety Consequence (F) Frequency (RR) Risk Rating (Consequence x Frequency) E1 Insignificant (No Effect) S1 Insignificant (No Effect) 1 Improbable 1-5 Insignificant E2 Marginal (Minor Effect) S2 Marginal (Minor Injuries) 2 Unlikely 6-8 Acceptable PROCEED E3 Serious (Major Effect) S3 Serious (Major Injuries) 3 As Likely As Not 9-15 Unacceptable WORK SHALL NOT START E4 Critical (Irreversible) S4 Critical (Fatalities) 4 Probable 16-25 Intolerable E5 Catastrophic S5 Catastrophic 5 Highly Probable No Activity/ Event/ Feature/ Situation Hazard/Issue/ Interaction (Cause) Undesired Event Consequences Before Control After Control (C) (F) (RR)CONTROL (C) (F) (RR) NB: Any risk assessments for expectant/nursing mothers and young persons must be in conjunction with the South Wales Safety Consultancy Person completing the risk assessment: Enter name and position Date : Enter Date  Page  PAGE 18 of 20 Rev. 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