SAFE WORK METHOD STATEMENT DOCUMENT

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

Project: Lot 349 SWMS No: AJ 0034
This SWMS will be reviewed: 06th Jan 2018____ (Date)
SWMS Title: Ingress access for Gate 2 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

Contractor 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 contractor 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 contractor 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 contractor acceptance criteria.

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

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: ….…/….…/….…

Enter SWMS No and Version here Page 1 of 10

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.

Enter SWMS No and Version here Page 2 of 10

B APPLICATION (to be completed by Contractor / Service Provider)
Section 1: Scope of Works
Tasks / Activities: Securing Road Side, Formwork, Concreting

Work Location (Attach Site Plan): Refer Attachments Duration: From 07/7/2017 (Date) to 11/07/2017 (Date)

Remarks:
- Nil

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

Type of Plant / Machinery / Equipment Is this equipment inspected? Remarks
1 Crawler Crane LB 855 Yes No WP/16/OK/03/29

2 Concrete Lorry Yes No -TBA -

3 Mobile Concrete Hacker Yes No TOKU TPB Series

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 Siva A/L Naggapan Construction Manager

2 Kamal Nur Azam Site Safety Supervisor

3 Tan Jiun Shiun Site Engineer

4 Chen Chee Kiet Crawler Crane Operator

10

Enter SWMS No and Version here Page 3 of 10

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

Section 1: General Information

PREPARED BY: REVIEWED / APPROVED BY:

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

Designation: Safety and Health Officer Date: …06……. /……7…. /……17…. Designation: Project Manager Date: …06……. /……7…. /……17….
Applicable Environment, Safety & Health (ES&H)
Risk Assessment Team Approved Code of Practice (COP) and/or CSR
Legislation
Name Designation Signature

 Siva A/L Nagappan  Construction Manager  ________________________

 JS Tan  Site Engineer  ________________________
   ________________________
 ________________________  ________________________  ________________________
 ________________________  ________________________  ________________________
 ________________________  ________________________  ________________________

Enter SWMS No and Version here Page 4 of 10

 Table 1:

RISK DESCRIPTION ACTION

A HIGH risk requires immediate action to control the hazard as detailed in the
HIGH RISK
15- 25 hierarchy of control. Actions taken must be documented on the risk assessment form
(H)
including date for completion.

A MEDIUM risk requires a planned approach to controlling the hazard and applies
MEDIUM RISK
5 – 12 temporary measure if required. Actions taken must be documented on the risk
(M)
assessment form including date for completion.

A risk identified as LOW may be considered as acceptable and further reduction may
LOW RISK
1–4 not be necessary. However, if the risk can be resolved quickly and efficiently, control
(L)
measures should be implemented and recorded.

The result of the hazard identification and risk assessment exercise shall be documented.

a. Qualitatively Risk Table (Matrix) – Probability (P)

b. Semi-Quantitative Risk Table – Severity (S)

Table 2:

Severity (S)
Negligible Minor Serious Fatal Catastrophic
(1) (2) (3) (4) (5)
Probability (P)

Risk Assessment can be calculated Most likely using the following formula:
5 10 15 20 25
(5)
P x S = Relative Risk; Where P is Possible Probability and S is Severity
4 8 12 16 20
(4)
Conceivable
3 6 9 12 15
(3)
Remote
2 4 6 8 10
(2)
Inconceivable
1 2 3 4 5
(1)

Enter SWMS No and Version here Page 5 of 10

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 Material and Equipment to Site Contact between Severe injury to - PPE must be worn at all time.
personnel and personnel due to - Safety Toolbox Briefing must be conducted beforehand.
moving vehicles impact from moving - Signal man/ Traffic man must be presented at the entrance to 1 4 4
vehicle guide the transportation flow (when transporter moving in/out). Supervisor/ Traffic Man
- Traffic must be controlled by experienced signal man/traffic
man.

Contact between Damage to property of - Entrance pathway to site must not be obstructed.
moving vehicle and relevant party - Proper Signage must be installed at the visible area.
permanent - Safety Toolbox Briefing must be brief to signal man/traffic man
structure/ portable beforehand.
equipment - Signal man/ Traffic man must be presented at the entrance to 1 3 3 Supervisor/ Traffic Man
guide the transportation flow (When transporter moving in/out).
- Traffic must be controlled by experienced signal man/traffic
man.

2 Unloading of materials / Shifting of Falling object on Moderate to severe - Avoid overhead lifting.
materials site personnel injury to personnel due - Constant communication between signal man and crane
to impact from heavy operator.
object/ load - Lifting object/ load shall be guided via double tag lines.
- Lifting operation area shall be barricaded from unauthorized
personnel.
- Lifting operation shall be carried out with competent lifting team
members only. 2 3 6 Lifting Supervisor
- Lifting operation shall be under supervision from lifting
supervisor at all time.
- PPE must be worn at all time.
- Safety Toolbox briefing must be conducted beforehand.
- Safety pre-check on lifting equipment prior lifting operation.
- Unloading/ Loading platform shall be maintained in good shape,
rigid and stable.
Tripping of Damage to property of - Avoid overload lifting. 2 3 6 Lifting Supervisor/ Crane
Machinery/ Crane relevant party - Constant communication between signal man and crane Operator
operator.
Moderate to severe - Crane operate platform shall be properly formed, ensure its
injury to personnel due rigid, and firm.
to impact from - Lifting crane shall be operated by experienced operator.
collapsing machinery - Lifting operation shall be barricaded from unauthorized

Enter SWMS No and Version here Page 6 of 10

 personnel.
- Lifting operation shall be under supervision from lifting
supervisor at all time.
- PPE must be worn at all time.
- Safety Toolbox briefing must be conducted beforehand.

3 Securing Work Area Contact between Severe injury to - PPE must be worn at all time.
personnel and personnel due to - Safety Toolbox Briefing must be conducted beforehand.
moving vehicles impact from moving - Signal man/ Traffic man must control traffic during barricade Traffic Controller /
1 3 3
vehicle activity Supervisor
- Road Signage at least 20m from the working area
- Blinker light must be installed along the barriers
4 Hacking Flying object Minor / Major injury - PPE must be worn at all time.
due to flying object - Safety Toolbox briefing must be conducted beforehand.
- Working area shall be barricaded from unauthorized site
Hit by high Minor / Major injury personnel.
pressure hose due to hit by high - PPE must be worn at all time
pressure hose - Trowel must only be handled by appointed worker 1 3 3 Supervisor
- Check equipment and cable for worn and tear before use
Dust Disease due to - Use only industrial cable and plug for supply
inhalation of dust - Keep cable organized at all time during usage
- Avoid working long hours / Worker needs to take rest every ½
hour when using trowel
5 Formwork Contact with Minor/major injury due - PPE must be worn at all time.
protruding rebar to trip or struck by - Safety Toolbox briefing must be conducted beforehand.
protruding rebar - Working area shall be barricaded from unauthorized site
personnel.
Contact with tool Minor injury to hand - Protruding rebar must be covered with rebar cap
used to construct due to improper saw - Formwork must be inspected by supervisor and consultant
formwork and hammer usage before concreting
- Workers must wear protective clothing and PPE all the time
- Wear protective hand gloves to prevent finger injuries
1 3 3 Supervisor
- Always handle hand tools with extra care
- Wear PPE and eyes protection at all time
- Installation of BRC must be systematic from one side to another
to prevent trip and fell
- Use proper tools to tie up BRC
- Installation of formwork must be systematic from one side to
another to prevent trip and fell
- Housekeeping must be maintained at all time
- Proper safe working platform
6 Concreting Eyes and skin Skin disease due to - Proper operator for concrete chute discharge controller 1 3 3 Supervisor
contact with contact with concrete - Workers involved in concreting process must wear full
concrete protective clothing with full PPE
Major injury to eyes if - Underneath of concrete chute shall be covered with canvas or
Concrete spill on contact with concrete zinc cover to make concrete spills doesn’t pollute the ground

Enter SWMS No and Version here Page 7 of 10

 ground - Concrete lorry to discharge direct into formwork with proper
Environmental access surrounding the formwork
pollution due to - Concrete spills will be disposed as scheduled waste
concrete spill to - Workers with contact with concrete must wash contact area
ground immediately with clean water
- Provide safe working platform during concreting

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 Pre-Start - Safety Toolbox briefing must be briefed to the assigned site personnel before work start.
- Safety precaution steps and measurement shall be briefed clearly during the safety
briefing. Supervisor
- The objectives of work/ mission shall be stated clearly during the pre-start meeting.

- Delivery of Material and Equipment to Site - Designated traffic man shall be aware upon arrival of transporter. Visible orange vest, Traffic
- Upon arrival of transporter, the traffic man shall control the traffic flow, to ensure the Whistle, Red/ Green Controller
vehicle movement can be diverted or controlled. Flag
- Traffic man shall equipped with proper PPE which include the following:-
 A visible vest
 A whistle
Enter SWMS No and Version here Page 8 of 10
  A pair of red/ green flag – indicator to stop/ move the vehicle flow
- Unloading of materials / Shifting of materials - Heavy load/ object shall have PE endorsed on the particular lifting points/ design.
- Lifting load/ object shall be guided and directed by double tag lines system.
- Lifting load/ object shall be lift and hooked at designed lifting points only.
- Lifting operation shall be under supervision of experienced lifting supervisor only.
- Lifting supervisor and riggers shall pre-check the lifting equipment, to ensure the lifting
equipment are in good condition, free from defects.
- Overhead lifting is strictly prohibited.
Lifting
- Prior unloading/ loading, the crane operator shall pre-inspect the working platform of the Lifting
Supervisor
designated area, to ensure the area is safe, firm and rigid to perform the lifting
operation.
- Signal man shall constantly communicate with crane operator, to guide, to lead the
movement of lifting object/ load.
- The lifting team shall ensure the working area is barricaded and prevent from
unauthorized personnel.
- The unloading/ loading platform shall be in good shape, barricaded, and rigid to use.
- Securing Work Area - Traffic Controller to control traffic at the corner of the road
Visible orange vest, Traffic
- Road signage then to be placed 5m in front of the work area
Whistle, Red/ Green Controller /
- Working space then to be barricaded with complete road barriers locked to one another
Flag Supervisor
- Blinking lights to be installed on the road barriers
- Hacking - Next mobile hacking equipment shall be connected with compressor
- Hacker hose must have tie back at the compressor joint and equipment joint
- Hose joint must have safety pin lock at both compressor and at hacker
- Worker operating the mobile hacker must wear full PPE including face shield Full Protective Clothing,
Hacking Supervisor
- Hacker must be rotated every 30 minutes Face shield, Face Mask
- Area barricaded to make sure no unauthorised entry during hacking activity
- Water used to reduce dust during hacking activity
- After hacking completed, all hacking waste cleared and treated as construction waste
- Formwork - Form work installed shall be constructed at all sides
- Then rebar shall be installed on formwork from one side to another Face mask, long
Supervisor
- Protruding rebar shall be covered with rebar cap sleeves clothing
- Plywood shall be used as platform to work along the completed rebar
- Concreting - Ensure designated and trained traffic controller assigned at the entrance to guide the
concrete mixer truck to work zone
- Trucks needs to be parked on levelled and stable ground condition
- Truck mixer operator to manage concrete discharge into pit wall formwork Supervisor
- The formwork to be covered with timber working platform to allow workers access on
top
- Workers shall wear proper rubber boots with steel toe and rubber gloves

Enter SWMS No and Version here Page 9 of 10

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 Che Kam Seng Project Manager
2 Siva A/L Naggapan Construction Manager
3 Tan Jiun Shiun Site Engineer

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

Enter SWMS No and Version here Page 10 of 10