METHOD OF STATEMENT SUBMITTAL

Project: AL-Ahsa Employer: SEVEN

Supervision
Engineer: WSP Middle East Dar Al-Handasah Consultants
Consultant:
Cost
Consultant: Turner & Townsend Contractor: Ansab General Contracting
A

Civil Strucs Mech Elec Arch Submittal 3HASA13-HASA-07-AGC-ST-MES- REV.

Discipline: (Specify) Ref:
CI ST ME EL AR 0004 B
Location: Al-Ahsa Date: 13-08-2024
Description
METHOD OF STATEMENT OF

MSRS for Sika Grouting

Compliance Statement:

Initiator/Quality Engineer QA/QC Manager Project Manager

MohamedGobra Mohamed
Gobran
n
13-08-2024 Name, Signature & Date 13-08-2024
Name, Signature & Date
Name, Signature & Date
REVIEWER’S COMMENTS

LDC(Str/MEP) A☐ B☐ C☐ D☐ ARCHITECTS A☐ B☐ C☐ D☐

A−Approved
B−Approved With A−Approved
comments C−Revise and B−Approved With
resubmit. comments C−Revise and
D−Rejected resubmit.
D−Rejected

Name, Signature and date Name, Signature and date

Comments Sheet Attached? Yes ☐ No ☐ Comments Sheet Attached? ☐ No ☐
Yes
ENGINEER/ EMPLOYER’S REPRESENTATIVE A☐ B☐ C☐ D☐

Name & Signature: Date:

 Program 3 Eastern
Province (Dammam, Al
Khobar & Al Ahsa)

METHOD STATEMENT
Saudi Entertainment
Project Location Al ahsa Client :
Ventures (SEVEN)

PMC WSP LDC / Consultant DAR

Cost Consultant: Turner & Townsend Arabia Contractor: ANSAB GENERAL CONTRACTING

METHOD STATEMENT NO.: 3HASA13-HASA-07-AGC-ST-MES-00004 REV: A

ORIGINATOR: Mazen Salameh – Engineer DISCIPLINE:

Structure

Title: METHOD STATEMENT OF

MSRS for Sika Grouting

STAT
REV DATE PURPOSE OF ISSUE
US

07-08-2024
A FA First submission for approval.

B 13-08-2024 First submission for approval.

Status
Code:
 Method Statement / Risk Assessment
Sika Grout Application
Rev: B Date of Issue 13-08-2024

Table Of Contents
1: Scope:............................................................................................................................................................3
2: References.....................................................................................................................................................3
3: Health & Safety Hazards...............................................................................................................................3
4: Definitions:.....................................................................................................................................................3
5: Personals Responsibilities:............................................................................................................................3
5.1 : Project Manager........................................................................................................................................3
5.2 : Construction Manager:..............................................................................................................................3
5.3 : Health & Safety Manager:.........................................................................................................................4
5.4 : Architect/Design Engineer:........................................................................................................................4
5.5 : Civil/Structural Engineer:...........................................................................................................................4
5.6 : Project Engineer:........................................................................................................................................4
5.7 : Quality Control/Quality Assurance Manager:..........................................................................................4
5.8 : Safety Officer:............................................................................................................................................4
6: Procedure & Method To Be Applied...........................................................................................................5
6.1 : Required Material & Proper Storage for Grout.......................................................................................5
6.2 : Surface Preparation...................................................................................................................................5
6.3 : Mixing.........................................................................................................................................................5
6.4 : Application..................................................................................................................................................5
6.5 : Quality Assurance and Safety Measures:.................................................................................................5
Quality Assurance:.............................................................................................................................................5
Safety Measures................................................................................................................................................6
7: Manpower Requirement..............................................................................................................................6
8: Material Requirement...................................................................................................................................6
9: Test Reports for Material Sika Grout:.........................................................................................................6
10: Health & Safety Provisions:........................................................................................................................6
11: QA Approval & Quality Requirements.......................................................................................................8
QA Approval.....................................................................................................................................................8
Quality Requirements........................................................................................................................................8
12: Record to be Produced...............................................................................................................................8
13: Distribution..................................................................................................................................................9
14: Site Safety Approval Requirements............................................................................................................9
15: Risk Assessments and Control Measures..................................................................................................9
16: Environmental Aspect, Impacts & Control Measures..............................................................................9
17: List of Hazardous Material To Be used....................................................................................................10
17.1 : Sika Grout...............................................................................................................................................10
Main Components:........................................................................................................................10
Hazards..........................................................................................................................................10
Storage Requirements:..................................................................................................................10
17.2 : Water (if mixed with Sika Grout ).........................................................................................................10
Hazards..........................................................................................................................................10
17.3 : Cleaning Agents (if applicable)..............................................................................................................10
Types:............................................................................................................................................10
Hazards..........................................................................................................................................10
17.4 : Additional Admixtures (if any used).....................................................................................................10
Description....................................................................................................................................10
Hazards..........................................................................................................................................10
17.5 : Sealants or Protective Coatings (if applied postgrouting)...................................................................11
Types:............................................................................................................................................11
Hazards..........................................................................................................................................11
17.6 : Other Possible Additives........................................................................................................................11
Expansive Agents (if used):.........................................................................................................11
General Considerations:..................................................................................................................................11
MSDS (Material Safety Data Sheets):.........................................................................................11

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 Method Statement / Risk Assessment
Sika Grout Application
Rev: B Date of Issue 13-08-2024
18: List of Hazardous Wastage To Be Generated..........................................................................................11
18.1 : Residual Sika Grout Mixture.................................................................................................................11
Description.....................................................................................................................................11
Hazards..........................................................................................................................................11
18.2 : Packaging Materials...............................................................................................................................11
Description.....................................................................................................................................11
Hazards..........................................................................................................................................11
18.3 : Cleaning Agents and Wastewater.........................................................................................................12
Description.....................................................................................................................................12
Hazards..........................................................................................................................................12
18.4 : Used Personal Protective Equipment (PPE)........................................................................................12
Description.....................................................................................................................................12
Hazards..........................................................................................................................................12
18.5 : Spill Residues..........................................................................................................................................12
Description.....................................................................................................................................12
Hazards..........................................................................................................................................12
18.6 : Hardened Grout Waste.........................................................................................................................12
Description.....................................................................................................................................12
Hazards..........................................................................................................................................12
18.7 : Contaminated Soil or Materials............................................................................................................13
Description.....................................................................................................................................13
Hazards..........................................................................................................................................13
19: Permits:......................................................................................................................................................13
20: Attachments..............................................................................................................................................13

2
 Method Statement / Risk Assessment
Sika Grout Application
Rev: B Date of Issue 13-08-2024

1: Scope:
The scope of work for ansab Contracting in the Seven Fences Project includes the
preparation and construction of a site office, fulfilling the architectural, mechanical, and civil
requirements as outlined in the contract with SEVEN. This scope is to be executed in strict
compliance with the project’s quality standards, ensuring that all work is completed safely,
on time, and within the stipulated budget.

2: References:
1. Contract
2. Shop Drawings
3. Material Submittal
4. Approved Sample
5. Material Inspection Request
6. Technical Data Sheet
7. Lab Test Reports
8. Foundation Detail ( Shop Drawing & MSRS)
9. Survey Report Approval Of Foundation
10. Inspection Testing Plan (ITPs)

3: Health & Safety Hazards:

Refer to Risk Assessment

4: Definitions:
Sika Grout is a high-performance, non-shrink, cementitious grout designed for precision grouting
applications. It offers excellent flowability and high early strength, ensuring stability and durability for
structural components. Ideal for base plate grouting, anchoring, and various other construction uses.

5: Personals Responsibilities:
In a construction project involving Sika Grout Application, a well-defined project organization with
key personnel and their responsibilities is crucial for the successful execution of the work. The
following are key personnel and their respective responsibilities in the context of Sika Grout
Application: (Ansab General Contracting Project Organization Chart is attached)
5.1 : Project Manager:
Responsibilities:
 Overall project oversight.
 Budgeting and cost control for Sika Grout Application activities.
 Coordination with other project stakeholders.
 Ensuring adherence to project timeline.
 Quality control and assurance.

5.2 : Construction Manager:

Responsibilities:
 On-site management of construction activities.
 Coordination of subcontractors, including Sika Grout Application teams.
 Schedule management for Sika Grout Application.
 Ensuring compliance with safety regulations.
 Addressing any on-site challenges.

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 Method Statement / Risk Assessment
Sika Grout Application
Rev: B Date of Issue 13-08-2024

5.3 : Health & Safety Manager:

Responsibilities:
HSE Manager is responsible for establishing and implementing an effective HSE
Management System by Ansab General Contracting HSE requirements.
 Ensures the HSE management system requirements are implemented and maintained.
Coordinates with the Site HSE team and the Construction Management team to ensure effective
implementation of the HSE Procedures.
 He may lead the entire team, maintaining HSE awareness and creating the safe culture
and working environment through innovative ideas.
 Planning and coordinating the HSE Training for the project.
 Issue necessary directives to Safety Officer / Supervisor and render advice to the Project
Manager, as required.
 Carry out HSE inspections at construction sites concerning all HSE issues.
 Liaise with Ansab General Contracting HSE Department.
 Take part in incident investigation and reporting of all Incidents.
 Take part / attend in Client's HSE meetings.
 Monet or/and assess HSE measures on visits to sites.

5.4 : Architect/Design Engineer:

Responsibilities:
 Joint design and detailing for Sika Grout Application.
 Specification of Erection of Sika Grout Application types and requirements.
 Reviewing shop drawings related to Grout.
 Ensuring architectural intent is maintained.

5.5 : Civil/Structural Engineer:

Responsibilities:
 Assessing structural implications of Sika Grout Application.
 Providing specifications of Sika Grout Application on structural elements.
 Collaborating with the design team to ensure structural integrity.

5.6 : Project Engineer:

Responsibilities:
 Coordination of daily construction activities.
 Liaison between on-site teams and project management.
 Monitoring progress of Sika Grout Application.
 Ensuring compliance with project specifications.

5.7 : Quality Control/Quality Assurance Manager:

Responsibilities:
 Developing and implementing quality control plans for Sika Grout Application.
 Conducting inspections and tests on Sika Grout materials.
 Ensuring compliance with industry standards.
 Documenting and addressing non-conformities.

5.8 : Safety Officer:

Responsibilities:
 Implementing and enforcing safety protocols for Sika Grout Application.
 Conducting safety training for personnel involved.
 Regular safety audits on-site.
 Addressing safety concerns promptly.

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 Method Statement / Risk Assessment
Sika Grout Application
Rev: B Date of Issue 13-08-2024

6: Procedure & Method To Be Applied:

6.1 : Required Material & Proper Storage for Grout

6.2 : Surface Preparation:

 Concrete surfaces should be clean, rough, sound, and free from oil, grease, cement laitance, and
all loosely adhering particles.
 Absorbent surfaces should be saturated thoroughly with clean water.
 Galvanized anchor bolts should be free from scale, rust, oil, and grease.

6.3 : Mixing:

 Begin by adding 3.25 to 3.5 liters of water per 25 kg bag into a clean mixing vessel to achieve the
desired consistency.
 Slowly introduce the Sika Grout powder into the water.
 The grout is optimally mixed using a forced action mixer for 2 to 3 minutes until the mixture is
free of lumps.
 Alternatively, a slow-speed drill with a maximum speed of 500 rpm can be used.
 The recommended water temperature for mixing Sika Grout should ideally be between 15°C and
25°C (59°F to 77°F)

6.4 : Application:

 Provide strong formwork around the base plates before grouting.

 Before pouring let the mixed grout stand for approximately 5 minutes after mixing to allow
entrapped air to escape.
 Pour into the prepared area such that the grout has the shortest distance to travel.
 Ensure that air displaced by the grout is allowed to escape.
 When carrying out the base plate grouting, ensure a sufficient head of pressure to keep the mortar
flowing.
 All exposed areas of the mortar surface should be kept as small as possible.
 Required thickness for grout as per approved shop drawing.
 Pot life 2hrs at 23 °C.

6.5 : Quality Assurance and Safety Measures:

Quality Assurance:
 Regularly inspect all materials and workmanship to ensure compliance with design specifications
and standards.

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 Method Statement / Risk Assessment
Sika Grout Application
Rev: B Date of Issue 13-08-2024

 Verify the water-to-powder ratio is within the recommended range.

 Check the consistency and workability of the grout before application.
 Inspect the formwork to ensure it is secure and leak-proof.

Safety Measures:
 Follow all safety protocols and provide necessary PPE (Personal Protective Equipment) to all
workers.
 Conduct regular safety meetings and site inspections to ensure a safe working environment.

7: Manpower Requirement:
 Construction Manager
 Surveyor
 Civil Engineer
 Supervisor
 Foreman
 Mason
 Mason Helper
 Carpenters
 Mixer Machine operator
 Third-Party For Testing

8: Material Requirement:
 Sika Grout
 Clean, Potable water
 Formwork materials
 Curing compound (if applicable)

9: Test Reports for Material Sika Grout:

As Per the Approved Material Submittal, Refer to Material
Submittal. It Will Be submitted with a Material Inspection Request
(MIRs)

10: Health & Safety Provisions:

Health and safety are paramount in steel erection work due to the high-risk nature of the
tasks involved. The following provisions should be implemented to ensure the safety of all
personnel on site:
1. Planning and Preparation: Risk Assessment: Conduct a thorough risk assessment before
starting the work to identify potential hazards and implement appropriate control measures.
Safety Briefings: Conduct daily toolbox talks and safety briefings to ensure all workers are
aware of the risks and safety measures.
2. 2. Personnel Safety: Training and Certification: Ensure that all personnel involved in
steel erection are properly trained and certified, particularly in areas like working at heights,
rigging, and welding. PPE (Personal Protective Equipment): All workers must wear
appropriate PPE, including helmets, safety glasses, gloves, high visibility clothing, and steel
toed boots. Harnesses and lanyards should be used when working at heights.
3. Fitness for Work: Regular health checks should be conducted to ensure that workers are
fit for duty, especially for those engaged in physically demanding tasks.

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 Method Statement / Risk Assessment
Sika Grout Application
Rev: B Date of Issue 13-08-2024

3. Working at Heights: Fall Protection Systems: Install and use fall arrest systems,
guardrails, safety nets, and other fall protection measures in all areas where workers are
exposed to height risks. Scaffolding and Platforms: Ensure that all scaffolding and working
platforms are stable, properly erected, and inspected regularly.
4. Lifting Operations:
Crane Safety: Only qualified personnel should operate cranes, and all lifting operations
should be supervised by a competent person.
Rigging Safety: Ensure that all rigging equipment is in good condition and that the load is
properly secured and balanced before lifting.
Communication: Use clear and agreed upon signals for communication between crane
operators and riggers.
5. Welding and Cutting Operations
Fire Prevention: Implement fire prevention measures such as having fire extinguishers on
hand, and ensuring that flammable materials are removed from the welding area.
Ventilation: Provide adequate ventilation to remove fumes and gases produced during
welding or cutting.
Welding Screens: Use welding screens to protect other workers from arc flash and to
contain sparks.
6. Hazardous Materials
Handling and Storage: Store hazardous materials like gases, solvents, and paints in
designated areas with proper labeling. Ensure safe handling procedures are in place.
MSDS (Material Safety Data Sheets): Keep MSDS accessible for all hazardous materials
used onsite.
7. Emergency Preparedness
First Aid: Ensure that first aid kits are readily available and that there are trained first
aiders onsite.
Emergency Evacuation Plan: Develop and communicate an emergency evacuation plan
that includes routes and assembly points.
Rescue Plans: Have a rescue plan in place for workers who may be incapacitated at height
or in confined spaces.

8. Site Security and Housekeeping

Access Control: Restrict access to the work area to authorized personnel only.
Good Housekeeping: Maintain a clean and organized worksite to reduce tripping hazards
and ensure safe access to all areas.
Signage: Use clear signage to indicate hazards and safe pathways.
9. Monitoring and Supervision
Safety Inspections: Conduct regular safety inspections and audits to ensure compliance
with safety protocols.
Supervision: Ensure that competent supervisors are present at all times to oversee safety
practices and intervene if necessary.
10. Reporting and Documentation
Incident Reporting: Implement a system for reporting and investigating accidents, near
misses, and unsafe conditions.
Safety Records: Keep detailed records of all safety related activities, including training,
inspections, and incident reports.

Implementing these safety provisions helps mitigate risks and ensures a safer working
environment during steel erection activities.

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 Method Statement / Risk Assessment
Sika Grout Application
Rev: B Date of Issue 13-08-2024

11: QA Approval & Quality Requirements :

QA Approval:
Material Submittal
Shop Drawings Approved
Approved Samples

Quality Requirements:
1) Ensure that the substrate has been properly prepared, cleaned, and pre-wetted as
described in the method statement.
2) Measure and record ambient temperature, substrate temperature, and relative
humidity. Ensure they are within the recommended range for application.
3) Accurately measure the amount of water to be used for mixing. Use a calibrated
measuring jug or scale.
4) Ensure that the grout is mixed for the correct duration (approximately 3 minutes) to
achieve a homogeneous consistency.
5) Perform a flow test (ASTM C1437) or similar to verify the consistency of the mixed
grout. Adjust water content within the recommended limits if necessary.
6) Ensure formwork is secure and watertight to prevent grout leakage.
7) Apply grout continuously to avoid cold joints and ensure a consistent pour.
8) Check for proper vibration or tapping to release entrapped air, but avoid over-
vibrating, which can lead to segregation.
9) Inspect the grout surface for uniformity and absence of voids or cracks. Trowel as
necessary for desired finish.
10) Monitor and record the initial set time to ensure it aligns with the product
specifications.

12: Record to be Produced:

1) Document delivery dates, supplier details, batch numbers, and expiry dates of
SikaGrout.
2) Inspection Records log initial inspections for packaging integrity and any signs of
contamination or damage.
3) Surface Preparation Records document the cleaning, roughening, and pre-wetting of
the substrate.
4) Environmental Condition Records ambient temperature, substrate temperature, and
relative humidity before and during application.
5) Water Usage Records log the amount of water used for each batch, ensuring it falls
within the specified range.
6) Mixing Time Records note the mixing duration for each batch to ensure consistency.
7) Consistency Test Records document the results of flow tests or similar consistency
checks.
8) Formwork Inspection Records verify the integrity and setup of formwork prior to
grouting.
9) Application Method Records describe the pouring technique and any measures taken
to release entrapped air (e.g., vibration method and duration).
10) Curing Method Records detail the chosen curing method (wet curing or curing
compound) and its application.

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 Method Statement / Risk Assessment
Sika Grout Application
Rev: B Date of Issue 13-08-2024

11) Curing Duration Records log the start and end times of the curing period, ensuring
compliance with recommended durations.
12) Compressive Strength Test Records maintain records of sample collection, curing
conditions, and compressive strength test results at specified intervals (1 day, 7 days, 28
days).
13) Shrinkage Monitoring Records document observations for any signs of shrinkage or
cracking during the curing period.
14) Daily Activity Logs record daily activities related to grouting, including the number
of batches mixed, application progress, and environmental conditions.
15) Observations and Issues note any deviations from the method statement,
observations of defects, and actions taken to address issues.
16) Non-Conforming Material Reports document instances of non-conforming material,
including batch numbers, nature of the issue, and corrective actions taken.
17) Rectification Logs record details of any rectification work performed, including
methods used and results achieved.
18) Final Inspection and Approval Records

 Visual Inspection Reports: Conduct and document final inspections of the grouted
area, noting any defects or inconsistencies.
 Approval Records: Obtain and log approvals from quality control supervisors or
project engineers before proceeding to subsequent project phases.

13: Distribution :
As per Site Requirements

14: Site Safety Approval Requirements :

 Approved Risk Assessment
 Valid Shift Permit To Work
 Competent Staff & Personals
 All lifting/Welding Equipment Shell has current third-party Inspection certificates

15: Risk Assessments and Control Measures :

 Please refer to Annex 1

16: Environmental Aspect, Impacts & Control Measures:

 Please refer to Annex 2

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 Method Statement / Risk Assessment
Sika Grout Application
Rev: B Date of Issue 13-08-2024

17: List of Hazardous Material To Be used:

List of Hazardous Materials to Be Used in the application of Sika Grout , detailed
information on all chemical components and materials that may pose health, safety, or
environmental risks.
17.1 : Sika Grout
Main Components:
Cementitious Material: Portland cement, which is a common irritant.
Silica: May be present as an ingredient, hazardous if inhaled in dust form
(respirable crystalline silica).
Chemical Admixtures: Used to modify the grout properties (may include
surfactant, plasticizers, etc.).
Hazards:
Skin and Eye Irritation: Contact with skin or eyes can cause irritation or burns.
Respiratory Irritation: Inhalation of dust can irritate respiratory passages.
Environmental Hazards: Avoid release into the environment, particularly
watercourses.
Personal Protective Equipment (PPE):
Safety goggles, chemicalresistant gloves, dust masks or respirators, and protective
clothing.
Storage Requirements:
Store in a dry, cool place. Ensure that bags are sealed and stacked properly to
prevent dust release.

17.2 : Water (if mixed with Sika Grout )

Hazards:
Although water itself is not hazardous, improper mixing or spills can lead to
splashes that may cause irritation, especially in the eyes or on broken skin.

17.3 : Cleaning Agents (if applicable)

Types: Detergents or solvents used for cleaning tools and surfaces after application.
Hazards:
Chemical Burns: If corrosive cleaning agents are used, they may cause burns or
irritation.
Inhalation Risks: Some solvents may emit harmful fumes.
PPE: Gloves, goggles, and ventilation or masks depending on the type of cleaner.

17.4 : Additional Admixtures (if any used)

Description: Projects may require the addition of other admixtures to Sika Grout to
enhance certain properties (e.g., accelerators, retarders, or plasticizers).
Hazards:
Chemical Reactions: May react with other materials, generating heat or harmful
fumes.
Skin Contact and Inhalation Risks: Depending on the chemical, contact or
inhalation could be hazardous.
PPE: Use appropriate gloves, protective clothing, and masks.

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 Method Statement / Risk Assessment
Sika Grout Application
Rev: B Date of Issue 13-08-2024

17.5 : Sealants or Protective Coatings (if applied postgrouting)

Types: Epoxy or polyurethanebased coatings or sealants.
Hazards:
Flammability: Some sealants are flammable or combustible.
Vapors: Many produce harmful vapors that can affect breathing.
Skin Contact: Can cause allergic reactions or dermatitis.
PPE: Gloves, masks, eye protection, and ensure good ventilation during application.

17.6 : Other Possible Additives

Expansive Agents (if used): These can contain chemicals that, when added to grout,
can create expansion.
Hazards: Potential skin, eye, and respiratory irritants.
PPE: As recommended by the manufacturer, usually including gloves, masks, and
goggles.

General Considerations:
MSDS (Material Safety Data Sheets): Attach MSDS for each hazardous material listed,
providing detailed safety, handling, and emergency information.
Handling Instructions: Include proper methods for handling each material safely,
particularly during mixing, application, and cleanup.
Disposal Procedures: Outline how to safely dispose of each material or any waste
containing these materials, ensuring compliance with environmental regulations.

18: List of Hazardous Wastage To Be Generated:

List of Hazardous Wastes to Be Generated during the application of Sika Grout.

18.1 : Residual Sika Grout Mixture

Description: Any leftover or unused grout material, particularly if mixed with water,
becomes waste after the application is completed.
Hazards:
Environmental Impact: Can harden and block drainage systems if disposed of
improperly.
Dust: If dried, it can create hazardous dust that may cause respiratory irritation.
Disposal: Must be disposed of as construction waste, following local regulations for
cementitious materials. Avoid disposal in regular waste or water systems.

18.2 : Packaging Materials

Description: Bags, containers, or packaging used for Sika Grout and any other
additives or admixtures.
Hazards:
Contamination: Packaging may retain residues of hazardous chemicals, posing a
risk of skin contact or environmental contamination.

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 Method Statement / Risk Assessment
Sika Grout Application
Rev: B Date of Issue 13-08-2024

Dust and Debris: Residual dust from bags or containers can become airborne,
causing respiratory hazards.
Disposal:
Should be collected and disposed of as hazardous waste if contaminated. Clean
packaging may be recycled if permitted.

18.3 : Cleaning Agents and Wastewater

Description: Any solvents, detergents, or water used to clean tools and equipment
after grout application.
Hazards:
Chemical Contamination: Cleaning agents may contain hazardous chemicals that
can contaminate water and soil.
Water Contamination: Wastewater may contain grout residues, which could
solidify and clog drains or cause environmental harm.
Disposal:
Should be collected in designated containers and treated as hazardous waste.
Wastewater should not be discharged directly into drains or watercourses.

18.4 : Used Personal Protective Equipment (PPE)

Description: Contaminated gloves, masks, and other PPE used during the handling
and application of Sika Grout .
Hazards:
Chemical Residues: PPE may be contaminated with grout or other hazardous
materials, posing a risk during handling and disposal.
Disposal:
Should be treated as hazardous waste. Contaminated PPE should be collected
separately and disposed of according to local hazardous waste disposal guidelines.

18.5 : Spill Residues

Description: Any material used to contain or clean up spills of Sika Grout or other
chemicals (e.g., absorbent materials, rags).
Hazards:
Chemical Exposure: Spill residues can be highly concentrated with hazardous
materials, posing significant risks during cleanup and disposal.
Disposal: Collected in hazardous waste containers and disposed of in compliance
with environmental regulations.

18.6 : Hardened Grout Waste

Description: Any hardened grout that is removed or chipped away after application,
including waste generated during correction of errors or excess material.
Hazards:
Physical Hazards: Can create trip hazards or cause injuries if left uncontrolled on
site.
Dust Generation: Cutting or grinding hardened grout can generate dust, which
may be harmful if inhaled.
Disposal: Should be disposed of as construction waste, ensuring it is not mixed
with nonhazardous waste streams.

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 Method Statement / Risk Assessment
Sika Grout Application
Rev: B Date of Issue 13-08-2024

18.7 : Contaminated Soil or Materials

Description: Any soil, tools, or other materials that come into contact with Sika
Grout or associated hazardous chemicals.
Hazards:
Environmental Contamination: Can lead to soil or groundwater contamination if
not handled properly.
Disposal: Must be treated as hazardous waste and disposed of according to
environmental regulations. Soil contamination may require special remediation
procedures.

19: Permits:
 General Work Permit
 Shift Permit (As Per Requirement)

20: Attachments
 Organization Chart
 Competency of those involved.
 Equipment Register
 ITP Plan and Checklist

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 Risk Assessment Document Ref 3HASA13-HASA-07-AGC-ST-ME S-0004

H&S Management Revision B

Instructions for completing Job Safety Analysis (JSA) form

Section I -Enter general information about the site and job task.
Section II - Determine whether any of these operations apply to the job task to be performed. Make note of any special training, permit, certification, and risk
assessment requirements.
Section III - Identify any human/organizational factors that could impact the ability to perform the work safely.

1. Break the job down into steps - Be as specific as possible. Write each job step in a new row of column A (Activity/Step). It’s a good idea to leave an
extra row between steps in case you need them later. Add additional rows to the table as needed, or if completing the JSA on paper, print
additional copies of the sheet to accommodate all job steps.
2. Determine the hazards associated with each job step and write them in column B (Hazards). Use the examples of hazards provided below to
trigger your thinking about different types of hazards and energy sources.
3. List any control measures that will be taken to ensure that step is done safely in column C (Control Measures). Use the control measure examples
and hierarchy provided to trigger your thinking about different types of controls and their effectiveness at reducing risk. Controls toward the top
of the table tend to be more effective at minimizing the severity and/or likelihood of an event than the controls toward the bottom of the table. If
this job involves a Life Crucial Operation, continue to step 4. Otherwise, repeat steps 2-3 for each of the job steps identified, then proceed to step
8.
4. Considering the hazards involved and the control measures that will be in place, determine the worst credible severity of an incident that could
result from this job step. Use the severity table provided. Write the severity number in column D (Severity).
5. Considering the hazards involved and the control measures that will be in place, determine the likelihood that an incident will result from this job
step. Use the likelihood table provided. Write the likelihood number in column E (Likelihood).
6. Multiply the severity number by the likelihood number and enter the product in column F (Risk).
7. Consider the risk rating against the thresholds provided in the Overall Risk Ratings.
i. Very low and low risk ratings of 1-3. This level is generally considered acceptable provided that all control measures are applied.
ii. Medium risk ratings of 4-6. Medium risk requires a planned approach to control the hazard and applies additional controls if required.
Action taken must be documented on the risk assessment form.
iii. High and Very High-Risk ratings of 8-24. For all high and very high risk, Column G (Additional control measures) must be implemented to
further reduce the risk to a medium or low level. Such activities shall not be proceeded until applying additional control measures. The
Construction Director/Manager or facility Manager must personally review the activities with a High or Very High residual risk score and approve
additional control measures by signing off the JSA.
8. Repeat steps 2-7 for each of the job steps identified.

Section IV - Provide the name, company, and title of those who prepared and reviewed/approved this form in the signature box provided. The Construction
Director/Manager or facility Manager must review and approve the additional control measures that have a High or Very High-Risk rating before proceeding
the task. Additional space is also provided for crew members to sign the JSA if desired.

Reference Table in completing Section III – Job Safety Analysis (Column B – Hazard)
Biological & Environmental Electrical Chemical Gravity/Height Mechanical & Motion
Altitude Arc Flash Air Emissions Equipment Being Thrown
Animal Bite/Sting Buried Chemical Products Tipping/Collapsing Off/Under Equipment
Blood-Borne Pathogens Utilities  Carcinogenic Excavation/Trench Disintegration of
Contaminated Damage to Leads/Cables  Combustible/Flammable Falling Objects Moving Components
Food/Water Insect- Damage to Switches  Explosive Floor Openings/Edges Driving/Vehicle
Borne Disease Pests Energized  Toxic Grating Removed Traffic
Poisonous Plants Circuits/Conductors  Corrosive Inadequate Support Ejection of Workpiece/Debris
Precipitation Inadvertent Energization  Reactive Lack of Access Entanglement
Temperature/Humidit Lack of Isolation/Grounding Client/Process Ladders/Stairs Suspended Friction
y Unsanitary Missing/Damaged Insulation Chemicals Lack of Load Unstable/Insecure Movement/Shifting
Conditions Weather Overhead Lines Containment Materials Work Moving Parts
Wind/Turbulence Overload of Circuits Leakage/Spills Above/Below Others Work Pinch/Crush Points
Pressure Stored Energy Material Incompatibility at Height/Fall Hazards Projectiles
Abrasive Blasting (Batteries/Capacitors) Produced/Disturbed by Work Walking/Working Surface Rotating Equipment
Compressed Gases Water Near Electrical  Asbestos  Slippery Sharp Edges, Corners, or Points
High Pressure Fluid Conductors  Lead  Uneven Shearing
Pressure Testing Work Environment  Silica  Obstructed Stored Energy
Pressure Washing/Blasting Cluttered  Welding Fumes  Steep (Springs/Accumulator
Radiation Confined  Dust  Moving/Swaying/Pitching s) Striking
Intense Light Space Water Discharges  Insufficient/Unstable Trapped Between Equipment
Lasers Damaged Tools/Equipment Wastes Generated Ergonomic and Fixed Structures
Microwaves Entrapment  Hazardous Awkward Unexpected/Uncontrolled
Naturally Occurring Erosion  Non-Hazardous Postures/Movement Movement
Radioactivity Hazardous Atmosphere Sound Excessive Force/ Exertion
Radioactive Material  Oxygen Rich/Deficient Continuous Heavy/Awkward Load
X-Rays  Contaminants Noise Repetitive Motion
Ignition Sources Intermittent Same Position
Inadequate Noise Extreme Vibration
Ventilation Poor Noise Impact
Lighting/Glare Noise
Restricted Access/Egress
Runoff

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Reference Table in completing Section III – Job Safety Analysis (Column C – Control Measure)
Most Effective Controls Examples
Elimination  Make connections at ground level before erecting  Remove a dangerous machine from
(Remove the hazard service a structure to eliminate work at height  Provide power outlets to avoid trailing
altogether) cords
Substitution  Use latex rather than oil-based paints
(Replace the  Reduce energy, such as speed, force, amperage, pressure, and temperature
material/process with a less  Use water-based detergents instead of organic solvents
hazardous one)
Engineering/Isolation  Ventilation  Isolate hazardous energy sources
(Design effective control  Machine guarding  Interlocks  Secondary containment
 Barriers
measures to protect people  Enclosures  Platforms and guardrails
 Circuit breakers  Exclusion zones  Improve lighting
and
the environment)
Warning Signs  Horns  Labels
  High visibility paint
(Alert people to the hazards)  Backup alarms  Beepers  Tags
Administrative  Work rotation to minimize exposure
(Provide training,  Inspect safety equipment  Training and supervision
procedures, etc.)  Good housekeeping practices
PPE  Safety glasses  Fall harness and lanyards  Respiratory protection
Least Effective (Personal protective  Hearing protection  Gloves  High visibility vests
equipment)

Reference Table in completing Section Severity Reference Table in completing Likelihood

Impact On Likelihoo Chances of
Severity Level Probability
People Environment / Community Equipment / Property d Level Occurrence
 Long-term (multi-year) impacts  Extensive losses of high
to air, surface/ground water, or value equipment/property
Expected to
Critical / Single / Multiple soil; or  Loses exceeding Very
6 4 occur in most 1 in 100
Catastrophic fatalities  Widespread areas including $1,000,000; or Likely
 Major unplanned impact on circumstances
offsite area/community
affected; or project budget and schedule
 Some adverse publicity/media
coverage
 Lasting (up to one year) impacts  Losses of
Injury or to air, surface/ground water, or equipment/property that Strong possibility
Likely 3 1 in 1,000
illness soil; or cannot be readily the event will
Major 4 resulting in  Offsite area/community affected; or replaced; or occur
permanent  Events that are  Losses exceeding
total or reportable to regulatory $100,000; or
partial authorities; or  Significant unplanned
disability  Potential for adverse impact on project budget
publicity/media coverage The event might
Possible 2 1 in 10,000
Injury or  Temporary (up to one month) occur
illness impacts to air, surface/ground  Loss of equipment that can
resulting in water, or soil limited to the be readily replaced; or
Moderate 2 medical project site; or  Losses exceeding $10,000;
treatment or  Breach of regulatory or Highly unlikely
temporary requirement or limit; and  Minor impact on but may occur
disability/loss project budget Unlikely 1 1 in 1,000,000
 No potential for adverse in exceptional
of publicity/media coverage circumstances
function
 No direct impact to air,  No impact on

Reference Table in completing Risk

Risk Matrix Overall Risk Ratings

Likelihood
Very Low Mediu Hig Very
Severity
Unlikel Possible Likel Very Low 2-3 m 4- h High
y 1 2 y Likel 1 6 8- 24
3 y 4 18

Critical - 6 6 12 18 24

High and Very High-Risk ratings of 8-24.

Additional control measures must be implemented to further reduce the High
Major - 4 4 8 12 16
and very high risk to acceptable level.
Note: The Construction Director/Manager or Facility Manager must personally
review the activities with a High or Very High residual risk score and
Moderate - 2 2 4 6 8 approve suitable additional control measures by signing the JSA.

Minor - 1 1 2 3 4

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Section I – General Information

Emergency Procedures
Emergency Contact Name Emergency Contact Phone Number
Primary Contact Primary Contact
Secondary Contact Secondary Contact
Details
Program Number. Company Name Ansab

Project Name Date

JSA /Risk Assessment Title Sika Grout Category ☒ New ☐ Revised
Specific Location Building
Plant Tools & Equipment Required Area
Work Scope/Description

Section II – Does this job require any of the following operations?

 = Requires formal/special training  = Requires certification or Competent/Qualified Person designations

= Requires a permit/form/report ∆ = Life Crucial Operations = Requires full Risk Assessment

Description Yes Description Yes

Aerial Lifts  ∆ ☒ Cranes - Critical lift   ∆ ☒
Confined Space   ∆ ☐ Hot Work  ☒
Dismantling and Demolition  ☐ Loading/Unloading Material ∆ ☒
Electrical Hazards   ∆ ☒ Noise Exposure  ☐
Excavation/Trenching   ∆ ☐ Powered Industrial Trucks   ∆ ☐
First Line Breaks   ∆ ☐ Radiation Area Work   ☐
Grating/Floor Plate/ Guardrail Removal ∆ ☐ Respiratory Hazards  ☐
Hazardous Energy Control   ∆ ☐ Roof Work   ∆ ☐
Hazardous Materials
Asbestos & Lead Work   ☐ Scaffolding   ∆ ☐
Hazardous Materials
Crystalline Silica &   ☐ Site/Vehicle Traffic ∆ ☒
Cadmium
Hazardous Waste Operations  ☒ Steel Erection  ∆ ☒

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Heavy Equipment   ∆ ☐ Work at Height (> 6 ft)   ∆ ☒

Rigging, & Cranes   ∆ ☒ Other ☐

Section III – Job Safety Analysis Risk Assessment (Post Control Measures)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J)
Activity/Step Hazards Control Measures Severity Likelihood Risk Additional Control measures Severity Likelihood Risk
 Ensure all procedural requirements
are fulfilled.
 Conduct pre-task briefing and brief
crew on scope of work, approved
plans, requirements, potential
emergencies, do’s and don’ts,
during advent of an emergency,
emergency contacts, hazards  Assign trained banksman with
1: Work Preparation associated with the activities and motorized equipment and at
control measures. intersections and blind spots.
Preparation of tools,  Traffic Rules Violations
 Site Induction for all crew Banksman should be in high visible
 Slip, Trip & Falls
equipment and manpower members including operators and jacket/vest
 Worse Weather Condition 4 2 8 3 1 3
mobilization / demobilization, drivers is mandatory.  Conduct daily TBT Training
 Traffic accidents
control of equipment  Only qualified and TP certified  Post speed limits as per project
 Emergency Situations
movement over the course of drivers be allowed to operate rules and ensure strict
activity equipment / Vehicles compliance.
 Proper Inspection of all  Housekeeping: Ensure that site
equipment/vehicles. area is kept clean at all times.
 Exit route and safe area to be
discussed in PTB
 All operatives shall be inducted
and trained.
 Ensure that workers are wearing
half mask face cover
 Secure applicable work permits
before starting activity.
 Conduct pre-task briefing.
 Use Proper Manual
 Back Injury Handling Techniques.
 Ensure that operatives are  Conduct continuous Inspections
 Musko skeletal Disorders
2: Material Handling trained in safe manual handling. of worksites
 Fatigues
 Ensure that all workers are using 3 2 6  Ensure that all workers are using 2 1 2
 Pinch Points
proper PPEs including Dust Masks. PPEs
 Respiratory disorders
 Ensure proper access to job area.  Keep site access free of obstructions
 Slips, trips & falls
 Ensure proper supervision  Conduct daily TBTs.
by competent persons
at all times.
 Identify and address pinch
point hazards.
 Make sure to barricade the area
 Incompetent  ELCB must be installed in
3: Using Portable Power Tools and place a safety sign to avoid 3 3 9 2 3 6

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 unauthorized access.
Generator and DB. 04
employee using the
power tools.

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 Exposed live electrical  Only trained and competent  Designated supervisor to ensure
wiring and undetected workers permitted to use the safety compliance.
live cables in the walls power tools.  Specific trainings for all involved
or floors.  Competent electrician shall inspect parties
 User exposed to power tools prior to start activity.  Conduct Pre-Task Briefings prior
prolonged periods of  Ensure electric cable are properly starting job to brief workers on job
high noise levels. Time connected and insulated. steps, associated hazards &
delays, Property  Ensure availability of suitable fire control measures.
damage, minor to extinguishers on site along with
serious injuries with fire blankets.
the possibility of fatal  Make sure competent fire watch is
injury present on site at all time during
 Improper cable or poor hot work activity.
condition of power  Proper Use of face shield and dust
tools, power tools can mask.
lead to electric shock  Ensure use of PPEs specific to
and fire. tasks i.e., safety helmets, safety
 Unavailability of glasses, safety gloves, safety
suitable fire shoes, ear plugs and face masks,
extinguisher and fire Hi-Visible vest/Full body coverall
blankets will be mandatory.
 Unavailability of  Maintain good housekeeping and
competent Fire Watch proper cable management.
at site.
 Flying Objects
 High Noise
 Dust
 Pre-task briefing shall be done
prior to start work activity
 Materials to be stacked in drip tray
on level ground in storage area
 Collapse of stacked
 No stacking above than standard
of material.
level
 Heavy loads
 Follow instructions mentioned in
 Uneven loads  Close supervision of all work
MSDS form
 Poor Lifting techniques activities at all times.
 Manual handling technique trained
 Liquid spillage  Supervisor be aware about job
 Maximum weight to lift per
 Inhalation of chemical compliance and precautions
person should not exceed 20kgs
4: Storage of material fumes. 4 2 8  Only certified & pre inspected tools 2 2 4
 Materials to be secured
 Environmental aspects from falling/collapse will be allowed.
and impacts  Engage enough number of persons
 Make sure Emergency contact
 Untrained workers for number posted and availability of for handling the material
the task. Unfit worker according to material weight
 Eyewash facility, emergency
for the job
shower & first aider
 Improper use of PPEs  Dispose the waste buckets and
 Slip, Trip and Fall brush as hazardous waste
 Area shall be barricaded and
adequate signs posted around
 Select and use of appropriate

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 PPEs Provide proper
access/egress 04
 Tool box talk to be conduct on
 Inhalation of chemicals  Care to be taken for storage and
5: Surface preparation and regular basis prior to start every
 Direct contact with handling of materials stored in
grouting activity. 3 2 6 2 2 4
skin / eyes / body working area
 Make sure to barricade the area
parts\  Specific training for all involved
and post safety signs to avoid
 Spillage parties
unauthorized access.

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 Environmental aspects  Safe proper storage of Materials  Close supervision of all work
And impacts  Follow instructions as mentioned activities at all times.
 Slip trip fall. in MSDS form  Supervisor be aware about
 Personnel Injuries.  Provision of appropriate PPEs job compliance and Hazards.
 Adequate illumination and
ventilation provided
 Maintain area clean and tidy
 Eyewash facility, emergency
shower to be provided for in case
of direct contact
 Ensure only approved limited
material storage
 Ensure availability of spill kit and
drip trays
 Provision of fire extinguishers
 Dispose the waste chemical and
brush as hazardous waste as per
procedure
 Clear access/egress free from
any obstructions
 Heat stress awareness training
 Exposure to extreme
Hot just before and during the hot
summer months to all applicable
personnel (who work outdoors)
 Conduct mandatory Heat Stress
and those who manage personnel
Awareness training to all employees
and have responsibilities for
prior of deployment at site.
establishing heat stress mitigation
 Provide rest shelter and water on
measures.
site prior of activity at site.
 Ensure required rest period,
 HSE Dept. to monitor on daily basis
and
for the weather condition at site.
minimum water needed.
 HSE Dept. to identify the Heat
 Provide own calibrated data
Index
6: Adverse Weather Conditions logging Temperature and 3 2 6 danger category on daily basis. 2 1 2
Humidity monitor to ensure
 A standby qualified first aider/site
timely determination of weather
Nurse and first aid kit must be
condition.
available at site.
 Danger category color coding shall
 Ensure supply of water daily, to
be per the heat index.
provide abundant supply of water
 Take appropriate action upon
at site.
developing symptoms of heat  Ensure site with proper monitoring
cramps, heat exhaustion or heat and using kestrel equipment heat
stroke. stress program.
 Ensure designated rest shelter have
sufficient drinking water station.
 Administrative controls like

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 acclimatization, temperature, and
04
humidity monitoring, flagging
system etc. should be in place.


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 Ensure appropriate PPE’S to be use

 Exposure to extreme  Ensure all workers follow the use
Cold when temperature working to
of clothing when temperature
outside.
working to outside
3 2 6 2 1 2
Administrative controls like
 Ensure site with proper monitoring
acclimatization, temperature, and
and using kestrel equipment heat
humidity monitoring, flagging system
stress program.
etc. should be in place
 Work is strictly prohibited during
 Lighting /thunderstorm
lightning and project personnel  Ensure all workers working at site
are not allowed to stay outdoor. with proper shelter in place.
 If safe building structures are not  Stop work immediately if
accessible, employers should Lighting
guide workers to hard-topped /thunderstorm and notify the
metal vehicles with rolled up 3 2 6 transport foreman for the standby of 2 1 2
windows. Remain in the vehicle BUS as shelter at site.
for at least 30 minutes after  In any case of emergency, a standby
hearing the last sound of thunder. vehicle at site radio or cell phone to
After hearing thunder, do not use contact directly.
corded phones, except in an All emergency contact list must
emergency. Cell phones and cordless provide to all driver/s.
phones may be used
safely.
 Ensure work is strictly prohibited
 Heavy Rain
during heavy rains and project
 Ensure all workers working at site
personnel are not allowed to
with proper shelter in place during
work/stay outdoor.
the rain.
 If water accumulated or the area
 Always be vigilant of the flooding
is flooding due to rain, wait to
in the area, look for the high
subside before resuming the
3 2 6 location if flooded or call for an 2 1 2
work.
emergency.
 If water is present in the
 Ensure on any presence of water
excavation, de- watering shall be
performed by installing in excavated area don’t allow any
submersible pumps or equivalent worker/s to resume the works.
should land survey work is urgent. Provide appropriate protection for
If raining, sandbag shall be the excavation to prevent erosion of
positioned on the surrounding of the excavated works.
excavation to prevent rainwater
flowing in the excavated
area.
 Sandstorm

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 Work is strictly prohibited during  Ensure all workers working at site
sandstorm and project personnel are
04
with proper shelter in place during
not allowed to stay outdoor. sandstorm.
 Wear medical facemasks or use wet 3 2 6  Provide appropriate wearing of face 2 1 2
towel or gauze during sandstorms mask during sandstorm at site
outdoors. otherwise stop the work and wait
for further notice to proceed.

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 Wear eyeglasses preferably  Provide appropriate use of safety

airtight goggles or face shield to glasses, contact lenses are not
protect your eyes from blowing allowed during working at site.
dust or sand.  Ensure all workers to stay indoor
 Avoid wearing contact lenses in (car or office building) unless it is
areas prone to sandstorm. necessary to go out.
 Avoid rubbing eyes to prevent eye  Conduct maintenance of office and
infection. If eyes become irritated, accommodations to sealed
rinse with water. properly and prevent sands enter
 Stay indoor (car or office building) inside the room/office,
unless it is necessary to go out.  Drive with caution or stop on the
 Ensure office and accommodations shoulder of the road until the
if sandstorm proof (properly sandstorm remain calm.
sealed).
 Be vigilant of another vehicle near
 When driving, drive slowly with
you during the zero visibility on
caution when visibility is very low.
roads at site.
 Pull over completely to a safe
 Ensure you parked in right place
place off the paved portion of the
during this sandstorm to prevent
roadway during low visibility.
any collision
with other oncoming vehicles.
 Poor Housekeeping.
 Remove banding, crate material,
nails, paint bottle, etc. and
 Lack of proper planning
dispose of properly.
 Proper planning and look
 Lack of
ahead by Discipline
housekeeping
Supervisor/Foreman.
resources  Ensure all unwanted materials to
 Prior to commencing work, as part
daily be disposed properly on designated
progress, he shall plan for: location skip bins.
 Housekeeping resources -  Prioritize the housekeeping
hauling equipment (loader / scheduled on or before the activity
7: Housekeeping 2 2 4 2 1 2
dump truck / forklift) and on daily basis on site.
dedicated crew. Construction Team shall be accountable
 Regular collection of rubbish, every for all the materials and pre-
end of shift at minimum arranged staging location area to
 Waste skips / covered metal trash prevent any materials scattered on
bins / disposable trash bags, etc. the surroundings.
 Temporary staging area of scrap
materials
 Pre-arranged staging area
for construction
materials, tools /

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 equipment
04
 Access for personnel and
equipment Barricades / signs
required

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 Debris and other unnecessary  Ensure all waste materials to be

materials shall be discarded from disposed properly on timely manner
site. especially the hazard materials.
 Empty drinking bottles and wet  A designated garbage bins to be
Wet Garbage. garbage provided for segregated waste are
Accumulation from excess food should be properly to be followed.
attracts disease disposed at designated bins and 2 2 4  Assigned Housekeeper to ensure 2 1 2
carrying insect hauled out daily. Toilets are maintained with
and animals Not  Portable Toilets should be maintained checklist on daily signed by his
sanitized Toilets on
supervisor.
Environmental damaged Daily Basis.
 Ensure approved third-party
 Trash and garbage shall only be
garbage collector to be collected
disposed of at approved sites as
on site.
designated by SEVEN or local
Any hazard materials on site especial
municipality.
care for the environmental impact
 All unwanted materials at the site
should and disposed
be disposed of especial hazard properly.
materials.
 Proper planning and look ahead by
Discipline Supervisor. Prior to his
activities he shall:
 Lack of proper  Familiarize himself and his team
planning / with the site-specific emergency
emergency readiness procedure.  Ensure proper planning and look
/ awareness of safe  Know the actual locations of nearest ahead by construction team of
evacuation safe
any activity at site.
procedure. assembly areas.
 Ensure to comply with SEVEN
 Conduct toolbox talk with his crew
(Emergency Preparedness and
on emergency procedure.
Response) of any emergency
 See to it that safe access route is
protocol.
available from work area towards
 Follow the STOP Work or Evacuation
the nearest safe assembly area.
Alarm, as an instruction from Site
 Be familiar with the prevailing wind
9: Emergency Preparedness 4 2 8 ERT / HSE, of any emergency 2 1 2
against the locations of nearest
protocol.
safe assembly points. At least 2
 Conduct emergency training
safe assembly points in opposite
drills in coordination with SEVEN
directions shall be known to the
for the awareness by all workers
crew from each work location.
on site.
 Be familiar with site specific
Emergency  Ensure emergency contact list to be
Response Plan (ERP) and posted at site and keep up to date
requirements of this document. the contact list.

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 Understand / comply with  Provide training to all workers on
how to contact the details in the
04
SEVEN (Emergency
Preparedness and Response). emergency contact list.
 Upon hearing site STOP Work or  will comply with the seven
Evacuation Alarm, or receipt of an standards
instruction from Site ERT / HSE,  All emergency preparedness will
Discipline Supervisor shall lead his follow the SEVEN standards
crew to ensure
following actions are taken:

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 Stop work
 Alarm others
 Shutdown all machines e.g.,
generator, welding machines, etc.
 Check wind direction
 Proceed to nearest safe assembly
area in cross wind direction.
 Participate in the headcount,
report
missing person (if any)
 Stay at safe assembly area,
remain attentive, do not engage
in any unauthorized activity, wait
for further instruction.
 All site personnel to participate
in
training drills. Conduct
emergency training drills in
coordination with SEVEN.
 Maintain emergency contact list in
each work area.
 Call Project Nurse or Site Safety
Manager for medical emergencies,
include 24/7 emergency contact
details in the emergency contact
list.

Note: Insert additional rows or print additional sheets as necessary to accommodate all job steps.

Section IV – Approval and Signatures

Prepared by Company Position

Reviewed and Approved by Company Position

High and Very High residual risk rating (8-24)

Note: All High and Very High residual risk ratings (8-24) require review and approval by Construction Director/Manager or Facility Manager before starting work to ensure that the additional controls are adequate to execute the task safely.
Reviewed and Approved by Company Position

CLASSIFICATION: INTERNAL & SENSPIaTgIeV1E0

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 Risk Assessment Document Ref. 3HASA13-HASA-07-AGC-ST-MES-00 04

H&S Management Revision B

Construction Director/Manager or Facility Manager

Reviewed by Crew Company Position

CLASSIFICATION: INTERNAL & SENSPITagIVe E11

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