Safe Work Method Statement
Project Name: EVEREST IND. Project Address: Solitaire Corporate Park, 3rd Floor, Building No. 14. Opp- Kanakia wall street, Chakala. Andheri
Company Name: ANA Designs Pvt. Ltd. Company Address: 1A New india Chambers, MIDC central Rd, Andheri east. Mumbai
Engineer Name: Vinay Prajapati Contact No: 8850583837
Trade: Design & Build Work Location: 3rd floor
Description of work
Hazardous Work Activity:
(Please tick relevant work activity) Х Energised electrical installation / services. Х Structural alterations / repairs with a potential for structural collapse.
√ Coring / Chasing / Cutting (no electrical power in the area) Х Works involving asbestos. Х Demolition of a load-bearing element of a structure.
Х Roof Access √ Working at heights (risk of falling more than 2 metres). Х Works in or near a 1.5+ metre shaft / trench (excavation).
Demolition / Strip-Out Works (that does not involve disturbing a
Х load bearing structure) Х Use, transport or storage of chemical, fuel or refrigerant lines. Х Works in or near a tunnel.
Х Shop Front Works (including glazing) Х Works near to or use of moving mobile plant. Х Works in areas exposed to extreme temperature.
Х Fire Services Х Works in or near a confined space. Х Works in or near water or other liquids with a risk of drowning.
Structural Work (all structural works including steel posts, beams
Х and concrete works) Х Tilt-up or precast concrete work. Х Construction diving work.
Х Works in contaminated or flammable atmospheres / areas. Х Works involving traffic corridors or other non-pedestrian traffic. Х Use of explosives.
Hydraulics work (all mains, waste water, sewerage, storm water
Х and hydraulic supply) Х Works carried out on a tower. Х Works on or near pressurised gas / piping.
Х Mechanical Work (all works related to air conditioning and lift services; pumps, pipes and ductwork related to other services structural work) Х Other
Tick the Personal protective equipment (PPE) requirements. Emergency arrangement details
Other Job ✘ ✘
Specific PPE
Head ✘ Foot ✘ Hi-vis vest ✘ Hand ✘Eye ✘ Hearing Fall arrest ✘ Fire/evacuation First Aid Pollution/spill
Hazardous materials: Are hazardous materials to be used? Yes No Is MSDS Available
Mention Specific controls required as per MSDS:
Permit required (tick below)
Permit to work confined spaces Excavation Permit LOTO
Hot-work permit Night work permit Height Work Permit Other
Person responsible for ensuring compliance with SWMS: Date of SWMS review:
What measures are in place to ensure compliance with the SWMS?
Person responsible for reviewing the SWMS control measures: Date SWMS received by reviewer:
How will the SWMS control measures be reviewed?
(SWMS control measures to be reviewed (and revised if SWMS Monitoring Record Reviewed when scope of work changes
necessary) if work tasks / methods change or unexpected
issues arise)
Reviewed during weekly / regular contractor meetings Site Inspection observations
Review date: Reviewer's signature:
Version: 01 01/24/2025 Page 4 842659022.xlsx
Safe Work Method Statement
Inherent Risk Residual Risk
Potential Hazards / Risk Possible Control measures.
Description of Work Activity Risk before
Likelihood Consequences
Risk after
(What might go wrong?) Likelihood Consequences
controls (How do you stop it going wrong?) controls
Glass Partition Work: 1. Fall of Material, 1) Handling of glass should be done only with cut
1) All the Glass Partitions to be covered with protective 2. Cut Injury by Sharp Edge, resistance gloves
plastic film before performing any installation work 3. Electrical Shock due use to Electrical Equipment, Likely Moderate High 2) Correct posture must be imposed on workers for Possible Major High
2) Shifting and stacking of Glass should be done under 4. Eye Injury. handling Glass.
supervision with proper handling anti-slip gloves 3) Provide tool box talk/Training on daily basis.
4) Proper supervision should be done.
Likely Moderate High Likely Moderate High
Rare Insignificant Low Almost Certain Moderate High
Unlikely Catastrophic High Likely Major Extreme
Unlikely Catastrophic High Likely Major Extreme
Unlikely Catastrophic High Likely Major Extreme
Unlikely Catastrophic High Likely Major Extreme
Unlikely Catastrophic High Likely Major Extreme
Unlikely Catastrophic High Likely Major Extreme
Unlikely Catastrophic High Likely Major Extreme
Version: 01 01/24/2025 Page 4 842659022.xlsx
Safe Work Method Statement
Inherent Risk Residual Risk
Potential Hazards / Risk Possible Control measures.
Description of Work Activity Risk before
Likelihood Consequences
Risk after
(What might go wrong?) Likelihood Consequences
controls (How do you stop it going wrong?) controls
Unlikely Insignificant Low Unlikely Catastrophic High
Rare Minor Low Possible Insignificant Low
Unlikely Insignificant Low Unlikely Catastrophic High
Likely Major Extreme Unlikely Catastrophic High
Unlikely Major Moderate Unlikely Catastrophic High
Unlikely Major Moderate Unlikely Catastrophic High
Unlikely Major Moderate Unlikely Catastrophic High
Unlikely Major Moderate Unlikely Catastrophic High
Unlikely Major Moderate Unlikely Catastrophic High
Version: 01 01/24/2025 Page 4 842659022.xlsx
Safe Work Method Statement
Workers briefed on the hazard associated for the activity and control measures on safe execution.
I understand and agree to adhere to the contents of this method statement. I have attended the briefing that explained the safe way to execute the activity as per recommended control measures.
ID No Name of Worker Worker Signature ID No Name of Worker Worker Signature
Version: 01 01/24/2025 Page 4 842659022.xlsx
