NEPEAN ENGINEERING Pty Ltd

ABN 53 088 292 013

23 Graham Hill Road (PO Box 56) Narellan NSW
2567 Australia

M: 0407236576
T: +61 2 4646 1511
F: +61 2 4648 2505
E: tcb@nepeaneng.com.au
W: www.nepeaneng.com.au
NEPEAN ENGINEERING
PTY LTD

Safe Work Method Statement

Project: CBA Commercial Building 6
Principal Contractor: Bovis Lend Lease Pty Ltd
Work Activity/Task: ERECTION AND WELDING OF ATRIUM LIFT STEEL WORK BUILDING 6
Area: ATRIUM STEELWORK BUILDING 6

SWMS No. CBA BUILDING 6 SWMS 003

Revision No: CBA001-REV02

Prepared By: Tom Buchanan
Date: 27/12/2007

Signature: Tom Buchanan

Task Details:
Expected start date: 27/11/2007
Expected duration of work; 50 Days
Manager: Tom Buchanan 0407236576
No of employees on site: 2 (min) to 10 (max)

Skills/Training Details:

All Personnel must be inducted & added to the Nepean Engineering Project S-Pack prior to commencement of
work.

Resources:
Trade(s) involved: Riggers, Crane Drivers, TAs
Equipment used: Hydraulic Wrench, Welders
Plant required: Crane Truck/s, Crane/s, EWPs, and Mobile Scaffold.
Maintenance checks: Electric register for leads & power tools, Log book for applicable plant
Materials used: Grout & Bolts & Electrodes

Page 1 of 18
 NEPEAN ENGINEERING Pty Ltd
ABN 53 088 292 013
23 Graham Hill Road (PO Box 56) Narellan NSW
2567 Australia

M: 0407236576
T: +61 2 4646 1511
F: +61 2 4648 2505
E: tcb@nepeaneng.com.au
W: www.nepeaneng.com.au
NEPEAN ENGINEERING
PTY LTD

LEGISTRATION, CODES OT PRACTICE & GUIDELINES REGISTER

The following Legist ration, Standards, Code Of Practice, Guidelines are provided as being relevant to the activities in this SWMS

OH&S Act (NSW) 2000 OH&S Regulation 2001

WORKCOVER APPROVED INDUSTRY CODES OF PRACTICE GUIDES

Code Of Practice: Amenities for construction work ( No. 317) Use of personal protective equipment at work - a guidance note.

Code Of Practice: Electrical practices for construction work (No. 301) Skin cancer and outdoor workers - a guide for workers - the choice is ours (No. 117)
Code of practice: Noise Management and protection of hearing at work
(No. 150) Shin cancer and outdoor workers - a guide for employers (No. 116)

Code of practice: OHS Consultation (No. 311) Dust in the workplace (No. 351)

Code of practice: OHS Induction training for construction work (No. 302 Hazpak! Making our workplace safer (No. 228)

Code of practice: Overhead protective structures (No. 17) High visibility clothing OHS Safety Guide

Code of practice: Tunnels Under Construction (No. 10)

Page 2 of 18
 Standards and codes offer practical guidance on health and safety for construction
Code of practice: Work in hot or cold environments (No. 309) work. However, these are subject to change from time to time. For further
Code of practice: Moving Plant on Construction sites. information contact the workcover assistance services on: 131050

AUSTRALIAN STANDARDS REGISTER

The following Legist ration, Standards, Codes Of Practice, Guidelines are provided as being relevant to the activities in this SWMS
AUSTRALIAN STANDARDS
Standards mat be obtained directly from Standards Australia (www.standards.com.au)
National Standard for Construction Work [NOHSC:1016 (2005)

AS/NZS 1576.1:1995 Scaffolding - General Requirements

AS 1657-1992 Fixed platforms, walkways, stairways and ladders - design, construction and installation (an approved industry code of practice)
AS/NZS 1800:1998 Occupational protective helmets - selection, care and use
AS/NZS 1801:1997 Occupational protective helmets
AS/NZS 1336:1997 Recommended practices for occupational eye protection
AS/NZS 1337:1992 Eye protectors for industrial applications
AS/NZS 1338.2:1992 Filters for eye protectors - filters for protection against ultraviolet radiation
AS/NZS 1338.3:1992 Filters for eye protectors - Filters for protection against infra-red radiation
AS 1269.3:1998 Occupational noise management - Hearing protectors program
AS 1270:2002 Acoustics - Hearing protectors (an approved industry code of practice)
AS/NZS 1715:1994 Selection, use and maintained of respiratory protective devices
AS/NZS 1716:2003 Respiratory protective devices (an approved industry code of practice)
AS 1891.4:2000 Industrial fall-arrest systems and devices (an approved industry code of practice)
AS/NZS 1906.4:1997 Retro reflective materials and devices for road traffic control purposes - high visibility materials for safety garments
AS/NZS 4602:1999 High visibility safety garments

Page 3 of 18
AS/NZS 2161.2:1998 Occupational protective gloves - general requirements
AS/NZS 2161.3:1998 Occupational protective gloves - Protection against mechanical risks

Page 4 of 18
 NEPEAN ENGINEERING Pty Ltd
ABN 53 088 292 013
23 Graham Hill Road (PO Box 56) Narellan NSW
2567 Australia

M: 0407236576
T: +61 2 4646 1511
F: +61 2 4648 2505
E: tcb@nepeaneng.com.au
W: www.nepeaneng.com.au
NEPEAN ENGINEERING
PTY LTD

AUSTRALIAN STANDARDS REGISTER

The following Legislation, Standards, Codes of Practice, Guidelines are provided as being relevant to the activities in this SWMS

AS/NZS 2161.5:1998 Occupational protective gloves - Protection against the cold

AS 2225:1994 Insulating gloves for electrical purposes
AS 2359.2:1985 Industrial trucks known as the SAA industrial code of operation. (an approved industry code of practice) (this covers forklift use)
AS 2550.1-2002 Cranes, hoist and winches - Safe use part 1: General requirements (an approved industry code of practice)
NZS/AS 2865:2001 Safe work in a confined space

TRAFFIC CONTROL STANDARDS

AS 1742.1-2003 Manual of uniform traffic control devices - General introduction and index of signs
AS 1742.2-1994 Manual of uniform traffic control devices - Traffic control devices for general use
AS 1742.10-1990 Manual of uniform traffic control devices - Pedestrian control and protection

Page 5 of 18
 NEPEAN ENGINEERING Pty Ltd
ABN 53 088 292 013
23 Graham Hill Road (PO Box 56) Narellan NSW
2567 Australia

M: 0407236576
T: +61 2 4646 1511
F: +61 2 4648 2505
E: tcb@nepeaneng.com.au
W: www.nepeaneng.com.au
NEPEAN ENGINEERING
PTY LTD

Skills/Training Details:
Employee Additional training
Qualifications On-site experience
Name required for this task

Page 6 of 18
Page 7 of 18
 NEPEAN ENGINEERING Pty Ltd
ABN 53 088 292 013
23 Graham Hill Road (PO Box 56) Narellan NSW
2567 Australia

M: 0407236576
T: +61 2 4646 1511
F: +61 2 4648 2505
E: tcb@nepeaneng.com.au
W: www.nepeaneng.com.au
NEPEAN ENGINEERING
PTY LTD

Risk Score Calculator

Consequence
Disaster Very Serious Substantial Minor Likelihood/ Consequence Risk Class
Serious
Likelihood The hazard has the potential to:
- permanently disable or kill;
Almost
1 1 1 2 2
- cause major damage to structure;
- have significant impact on surrounding
1
certain population and environment.
Likely The hazard has the potential to:
1 1 2 2 2 - temporarily disable or seriously injure;

Possible
- cause minor damage to the structure;
- breach the site boundary and pollute local 2
1 2 2 2 3 environment.

Remotely The hazard has the potential to:

possible 2 2 2 3 3 - cause minor injury;

Practically
- be contained within the site boundary.
3
impossible 2 3 3 3 3

Installation Procedure, Hazard Identification & Risk Control

Job Step Person

Potential Hazard
(Break the job Risk Controls (What you are going to do to (Who will
Item (What can harm
down into Class make the job as safe as possible ensure this
you?)
steps) happens?)
1. 1
Site Induction General. All personnel to be inducted into TOM
company EHS plan prior to induction BUCHANAN

All personnel to be inducted to the

SWMS before being site inducted

All personnel are to attend a Site

Specific Induction.

2. Personal
2 Various. 2 The Following PPE is to be used during TOM
Protective this task- BUCHANAN
Equipment
(PPE) Hardhats to be worn at all times, brim
attachment to be worn when working
outdoors.

Safety footwear & high visibility

protective clothing to be worn at all
times.

30+ sunscreen to be applied regularly to

all exposed skin whilst working
outdoors.

Riggers Gloves to be worn at all times

Page 8 of 18
 Safety glasses are now mandatory on
all Nepean Engineering projects
Glasses to be worn at all times UV
protection glasses to be worn when
excessive sun glare and glare from
visible radiation is present.

Hearing protection to be worn whilst

operating (or near) noisy machinery
etc.and whilst drilling anchors Higher
rated protection may be required in an
extremely noisy environment. Above 80
dsi

Dust/face mask, respirator or similar to

be worn when working in area where
inhalation danger is present, this
includes concrete dust, welding fumes
and chemicals

A harness to be worn whilst operating

boom type EWPs personnel to be
trained in safe use of harness

TOM
3 Delivery of Lift Transport arrival 3 As per RTA Permit transport truck will BUCHANAN
Shafts route arrive via Home Bush bay drive onto
Australia Ave then turn into Herb Elliott
Ave at 4 am

Transport Pilot vehicles will secure Herb

Elliott Ave and stay in place to
Nepeans Two warning Vehicles are in
place and implement traffic control plan

Clearwater will provide Traffic

Management Services from 0400 hrs to
0800 hrs

3 Unload Trucks Load falling - 2 All Steel Members must be removed Tom
and move Loading & from transport vehicle with BLL Crane Buchanan
materials (incl Unloading Crew and lowered into position to works
steelwork) to Transport. area
work areas.
2 Lifts will not be removed until all Traffic
Management Plan 84 has been
implemented and all Clearwater
employees are ready to start

2 Once load has been removed transport

truck is to remove itself from Herb Elliott
Ave and clear all road ways

All traffic control area will be cleared

and road cleared for all traffic

Straining/pulling 2 Ensure an adequate quantity of TOM

muscles - Manual personnel carry out lifting within safe BUCHANAN
Lifting. work practice guidelines. Otherwise
mechanical lifting only

Page 9 of 18
 Traffic control 2 Ensure TCP is Current and approved by TOM
BLL before delivery BUCHANAN

4 Working with Delivery 1 Operator be trained and be familiar with TOM

ewps to erect controls and general requirements of BUCHANAN
lift shaft machine.
members
EWP must have a checklist from hire
company that confirms EWP is safe to
use and signed by a licensed mechanic.

Certificate of competency (EWP)

required to operate boom lifts over 11M

Pre-Start Daily Death or serious 1 Carry out daily inspection / checks as TOM
inspection injury per manufacturers recommendations in BUCHANAN
the operators manual

EWP log book to be filled out daily and

all safety checks completed as per
logbook.

Ensure that the EWP services have

been completed as per manufactures
requirements.

Read and familiarize yourself with any

safety stickers and hazard stickers that
you may find on the EWP

Record inspections in the machines log

book and sign off accordingly.

Any faults or mechanical problems to be

reported immediately.

Operating EWP - Fall from 1 Never stand or sit on kick boards, TOM
platform. handrails or mid-rails, Ensure gate is BUCHANAN
- Tip m/c over. securely closed.
- Collision injury
Ensure tyres are inflated to correct
pressures.

Never operate when wind speeds are

above 12.5m/sec.

Ensure outriggers (if fitted) are fully

extended and on a solid bearing.

Ensure you look up, down, forward,

backwards, left and right when driving.

-Structural failure 1 Machinery loads on slab to be approved

by Structural Engineer prior coming to
site

Page 10 of 18
Working from - Tip over, injury 1 Do not use EWP as a crane, do not TOM
EWP to people below. overload the platform, observe and do BUCHANAN
- Fall from not exceed SWL.
platform.
-tools falling
Never use to push or pull other objects.

Ensure all tools and materials are safely

secured with lanyards at all times

Set up an exclusion zone around the

base of the EWP and display signage if
necessary.

Keep away from pinch points.

Safety harness to be worn and

connected at all times in boom type
EWPs.

Never enter or exit platform when

extended.

Never use ladders or other objects in

the EWP to gain additional height.

Securing the Unauthorised 1 Lower platform at end of shift. TOM

EWP after use. use. BUCHANAN
Position m/c in safe location.

Remove keys and secure

Refueling the -Fire 1 Equipment is to be turned off and shut TOM

EWP. -Slips, trips, falls down. BUCHANAN
-Spills.
-Contact with Do not use mobile phones.
chemical.
-Inhaled petrol Avoid sources of ignition, heat, sparks.
vapor.
Ensure fully charged carbon dioxide,
Dry chemical or foam extinguisher is in
close proximity when refueling.

Ensure funnel or nozzle attachment is

used when refueling.

Avoid contact with eyes, eye protection

to be worn.

Over spills to be immediately cleaned

up. A spill kit (cats Litter) is to be in tool
box at all times ready for spillages

Remove any contaminated clothing and

wash prior to re-use.

Do not intentionally inhale vapors.

Page 11 of 18
 Charging Electrocution 1 Use only earth leakage supply. TOM
batteries BUCHANAN
Extension leads to be inspected before
use, and elevated off the ground using
insulated hooks or stands.

All electrical equipment to be tested &

tagged every month.

Keep away from water and damp areas.

Securing the Unauthorised 1 Lower platform at end of shift. TOM

EWP after use. use. BUCHANAN
Position m/c in safe location.

Remove keys and secure.

5 Erecting steel Nepean 2 All Employees and Contractors

using crane Engineering Pty reporting for work at the site must TOM
Ltd Employees possess the necessary trade BUCHANAN
and Contractors qualifications to meet the requirements
not aware of the of competent person definition under
current site work the regulation for the work they will
activities, perform, a valid Construction Industry
hazards and General Induction Card and be inducted
risks. into the Principal Contractor Project

2 On arrival at the worksite report to the

Site Supervisor Via 2 - way radio.
Follow instructions for access to the site
and meet with the Site Supervisor.
Flashing lights on vehicles must be
turned on and all personnel are to wear
high visibility vest, hard hats, safety
boots, and eye protection and riggers
gloves at all times. Drivers and
pedestrians must observe the site traffic
rules and the directions of
spotters/traffic controllers. install signs
and barriers to provide an exclusion
zone for the job

2 On their initial arrival on site all Nepean

Engineering Employees and
Contractors must attend a toolbox
meeting to:

Discuss the identified hazards

* Assess the risk's

Use the information contained in this
SWMS, Industry Codes of Practice and
Standards, To:

Agree on the risk control Measures

Document them on the JSA
and
Sign the Tool Box Talk before starting
Any work at the job site.

Page 12 of 18
 Carry out daily inspection / checks as
per manufacturers recommendations in
the operators crane manual

Crane log book to be filled out daily and

all safety checks completed as per
logbook.

Lifting schedule to be completed.

Read and familiarize yourself with any

safety stickers and decals on the crane

Record inspections in the machines log

book and sign off accordingly.

Any faults or mechanical problems to be

reported immediately.

Machine not to be used until faults are

fixed and/or a service is carried out

Pre-start daily Death or serious 1 TOM

inspection injury. BUCHANAN
Operation of Traffic Movement 2 Observe site traffic rules, the directions TOM
the Crane on site. of traffic controllers and/or BUCHANAN
rigger/Dogman.

Failure of the 1 Unsure that the crane is big enough to

Crane lift the load. Crane driver and
Rigger/Dogman determine the crane
capacity to lift the load within the correct
SWL of the Crane.

Outrigger 1 You will ensure that outrigger are set as

compaction per structural Engineers specs two
failure forward working outriggers must have
plates underneath wooden packers

Page 13 of 18
Failure of Lifting The crane has current approval by a
gear statutory authority. A hired in plant
inspection report has been carried out
for the crane by a competent person.
Records of crane inspections, services
record, changes to ropes, are
maintained. A.S. 2250 is the applicable
standard.
1
Failure of driver A competency assessment has been
carried out for the crane driver that
matches the requirements for operating
the crane.
1
Failure of A competency assessment has been
Rigger/Dogman carried out for the Rigger / Dogman that
matches the requirements for the lift to
be undertaken.
1
Failure of the Ensure that the lift has been assessed
Operating system and the method agreed between the
crane driver and Rigger / Dogman prior
to the lift being made
1
Movement of Asses load for potential movement
load when before loosening restraints. Do not
removing stand on or amongst load when
restraints restraints are being loosened.
1
Placement of Ensure Materials are stored well clear
Materials of vehicle and pedestrian traffic ways.

Store materials in a manner that will

prevent unexpected movement under
the influence of gravity. If there is any
risk of unexpected movement the
materials must be adequately
restrained.
1
Pinch and crush Ensure direct eye contact is maintained
points in formed with the Rigger Dogman at all times and
by the slewing do not allow access to the danger area
action of the formed by the slewing action of the
crane crane.

It is essential that all parties agree,

understand and obey the work method
and communication selected for the lift

Page 14 of 18
Rigging, Load or parts of 1 Secure every part of a load whilst raised TOM
Slinging and load slipping or lowered to prevent danger from BUCHANAN
Dogging and/or falling slipping or displacement.
Securing the
Crane after Edges on load 1 Take adequate precautions to prevent
use. causing damage the edges of a load from damaging any
to load lifting sling, rope or chain
equipment

Inappropriate 1 Prohibit people being suspended from

work practices the hook of any crane to do any work.
using crane to
work at height

Inappropriate 1 Use only rope clips of approved design

rope fastening and construction, and only for such
purposes and in such way as is
approved.

Unaccredited 1
Rigger / Dogman Prohibit Riggers from
or not working to A) Riding the hook or the load
accreditation
criteria B) Sliding down lines and guys
C) Descending by "skinning" Columns
D) Jumping from elevated surfaces

Rigger / Dogman 3 Use clean, dry tag lines made from

using Tag Lines natural fibre or non-conductive
materials.

Unauthorised 1 Position crane in safe location.

use.
Remove keys and secure.

Refueling the -Fire 1 Crane is to be turned off and shut down.

Crane.
Do not use mobile phones.

Avoid sources of ignition, heat, sparks.

Ensure fully charged carbon dioxide,

Dry chemical or foam extinguisher is in
close proximity when refueling.

-Slips, trips, fall. 2 Ensure funnel or nozzle attachment is

used when refueling.

-Spills. 2 Avoid contact with eyes, eye protection

to be worn.

-Contact with 2 Over spills to be immediately cleaned

chemical. up. A spill kit (cats Litter) is to be in tool
box at all times ready for spillages

Remove any contaminated clothing and

wash prior to re-use.

Page 15 of 18
 TOM
-Inhaled petrol 3 Do not intentionally inhale vapors. BUCHANAN
vapor.

6 Install
Chemset/Hold
down Bolts

Mark Chemset Reaction to 3 Personnel to be trained in the use of the TOM

locations on chemicals product per the attached MSDS. BUCHANAN
the slab using Using marking
paint. paint

Chemset Structural 1 Chemset Locations to be checked by TOM

Locations damage to slab Post-Tensioning Contractor. Written BUCHANAN
checked. confirmation required prior to drilling
slab.
Drill & Install Electrocution - 1 All electrical leads and equipment to be TOM
Chemical Using electrical tagged monthly by a licensed BUCHANAN
Anchors equipment. electrician.
and,
A safety overload device is to be used
on all electrical equipment.
and,
Personnel to be aware of danger of
electrocution from over-head or hidden
cables, if in doubt ask then
insulate/isolate.
Noise 2 All workers must where hearing TOM
protection at all times whilst working BUCHANAN
with drills.

Dust Inhalation 3 Dust mask to be worn if excessive dust TOM

is created whilst drilling holes. BUCHANAN
and,
Whilst cleaning out drilled holes with a
puffer.

Dust/Foreign 3 Safety Glasses to be worn whilst TOM

body blown into cleaning out drilled holes with a puffer. BUCHANAN
eyes.

Sunburn - 3 Wide brim hat, tinted UV safety glasses TOM

Working & full length clothing to be worn at all BUCHANAN
Outdoors. times, 30+ sunscreen to be applied
regularly to all exposed skin.

Reaction to 3 Personnel to be trained in the use of the TOM

chemicals - product per the attached MSDS. BUCHANAN
Installing Hilti
chemsets.

Page 16 of 18
6 Install lift shaft Lifting steel 2 Set up an exclusion zone around the TOM
Members Members into atrium area and display signage if BUCHANAN
location anyone comes into the exclusion zone
BLL to be informed and a near miss /
hazard identification form filled out and
Given to site safety officer to take action

2 BLL will lift steel that has been

unloaded and place it into works area
Nepean will secure the lift shaft with our
crane and lift into position.

2 Once steel members are at correct

position and surveyed. members to be
secured down to hold down bolts before
crane releases the weight off the hook

2 Once crane has released the weight

riggers to check again all connections
are correct, once checked then hook
can be released

3 Steel to be surveyed again to ensure

correct positions and RLs Sent to BLL

7 Welding and Install shs 2 After each section of lift shaft members TOM
oxy cutting members and have been erected, welding of the shs BUCHANAN
steel shs to fit weld into place at stubs will be required.
lift shaft all levels
2 Access will be gained to areas using
only telescopic booms or spider booms

2 All areas are to be confirmed to be

barrier tape off and signs up

2 Flash shield to be installed before

welding starts shield is to be continually
monitor for effectiveness

Damage to steel 1-3 Builder to approve all site-welds prior to TOM

structure. commencement (unless shown on shop BUCHANAN
drawings).

Site Welding only to be completed by a

qualified welder, NDT is reqd for 100%
of all butt welds.

All repairs to be painted with cold gal

(final touch up painting to be completed
following installation)

Electrocution - 1-2 All electrical leads and equipment to be TOM

Using electrical tagged monthly by a licensed BUCHANAN
equipment. electrician.

Page 17 of 18
 A safety overload device is to be used
on all electrical equipment.

Welding flash, 2 Safety work clothes to be worn by TOM

sparks or fire - operator i.e. long sleeve shirt, long BUCHANAN
Stick (Arc) pants or overalls, safety footwear,
Welding. welding gloves and helmet.

Work area to be examined and all

external fuels removed (i.e. cardboard,
timber, fabric, general rubbish, petrol).

Fire extinguisher is to be on hand at all

times.

Welding screen used to block arc when

area is exposed to others.

All welds to be marked HOT with chalk

upon completion.

Fire blanket to be used to contain

sparks (if required).

Area below to be cordoned off &

warning signage displayed
and/or,
Extra person positioned to act as a
spotter.

Fire/Explosion 2 Gas bottles to be TOM

Oxy Cutting stored/moved/operated in a safe BUCHANAN
manner, Flash-back arrestors to be
used, and regulators/hoses/torches to
be inspected for damage prior to use.
and,
Work area to be examined and all
external fuels removed (i.e. cardboard,
timber, fabric, general rubbish, petrol).

Gas bottles to be stored separately

when not in use in a lockable cage and
fire extinguisher attached

All signage to be attached to gas cage

Supervisors contact details to be

attached to gas cages also

Sparks/ hot metal 2 Safety work clothes to be worn by TOM

Oxy Cutting operator i.e. long sleeve shirt, long BUCHANAN
pants or overalls, welding gloves, safety
footwear and dark protective eyewear.

Fire extinguisher is to be on hand at all

times.

All cut steel pieces to be marked HOT

with chalk upon completion.

Page 18 of 18
 Area below to be cordoned off &
warning signage displayed
and/or,
Extra person positioned to act as a
spotter.

Area to be re-inspected 30 mins after

work has nee completed to ensure no
fire has started

Reaction to 3 Personnel to be trained in the use of the TOM

chemicals - Using product per the attached MSDS. BUCHANAN
Cold-Gal touch-
up paint.

8 Plumb/Align Damage to steel 1-3 Plumb/Align steelwork to erection TOM

Steelwork and structure. Tolerances as per AS4100. and QA BUCHANAN
Fully Tension And plan
all bolted Noise from
connections. Tighten up bolts All bolted connections are to be
installed as per shop drawings.

Joints containing a number of bolts shall

be tightened from the centre outwards
(per 15.2.4/AS4100).

All bolts are to be wrench tight using

only a hydraulic wrench no electric or
air compressed wrenches to be used

9 Grout & Tidy Reaction to 3 Personnel to be trained in the use of the TOM
Up. chemicals - product per the attached MSDS. BUCHANAN
Installing grout.

Slips, trips & falls 1-3 Personnel are to ensure the work area TOM
is kept clean and free from trip hazards BUCHANAN
at all times.

Page 19 of 18
I have read and understood the above SWMS and I will carry out all work in accordance with the procedures
and safety controls listed. If the work or conditions differ to that stated above, I will consult with the Project/Site
Manager to seek directions prior to continuing work.

NAME DATE SIGN

Page 20 of 18