RISK ASSESSMENT FORM - ‫نمــوذج تقييم المخاطــــر‬
Date : 11-03-2015
‫ التاريخ‬:
Ref No:
‫ رقم المرجع‬:
RA/AK/34
‫ اسم المشروع‬:
Project Name : Roads and Infrastructure in Al Kheesa North and East
Assessment location : Site locations for pipeline works
‫ موقــع التقييـم‬:
Description of work : Hydro pressure testing
‫معدل الخطر‬
Risk Rating
‫من قد يتعرض‬
‫الرحجية‬
Likelihood
‫ الظرلوف‬/‫الخطر‬
‫التي قد تفاقم لوتطور الخطر‬
‫العواقب‬
Consequences
‫النشاط‬
RISK
Safety precautions needed to control the Risk to ALARP *
‫معدل الخطر‬
Risk Rating
Who Might be
Harmed
‫الرحجية‬
Likelihood
Hazard / Conditions that could
develop hazard
‫العواقب‬
Consequences
Activity
Manual Works inside Improper accesses to trenches / workers, public in
trenches
No access to come out in case of the vicinity.
an emergency.
1
1
3
9
Provide proper access into the trench.Ladders shall be securred by
tying against sliding. There shall be one ladder at minimum 50 mtr
apart.
1
3
Falling of loose materials from Workers inside the
the sides of trenches - injury
trench
3
3
9
Clear loose materials including stones from the edges trenches
Install and secure green mesh at the walls of trench.
1
1
1
2
1
2
12
Conduct TBT on heat stress symptoms and Precaustions.Ask
workers to come out of trench at frequent intervals on rotation
basis, breathe fresh air and to cool down their body. Drink cool
water. Avoid each man remain for long time inside trench.Report
any symptoms of heat stress immediately.
SR #
1
‫وصـف العمـل‬:
‫ الخطــر المتبقي‬RESIDUAL
‫الخطــر اللولي‬
Initial Risk
‫للخطر‬
Fatigue
/ Heat stress while
working inside trench.
Involved workers
4
3
‫"الحتياطيات اللمزمة لضبط الخطر لوتقليصه الى الحدلود المقبولة عمليا‬
Responsible Person
‫الشخص‬
‫المسؤلول‬
Gen. Foreman,
Foreman
Gen.Foreman,
,Foreman
Gen.Foreman,
Foreman
*ALARP - As Low As Reasonably Practicable
Assessed By:
Date:
Eng.Enrique Fajardo
‫ معد التقييم‬:
11/3/2015
Signature :
1
2
3
4
Likelihood / ‫التحتمالية‬
Severity / ‫الشدة‬
Remote / ‫مستبعد‬
Unlikely / ‫غير مرجح‬
Likely / ‫مرجح‬
Frequent / ‫متكرر‬
Minor / ‫طفيف‬
Major / ‫اساسي‬
Severe / ‫تحاد‬
Fatality / ‫الوفاة‬
HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012
Reviewed by :
Date:
‫ التوقيع‬:
Signature:
Likelihood
Severity
4
3
2
1
Eng.Salameh Haddadin (Project Manager)
11/3/2015
‫التاريخ‬:
‫ التوقيع‬:
4
3
2
1
16
12
8
4
12
8
6
4
2
4
3
2
1
9
6
3
‫ المراجعة من قبل‬:
‫التاريخ‬:
Page No. 1 of 7]
working near
dewatering area.
2
‫"التحتياطيات اللمزمة لضبط الخطر وتقليصه الى الحدود المقبولة عمليا‬
‫معدل الخطر‬
Risk Rating
‫من قد يتعرض‬
‫للخطر‬
‫الرتحجية‬
Likelihood
‫ الظروف‬/‫الخطر‬
‫التي قد تفاقم وتطور الخطر‬
Slip / Trip and Fall
Safety precautions needed to control the Risk to ALARP *
‫العواقب‬
Consequence
s
Who Might be
Harmed
‫الخطــر المتبقي‬
RESIDUAL RISK
‫معدل الخطر‬
Risk Rating
‫النشاط‬
Hazard / Conditions that could
develop hazard
‫الرتحجية‬
Likelihood
Activity
SR #
‫العواقب‬
Consequence
s
‫الخطــر الولي‬
Initial Risk
Responsible Person
‫الشخص‬
‫المسؤول‬
1. Area to be barricaded and signs to be displayed
2. Sides of excavation to be stepped or protected against collapse
while doing dewatering.
Engineer, Gen.Foreman,
Foreman, HSE
3. Ensure proper illumination during night.
4. Ensure operators are trained and work is under close
supervision.ocedure. No unauthorized / job related personnel
should be on site
Involved workers,
others nearby
5. Proper usage of PPE’S
6. Good house keeping.
7. Proper access to the dewatering area.
Date:
Eng.Enrique Fajardo
‫ معد التقييم‬:
11/3/2015
Signature :
1
2
3
4
Likelihood / ‫التحتمالية‬
Severity / ‫الشدة‬
Remote / ‫مستبعد‬
Unlikely / ‫غير مرجح‬
Likely / ‫مرجح‬
Frequent / ‫متكرر‬
Minor / ‫طفيف‬
Major / ‫اساسي‬
Severe / ‫تحاد‬
Fatality / ‫الوفاة‬
HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012
1
1
Engineer, Gen.Foreman,
Foreman
6. Good house keeping.
*ALARP - As Low As Reasonably Practicable
Assessed By:
1
Reviewed by :
‫التاريخ‬:
Date:
‫ التوقيع‬:
Signature:
Likelihood
Severity
4
3
2
1
Eng.Salameh Haddadin (Project Manager)
11/3/2015
4
3
2
1
16
12
8
4
12
8
6
4
2
4
3
2
1
9
6
3
‫ المراجعة من قبل‬:
‫التاريخ‬:
‫ التوقيع‬:
Page No. 2 of 7]
T FORM - ‫نمــوذج تقييم المخاطــــر‬
‫ رقم المرجع‬:
‫ اسم المشروع‬:
‫ موقــع التقييـم‬:
RA/AK/34
Responsible Person
1
1
Gen.Foreman, Foreman
1
1
Gen.Foreman, Foreman
‫العواقب‬
Conseq
uences
‫الرتحجية‬
Safety precautions needed to control the Risk to ALARP *
Use pressure testing equipments of appropriate capacity and hose,
fittings etc of adequate pressure rating. Assign trained
1
workers.Barricade
the area
andLocations
Prevent unauthorised
.Barricade
the pressurising
area.
of pipe joints,entry.
valves
‫وصـف العمـل‬:
Likelih
ood
‫معدل‬
‫الخطر‬
Risk
Rating
‫الخطــر المتبقي‬
RESIDUAL RISK
Likelih
ood
‫معدل‬
‫الخطر‬
Risk
Rating
‫العواقب‬
Conseq
uences
‫الرتحجية‬
Date: 11-03-2015
‫ التاريخ‬:
Ref No:
Project Name : Roads and Infrastructure in Bani Hajer North . Phase 1 & 2
Assessment location : Site locations for potable water works
Description of work : Potable water works
‫الخطــر الولي‬
Initial Risk
Hazard / Conditions that could
Who Might be
Activity
develop hazard
Harmed
SR #
‫ الظروف‬/‫الخطر‬
‫النشاط‬
‫من قد يتعرض‬
‫التي قد تفاقم وتطور الخطر‬
Electric shock / Over Heated
Machineries.
Involved workers,
2
3
6
others
‫الشخص‬
‫المسؤول‬
etc to be barricaded and watchman to be posted.
Releasing pressurised water /
draining
Involved workers,
others in the
vicinity
Assessed By: Eng.Enrique Fajardo
Date:
11/3/2015
‫ معد التقييم‬:
‫التاريخ‬:
Instruct and ensure nobody tamper with, or tighten any fittings,
1
valves,hoses, guage etc.) during pressurising/under pressure.
Location of pressure releasing should be barricaded and ensure
unauthorised entry. Water should be drained into prepared sumps
or into
a tanker(Project
to prevent
flowing around.
Reviewed by : Eng.Salameh
Haddadin
Manager)
Date:
Signature :
‫ التوقيع‬:
Signature:
11/3/2015
4
3
2
1
16
12
8
4
12
8
6
4
2
4
3
2
1
*ALARP - As Low As Reasonably Practicable
1
2
3
4
Likelihood / ‫التحتمالية‬
Severity / ‫الشدة‬
Remote / ‫مستبعد‬
Unlikely / ‫غير مرجح‬
Likely / ‫مرجح‬
Frequent / ‫متكرر‬
Minor / ‫طفيف‬
Major / ‫اساسي‬
Severe / ‫تحاد‬
Fatality / ‫الوفاة‬
HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012
Likelihood
Severity
4
3
2
1
2
3
6
9
6
3
‫ المراجعة من قبل‬:
‫التاريخ‬:
‫ التوقيع‬:
Page No. 3 of 7]
HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012
Page No. 4 of 7]
HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012
Page No. 5 of 7]
HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012
Page No. 6 of 7]