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]