Attachment 1 RISK ASSESSMENT FORM

SECTION 1-MASA Department / Contractor: - Veolia Date: 14/08/2017

APR (Authorized Permit Receiver) Name: Discipline: Mechanical

Facility / Assessment Team

Job Location : Specify Activity to be assessed :- Signature
Department: Member
SWC-1 1
2
3
Reviewed By -MaSa / Marafiq Coordinating Reviewed By - MaSa QHSE Dept. Safety Approved By (MaSa O & M Manager/Supt.):
Department Engineer: Section

Name: Signature: Name: Signature: Name: Signature

Date: Time: Date: Time: Date: Time:

SEVERITY /
POTENTIAL HAZARD CONSEQUENCES CONTROL MEASURE
SR JOB STEPS
(What can cause harm?) (What can go wrong to (What can be done to prevent it from going wrong?)
whom?)
01 Shut-Down and De-  Slip/trip/fall  Incident  Area to be barricaded and signs to be
watering of the tank.  Exposure to  Personal displayed
 Sides of excavation to be stepped or
(Confined Space) contaminated Injury
protected against collapse while doing
water dewatering.
 Exposure to  Ensure proper illumination during night.
 Proper usage of PPE
pressurized
 Proper access to the dewatering area.
water  Use pressure testing equipment of
 Electric shock appropriate capacity and hose, fittings
etc. of adequate pressure rating. Assign
 MARAFIQ –SAUR OPERATIONS & MAINTENANCE COMPANY Document ID No :MaSa- QHSE-SP-08
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(MaSa)
Rev. No.: 1
Date of issue: 11-08-2012
SAFETY PROCEDURE – RISK ASSESSMENT
Revision Date: 10-08-2015

trained workers. Barricade the area and

02 Inside Repairing of GRP
Tank. (Confined Space)
PROPRIETARY NOTICE
THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS
EXPRESSLY PROHIBITED EXCEPT UPON WRITTEN PERMISSION BY MASA.
Prevent unauthorised entry.
 Instruct and ensure nobody tamper with,
or tighten any fittings, valves, hoses,
gauge etc.) during pressurising/under
pressure.
 Deficiency of  Accident  Before start the activity must obtained
oxygen  Personal confined space Work Permit for to work
inside the Hypochlorite Tank.
 Toxic Gases Injury
 Fire  Property  Only a competent and trained person done
the job inside the confined space
 Lack of Access Damage
 Entry into any confined space is potentially
& egress. dangerous due to the possibility of oxygen
 Poor Visibility. deficiency, presence of flammable gas,
 Electric Shock. hydrogen sulfide, or other toxic substances.
 Falling Objects  Gas tests are required before any vessel entry
permit can be issued. The tests must include
the following:
 flammable (combustible) gas
 oxygen content
 Toxic substances which may be present, such
as carbon monoxide, or hydrogen sulfide.
 Gas test limits for a normal vessel entry are
oxygen at 20.9%, combustible gas at 0%,
and hydrogen sulfide at 0 parts per million.
 If gas test results are out of the normal range,
then special equipment such as respirators,
IMPORTANT
Only document with stamps are considered official.
 MARAFIQ –SAUR OPERATIONS & MAINTENANCE COMPANY Document ID No :MaSa- QHSE-SP-08
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(MaSa)
Rev. No.: 1
Date of issue: 11-08-2012
SAFETY PROCEDURE – RISK ASSESSMENT
Revision Date: 10-08-2015

Self-Contained Breathing Apparatus,

protective clothing and forced air ventilation
will be required.
 A confined space / vessel includes tanks,
drums, large piping, exchangers drains, pipes
or any other equipment that may contain
toxic substances or a lack of oxygen.
 A confined space must be ventilated and
have a constant flow of moving air. Air
blowers should be installed if necessary.
 Inside the confined space max. Voltage of
lighting 24V and for power tools 110V.
 Work in confined spaces should always be
done as a “buddy system”, and using
lifelines for rescue.
In case of emergency always report to nearest
assembly point.
02 Grinding the walls of the
tank. (Hot Work)
03 Painting the Walls of the
Tank. (Oil Based Paint)

SECTION 2-List of Materials

(Tools, work equipment, safety and emergency items)

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS Only document with stamps are considered official.
EXPRESSLY PROHIBITED EXCEPT UPON WRITTEN PERMISSION BY MASA.
 MARAFIQ –SAUR OPERATIONS & MAINTENANCE COMPANY Document ID No :MaSa- QHSE-SP-08
Page 4 of 5
(MaSa)
Rev. No.: 1
Date of issue: 11-08-2012
SAFETY PROCEDURE – RISK ASSESSMENT
Revision Date: 10-08-2015

Job should be started only after making provision of suitable and safe tools, work equipment, safety and emergency items on site as
stated in risk assessment.
Sr. Tools and other work equipment Qty Sr. Safety and Emergency items

1 01 Rescue Pulley with lifeline.

2 02 Full Body Harness
3 03 Full face Respirators
4 04 Gas Detector
5 05 Warning Barricade
6 06 Tool Bag with Rope.
07 First Aid Kit.
08 Fire Extinguishers.
09 Ventilation Fan
10 SCBA (Self Contained
Breathing Apparatus.

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS Only document with stamps are considered official.
EXPRESSLY PROHIBITED EXCEPT UPON WRITTEN PERMISSION BY MASA.
 MARAFIQ –SAUR OPERATIONS & MAINTENANCE COMPANY Document ID No :MaSa- QHSE-SP-08
Page 5 of 5
(MaSa)
Rev. No.: 1
Date of issue: 11-08-2012
SAFETY PROCEDURE – RISK ASSESSMENT
Revision Date: 10-08-2015

SECTION 3-Information to Employees

(Details of job, hazards, risks and safety precautions)

Prior to commencement of job, Authorized Permit Receiver / Supervisor must give information on details of job, hazards, risks and
safety precautions to all personnel involved in the job and obtain their signatures on the form to acknowledge the same.

Sr. Name of the employee Profession ID No. Signature of the employee

I am informed of job details, hazards, risks and
safety precautions in order to perform above job
safely.
1
2
3
4
5
6
7
8
7
8
9
10

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS Only document with stamps are considered official.
EXPRESSLY PROHIBITED EXCEPT UPON WRITTEN PERMISSION BY MASA.