Risk assessment form

Name of assessor Date

Time Work area

Task being assessed

New risk
Who How might Existing Risk Rating rating Action/ Action/
What is the Additional (Residual)
might be people be risk control monitored by monitored by
hazard? controls
harmed? harmed? measures whom? when?
L C R L C R
Activity :  The risk of fire  Proper  To replace Engineer –Piping One week
and explosion leather the damaged Department
Gas cutting at due to gloves and gas cutting
piping work damaged gas leather apron with new one
shop hose from have been
leaks at hose provided  To be One month
Hazard: which may to provide Engineer –Piping
Use of lead to  Including adequate Department
damaged gas multiple helmet, safety
cutting hose injuries and safety shoe training for
death safety glasses hot works
Source: with side
shields have  To be follow Site –Supervisor
Work place been up permit to
Inspection provided work (hot
work)
 Removed all
combustible 3 months
 Risk assessment form
materials  To be deploy Piping –
near working adequate Department Head
area trained fire
watchman at
 Hard barriers work area to
were monitor the
provided job

 Adequate  Inspection of One month

and suitable hot work tools Piping –Engineer
firefighting to be carried
equipment out during
(fire issuance to
-extinguisher the workers.
) have Briefing for
been the
provided at supervisors
near work and workers
area to inspect the
tools before
the start of
work

Source: WSH
Activity:  To risk of  Adequate PPE,  To be provide
suffocation due Safety helmet, adequate Engineer Immediately
Entering into to lack of safety shoe, ventilation and
confined Space oxygen which safety eye maintained
for inspection may lead to protector and
brain death have been Site Supervisor
Hazard: provided  To ensure that One week
 To risk of valid Confined
1. Failure to inhalation of  Adequate Hard space permit to
 Risk assessment form
toxic barrier at work to be
provide gases/vapour manhole followed
adequate which may lead entrance have
ventilation on to unconscious been provided Engineer
the confined and d  Adequate 3 months
space  Adequate confined space
 To risk of fire warning training to be
and explosion signboard have provide to
2. Presence of due to presence been displayed worker and
Lack of oxygen of flammable confined
gases/ vapour  Confined space attendant
which may lead attendant have (trained
Possible to death been deployed., ,certified and
presence of monitoring and conpetaed)
Toxic gases communicated Confined Safety
/vapours to workers  To ensure Assessor One week
Atmospheric
 Adequate testing for
Possible lighting (Flame oxygen and
presence of proof light) have flammable gas
Flammable gas/ been provided level to be
vapours done
periodically,
Source: Safety Officer
 To ensure the One months
1. Work place gas meter to be
inspection valid and
2. Source of calibrated and
information maintained Emergency team
leader One months
 Adequate
Emergencies
equipment’s
rescue team to
be available on
standby for on
Risk assessment form
emergencies
Fire Fighting Team One months
 Adequate and leader
maintained
Fire fighting
equipment to
be available
near to the
confined space
Engineer
 Proper PPE for Three months
respirators and
breathing
apparatus to be
provide to
worker and
confined space
attendant , and
PPE training
also to be
provide
Engineer
 To ensure that One months
isolation of
electrical
power and
mechanically
(any moving
and rotating
parts)

Source :
- Nebosh
book
- Element
no: 8
 Risk assessment form
- Section :8.6
Activity: The risk of person  Proper barrier  Suitable
falling from height have been safety full
Removable which may lead to provided at body harness
crane motor in multiple injuries, affected area to be provide
mechanical multiple fracture,
workshop neck injury , spinal  Work at
using a cord injury, and height safety
scaffolding death training to be
platform provide
 Adequate
and suitable
Hazard: anchor point
(Life line) to
Failure to use be provide
of safety  Safe working
harness while platform,
working at fencing,
height guard rails
and toe-
boards
 Safety net to
Source be provide
 warning
Work place signboard to
inspection be provide
 co-ordination
of work
 Risk assessment form

Training Provider name NIST PVT.LTD.

 Risk assessment form
Rev: