Form# ESH-001

Royal Commission & SABCO

Rev # 1
Jubail Project - ES&H Department
Date: 1.03.16

POTENTIA L INC ID ENT R EPOR T (PIR )

Date Observed: 28 Oct, 2018 Report # 003 Project # 09J-C06

Location: AHC LAYDOWN AREA Observer Name: Iqbal Mohammad

Risk Rating (Probability X Potential Severity) – Please refer to Risk Assessment Matrix

High (10 to 25)  Medium (5 to 9)  Low (1 to 4) 

Risk Assessment Matrix
Potential Probability (P)
Severity (S) 1. Improbable 2. Remote 3. Occasional 4. Probable 5. Frequent
1. Negligible 1 2 3 4 5
2. Marginal 2 4 6 8 10
3. Critical 3 6 9 12 15
4. Severe 4 8 12 16 20
5. Catastrophic 5 10 15 20 25

HAZARD DESCRIPTION Category

Please write what you saw and where it took place Please Tick () in the appropriate box

Th e re wa s Hea vy ra in o n 2 7 t h O cto be r 2 01 8, Working at height  Tools & Equipment. 

I na de q ua te f a cilit ie s fo r ra in wa t e r f lo win g Environment √ Manual Handling 
cau se d so me a re a so il co lla p se Scaffolding and or
MEPI  Falsework

Lifting Operations  Permit 
Confined Space
work
 Welfare 
Housekeeping  Training 
Any Other:

Were you able to correct the problem? Yes √ No 

What action was; Taken √ Suggested 
 A rea B a rrica de d
 Ma de a rra ng e men t s fo r p rop e r ra in wa t e r f lo w

Is Detailed Investigation Required? Yes  No √

If Detailed Investigation Required Name of Team
Members (Assigned by Site in-charge):

SL Recommendation(s) Action by Target Date


1. Une xpe ct ed ra in will t a ke it s o wn wa y t o f lo w
Wa te r f a cilit at e p ro pe r wa y t o f lo w
 2. Ha ve to a rran g e p rop e r f acilit ie s (o p en sto rm
28/10/2017 28/10/2107
d ra in /o p en cha nn e l) dra i n   exce ss ra in a nd
g ro un d wat e r f ro m imp e rviou s su rfa ce s su ch

as p aved st ree t s, ca r p a rks, p a rking lo t s,
fo ot p at h s, sid e wa lks, a nd roo f s.

Reviewed By: Name Designation Date Signature

Site In-charge Ali Al Dali CM 28/10/2018

HSE In-charge Iqbal Mohammad Safety Manager 28/10/2018

 Form# ESH-001
Royal Commission & SABCO
Rev # 1
Jubail Project - ES&H Department
Date: 1.03.16

POTENTIA L INC ID ENT R EPOR T (PIR )