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: 05 Nov, 2018 Report # 004 Project # 09J-C06

Location: AHC ACCESS ROAD Observer Name: Mohammad Layke (Civil Engineer)
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 is mo rn ing (o n 0 5/ 1 1/ 20 1 8 ) on e o f o u r Working at height  Tools & Equipment. 

e ng ine e r wh ile he ad in g t o wa rd s A l-Ha id e r S it e Environment √ Manual Handling 
o ff ice (09 J- C06 ) h is ve h icle wa s slip p ed a nd Scaffolding and or
st u ck o n t he sub -b a se a cce ss roa d , b ut h e
MEPI  Falsework

ma na g ed to d rive sa fe ly t o sit e of f ice. Lifting Operations  Permit 
Confined Space
work
 Welfare 
B e ca u se ye st e rda y’s (0 4 /1 1 /2 01 8 ) h ea vy ra in
S it e o ff ice a cce ss roa d wa s d a ma g ed . Housekeeping  Training 
Any Other:

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

What action was; Taken √ Suggested 
 I mmed ia t e ly are a b a rrica de d sig n ag e wa s p la ce an d in fo rme d a ll d rive rs
wh ile d rivin g acce ss roa d ma d e b y su b -b ase be ca u t io u s

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. Wh ile he avy ra in ing a vo id d riving o n ro ad
mad e by sub -b a se

2. Che ck fo r a lt e rn a t ive ro ad / d rive ve ry 05/11/2017 05/11/2108
ca u t iou s
 3. Con t ro l ve ry we ll wh ile d rivin g slipp e ry roa d
(A cce ss ro ad s mad e by sub - ba se )

Reviewed By: Name Designation Date Signature

Site In-charge Ali Al Dali CM 05/11/2018

HSE In-charge Iqbal Mohammad Safety Manager 05/11/2018