Power & Water Utility Company MSSS-1-SF-001

Document ID No :
for Jubail and Yanbu (MARAFIQ)
Page: 1 of 7

Rev. No.: 0
RISK ASSESSMENT FORM
Valid Until : November 12 - 2011

SECTION 1-Marafiq Department /Contractor: - Al Manar Arabian Corp. Date: May 19, 2011
Facility / Job Location : Specify Activity to be assessed :- Assessment team member Signature
Department:
Projects Behind MARAFIQ Concrete pouring for the Foundation, Grade
Admin. Building beam, Slab, Water Proofing installation and 1 Mohammed Hamdy
Backfilling and Compaction (MASJID and
CAFETERIA)
2 Mohammed Alabiad
3 Walter Castillo
Reviewed By (Marafiq coordinating Department ): Reviewed By ( Marafiq Safety Section): Approved By (Marafiq Operations Department):

Name: Signature: Name: Signature: Name: Signature

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

SR JOB STEPS POTENTIAL SEVERITY/ CONTROL MEASURE

HAZARD H/M/L/CONSEQUENCES (What can be done to prevent it from going wrong?)
(What can cause harm?) (What can go wrong?)
1. Foundation, Grade beam, Slab works
a. Steel cutting Protruding objects Puncture, strip Cutting/bending shop with proper working table shall be provided.
Scrap/Dismantled parts shall be separate immediately and pile on safe
place away from the working area.
Sharp edges of the Cuts, strip Wear proper PPEs for the job, hand gloves, safety glass, Face shield,
cutting machine ear plug when using cutting disk of grinding machine
Repeated motion Body pain, strains Proper posture and buddy system is required to avoid too much exert
of power.
Exposed /open Electrocution, Fire And burn When using Electric power tools make it sure cable, outlet and
energized cable machine is free from any defects, look for the inspection color coding
for that month. Any doubt discuss it with supervisor assigned, prior to
PROPRIETARY NOTICE IMPORTANT
THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MARAFIQ. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MARAFIQ. Only document with stamps are considered official.
 Power & Water Utility Company
for Jubail and Yanbu (MARAFIQ)
RISK ASSESSMENT FORM
b. Steel bending Improper working
postures
Congested working area
c. Form work lay out and Tripping Hazard
installation
Expose rebar/steel,
protruding objects.
Contact with the sharp
blade of the circular saw
Poor house keeping
d. Concrete pouring for column Fall,
grade beam & slab using Ergonomic/Chemical
pumpcrete truck/Mixer Hazards
(commercial…)
Moving machinery
PROPRIETARY NOTICE
THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MARAFIQ. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MARAFIQ.
Cuts, eye, face injury
Fire
Physical injury, body pains
Slip, punctured, cuts
Fall, cut,
Puncture, cuts, fall on the
same level, abrasion
Cuts,
Slip, strip, fall punctured,
fracture
Pump truck may fall
Hitting workers/facilities
MSSS-1-SF-001
Document ID No :
Page: 2 of 7
Rev. No.: 0
Valid Until : November 12 - 2011
the activities.
Used of cutting disk not a grinding disk, cutting area shall be
surrounded with sheet metal or fire blanket.
Provide fire extinguisher near the working area.
Buddy system is required to minimized too much power exertion, that
will result to body pains,,
Unwanted material shall be brought out from the bending working
area.
Provide a Carpentry Shop with proper working table. Maintain good
and regular house keeping to have tidy safe working area.
See to it that all steel marking shall be capped/cover and flagged with
safety ribbons.
Used hand gloves, Safety Glass, dust musk close fitting uniform.
Never try to fix any parts of the machine while in motion., safety guard
shall be in place and safe.
Scrap and dismantled parts shall be subjected for de nailing and pilled
properly away from the working area.
See to it that outrigger of the pump truck was properly place on a hard
surface, supplemented with wooden blockings and extend to the
extreme out reach .
Provide watchman to assist the driver /operator during reverse
maneuver of the machines.
IMPORTANT
Only document with stamps are considered official.
 Power & Water Utility Company MSSS-1-SF-001
Document ID No :
for Jubail and Yanbu (MARAFIQ)
Page: 3 of 7

Rev. No.: 0
RISK ASSESSMENT FORM
Valid Until : November 12 - 2011

RISK ASSESSMENT FORM (Contd.

SR JOB STEPS POTENTIAL HAZARD SEVERITY / CONTROL MEASURE

(What can cause harm?) CONSEQUENCES (What can be done to prevent it from going wrong?)
(What can go wrong?)
Contact with the cement Itching, irritation, burn Wear appropriate PPE for the job, Rubberize hand gloves,
Gumboots, safety glass, and avoid contact with the cement
PROPRIETARY NOTICE IMPORTANT
THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MARAFIQ. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MARAFIQ. Only document with stamps are considered official.
 Power & Water Utility Company
for Jubail and Yanbu (MARAFIQ)
RISK ASSESSMENT FORM
Protruding
objects/tripping hazard
Excess hardened concrete
2 Polyethylene application Concrete Protection Environment/Chemical
Hazard
Contact with the chemical
Liquid chemical
(Spillage)
3 Backfilling Ergonomics/fall hazard
Fall Hazards
Collision, crashing
Moving machinery
Foreign Particles/objects
4 Compaction Fall Hazard
a. Safety Inspection Compaction Machine malfunction, oil
Machine leakage
b. Un loading compactor machine by Un Certified operator
boom truck
Equipment malfunction
Under suspended load
PROPRIETARY NOTICE
THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MARAFIQ. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MARAFIQ.
MSSS-1-SF-001
Document ID No :
Page: 4 of 7
Rev. No.: 0
Valid Until : November 12 - 2011
Slip, fall on the same Expose rebar shall be capped and flagged with warning tape.
level
Slip, fall on the same Excess and hardened concrete shall be properly dispose
level immediately out of the working site.
L physical injury
Burn, Irritation Supervisor shall informed his people of the precautionary measure
and proper usage that was stated in the MSDS of the product.
Burn, Irritation Use rubberize hand gloves, safety glass in applying the product for
concrete protection.
Soil contamination Be careful and provide proper plastic on the ground to avoid
spillage.
L Physical injury
Damage to property.
Damage to Property Equipment is required to pass to the Safety inspection to avail
working sticker prior to the activities
Injury to the workers. Employ competent operator certified by a third party inspectorate
recognize by the Saudi Government.
Machine fall down, Provide watch man to assist the operator on the back and forth
hitting workers. movement of the equipment.
Eye and respiratory Wear safety glass, Dust mask, hand gloves and watered the
problem/injury backfilling materials if needed to reduce the dust exposure and
risk.
M Physical injury/Fire
Fire, soil contaminant Machine is subjected for Marafiq safety inspection prior to the
activities.
Load may fall Crane operator shall be competent and certified by third party
inspectorate recognized by the Saudi government.
Fracture, cuts Lifting equipment should be first inspected prior to the lifting
work. Shackle, chain, belt including the boom truck.
H Fatal/property damage No one is allowed to work/stay under a suspended load
IMPORTANT
Only document with stamps are considered official.
 Power & Water Utility Company MSSS-1-SF-001
Document ID No :
for Jubail and Yanbu (MARAFIQ)
Page: 5 of 7

Rev. No.: 0
RISK ASSESSMENT FORM
Valid Until : November 12 - 2011

c. Compactor Petrol refilling Environmental Hazard

Petrol and oil Spill Soil contamination Provide portable hand pump to be used for refilling, to avoid
spillage. Engine shall be stop when refilling.
Contact with the petrol Burn, irritation Person work on this activities shall wear rubber gloves, refilling
shall be away from a working machine/Equipment

SECTION 2-List of Materials

(Tools, work equipment, safety and emergency items)
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 Qty

1 Wheel Barrow 3 1 First Aid kits (Marafiq standard) 2

2 Circular Saw 1 2 Fire Extinguisher (6kg) 5
PROPRIETARY NOTICE IMPORTANT
THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MARAFIQ. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MARAFIQ. Only document with stamps are considered official.
 Power & Water Utility Company MSSS-1-SF-001
Document ID No :
for Jubail and Yanbu (MARAFIQ)
Page: 6 of 7

Rev. No.: 0
RISK ASSESSMENT FORM
Valid Until : November 12 - 2011

3 Boom truck 1 3 Warning/Working sign boards 6

4 Generator set JCB 1 4 Gloves 1 box
5 Shovel 15 5 Cover all
6 Piks 2 6 Safety Shoes
7 Nail Belt bag 4 7 Safety Glass 2 box
8 Ball /Claw Hammer 6 8 Warning tape
9 Claw bar 3 9 Traffic cone 5
10 Bob cat (used after installation of concrete protection) 1 10 Drinking Cooler 1
11 Compaction machine (to be brought in after back filling) 1 11
12
13
14
15
16

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
PROPRIETARY NOTICE IMPORTANT
THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MARAFIQ. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MARAFIQ. Only document with stamps are considered official.
 Power & Water Utility Company MSSS-1-SF-001
Document ID No :
for Jubail and Yanbu (MARAFIQ)
Page: 7 of 7

Rev. No.: 0
RISK ASSESSMENT FORM
Valid Until : November 12 - 2011

precautions in order to perform above job safely.

1 Mohammed Hamdy Projects Manager 3196
2 Mohammed Alabiad Project Engineer 3394
3 Mohmmed Abdul Salam Electrical Engineer 3813
4 Mohammed Kamal Foreman 3033
5 Saroj Labor 3499
6 Jit Labor 3497
7 Saidol Labor 3457
8 Sajan Carpenter 2914
9 Ruel Arapoc Operator Hyundai 3664
10 Radio Labor 3353
11 Mukesh Labor 3501
12 Mutho Carpenter 2862
13 Mohammed Carpenter 2895
14 Samen Carpenter 2958
15 Manager Carpenter 3306
16 Vincent Carpenter 3491
17 Amer Steel fixer 3704
18 Khan Carpenter 3724
19 Castillo Safety Officer 3479
20 Badul Rachman First Aid/NURSE 447

PROPRIETARY NOTICE IMPORTANT

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