Document Name: Hazard Identification and Risk Assessment Form EHS Form

Project/ Location: No.: Rev.

Activity/ Process: Disposal of old Material Issue Date:

The Risk Assessment Severity (S) Likelihood of Occ. (L) Risk Rating (R) = S x L Risk Table (R )
1. List down activity steps. 1 No Injury 1 Very Unlikely
2. Identify and record for each hazard or any potential NI No direct effect VU not expected to occur for years 1 to 6 = Low Risk (L) (Acceptable, Monitor & Review)
to cause harm. 2 Minor / 2 Unlikely Likelihood (L)
3. Outline consequences if hazard is realized. MI First Aid/ Simple treatment U Expected to happen/recur annually 8 to 12 = Medium Risk (M) (Acceptable with controls) 1 2 3 4 5

Severity (S)
4. Identify the appropriate rating for severity and 3 Lost Time Injury 3 Likely 1 1 2 3 4 5
likelihood. Use table (R) in this form. LTI ≥1 days away from work L Expected to occur monthly 15 to 25 = High Risk (H) (Unacceptable) 2 2 4 6 8 10
5. Register the hazard of medium and high risk in to 4 Major Injury 4 Very likely 3 3 6 9 12 15
the significant environmental aspect and hazard MAI Serious injury/disability VL Expected to occur weekly Note: 4 4 8 12 16 20
register form # FRSS.40.02 5 Catasthropic 5 Certain Please refer to the main procedure for clear scoring and 5 5 10 15 20 25
6. Identify and record the control measures to be used F One or more fatalities Cer expected to occur on a daily basis rating definitions
then repeat the assessment with the controls Hierarchy of 1st 2nd 3rd 4th 5th
in place. Control measure: Elimination Substitution Eng. Control Admin. Control PPE

Risk Revised Risk

Activity Steps Hazard Effect Additional
No. Existing Controls Note
(Detail Identification) (What could Cause Harm) (Who might be Harmed & How) S L R Controls S L R

1. Ergonomical hazard 1. Maintaining proper manual handling

2. Fall/Leg and body Injury posture.
1 Manual Handling Heavy or large object Worker 2 1 2
3. Body pain 2. Two person should handle the bulk
4. Hernias objects.

1. Using of dust mask, disposal coverall,

1. Inhalation of dust
gloves.
Dust Worker 2. Nose irritation 1 2 2
2. Proper ventilation.
3. Allergies
3. Remove the dust with vaccum cleaner

1. Need to store all materials away from

walkway.
Worn or torn flooring and
Worker Slips, Trips and Falls 2. Initial inspection. 3 1 3
narrow steps
3. being vigilant
4. Adequate lighting

1. Need to arrange the materials over the

pallet.
Disposal of materials Worker Housekeeping issue 2. Pallet transported by forklift. 2 1 2
3. Dispose in materials in the proper waste
container.

Assessed By (Team) Checked By Verified By (EHS)

Note: This risk assessment is valid only for one year from date of release unless otherwise required to be revalidated and/or conditions significantly changed.

Siemens Ltd. Saudi Arabia

FRSS.40.01 R2
Page 1 of 3 Arabia Electric Ltd. (E)
01.08.2018
ISCOSA
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Hazard Severity (S):
Rate the hazards severity from 1-5 as per the following situation:

1 = No Injury: Has no effect on health and safety

2 = Minor Injury: Does not significantly reduce system health and safety
3 = Lost time Injury: injury results in lost time (one or more days away from work), seeking medical
help
4 = Major Injury: injury results in permanent disability, serious health effects or property damage
5 = Catastrophic: Results in multiple fatalities and/or loss of the system

5 = Catastrophic: Results in multiple fatalities and/or loss of the system