‫نموذج تقييم المخاطر‬

Hazards Identification / Risk Assessment

: ‫ المنطقة‬/ ‫النشاط‬
Page of .........................................................................................................................................................
Area/Activity
‫مالحظات‬ ‫المسئول‬ ‫تعليمات السيطرة‬ ‫معامل‬ ‫درجة‬ ‫احتماال‬ ‫نتيجة الخطر‬ ‫مصدر الخطر‬ ‫م‬
‫الخطورة‬ ‫التأثير‬ ‫ت‬
‫الحدوث‬
Remarks Responsibility W. I RR S LH Hazard Result Hazard Sours No.

LH = Likelihood ‫احتماالت الحدوث‬ S = Severity (consequence ) ‫درجة التأثير‬ RR = Risk Rating ‫معامل الخطورة‬ Priority ‫األولوية‬
1 Low ‫ضعيف‬ 1 Slight ‫ضئيل‬ 1 No action ‫الشىء‬
2 Medium ‫متوسط‬ 2 Harmful ‫ضار‬ 2 Low Priority action ‫اولوية ضعيفة عمل‬
3 High ‫مرتفع‬ 3 Extremely Harmful ‫ضار جدا‬ 3 Medium Priority action ‫عمل اولوية متوسطة‬
Issue # (2) Rev # (0) 4 High Priority action ‫اولوية عالية عمل‬
6 Urgent action ‫عمل اجراء عاجل‬

HSF-4.3.1-01-1
 HAZARDS IDENTIFICATION / RISK ASSESSMENT

Title of Works Location Page

Activity / Materials Hazard / Risk Elimination / Mitigation Measures Reference LH S RR Priority Action Party

General Conduct  2 1 2 Low Production &

Safety Dept.
2 1 2 ,,

2 1 2 ,,

HSP-4.3.1-01
General  2 2 4 High Safety dept.
Environmental 2 1 2 Low Safety &
Hazards 1 2 2 .. Production
1 2 2 ..
1 2 2 ..
1 2 2 ..
1 2 2 ..

LH = Likelihood S = Severity( consequence ) RR = Risk Rating Priority

1 Low 1 Slight 1 No action
2 Medium 2 Harmful 2 Low Priority action
3 High 3 Extremely Harmful 3 Medium Priority action
Revision : 0 4 High Priority action
Date of issue : June 10,2004 6 Urgent action

HSF-4.3.1-01-1
HSF-4.3.1-01-1