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HANOI PEOPLES COMMITTEE

HANOI METROPOLITAN RAILWAY MANAGEMENT BOARD (MRB)

CONTRACTOR
NAME

RAMS Studies

PROJECT: HANOI PILOT LIGHT METRO LINE


Section Nhon - Hanoi Railway Station

PACKAGE: ELEVATED SECTION - LINE


PACKAGE NUMBER: HPLMLP/CP- CP-01

PRELIMINARY HAZARD ANALYSIS

Location: Hanoi, Vietnam

PROJECT IMPLEMENTATION CONSULTANT: SYSTRA S.A

12/2019

Project Reference: DLM-IMP-PPG-ZSO-J00-00030-E-1A


RAMS Studies

PROJECT: HANOI PILOT LIGHT METRO LINE


Section Nhon - Hanoi Railway Station

PACKAGE: ELEVATED SECTION - LINE


PACKAGE NUMBER: HPLMLP/ CP-01

PRELIMINARY HAZARD ANALYSIS


Location: Hanoi, Vietnam

Hanoi 18/12/2019

HANOI METROPOLITAN PROJECT IMPLEMENTATION


CONTRACTOR
RAILWAY MANAGEMENT CONSULTANT
(DAELIM)
BOARD (SYSTRA S.A.)

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IMP-PPG-ZSO-J00-00030-E-1A
Hanoi Pilot Light Metro Project Preliminary Hazard Analysis

Contractor Approval / Revision Record Sheet

Revision Date Subject of issue / Revision Authors

1A 19/12/2019 First version TRINH XUAN DAI

Revision
1A Name Date Signature
N°:

Prepared by TRINH XUAN DAI

Checked by KIM SHIN MYUNG

Validated by OH SEUNG JONG

Contractor specific comments:

Table of contents
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1. INTRODUCTION..........................................................................................................................................7
1.1 PURPOSE...................................................................................................................................................7
1.2 SAFETY POLICY........................................................................................................................................7
1.3 PROJECT DESCRIPTION.............................................................................................................................7
1.4 SCOPE OF WORKS....................................................................................................................................8
2. ORGANISATION & RESPONSIBILITIES...............................................................................................9
2.1 SAFETY ORGANISATION STRUCTURE.......................................................................................................9
2.2 ROLES AND RESPONSIBILITIES.................................................................................................................9
3. HAZARD ANALYSIS...................................................................................................................................9
3.1 PRELIMINARY HAZARD IDENTIFICATION.................................................................................................9
3.2 IDENTIIFICATION OF MITIGATIONS........................................................................................................10
3.3 IDENTIFICATION OF THE CAUSE/CONSEQUENCE OF HAZARDS..............................................................10
4. RISK ASSESSMENT CRITERIA..............................................................................................................10
4.1 FREQUENCY OF OCCURRENCE OF HAZARDS..........................................................................................10
4.2 SEVERITY OF HAZARDS.........................................................................................................................11
4.3 RISK ASSESSMENT MATRIX...................................................................................................................11
4.4 RISK MITIGATION STRATEGY................................................................................................................12
4.5 REVIEW ON THE HAZARD IDENTIIFACTION AND RISK ASSESSMENT.....................................................13
5. PRELIMINARY HAZARD ANALYSIS RESULTS................................................................................13
5.1 PHA FORMAT........................................................................................................................................13
5.2 HAZARD STATUS....................................................................................................................................14
6. HAZARD SUMMARY................................................................................................................................15
6.1.1 Hazards.........................................................................................................................................15
6.1.2 Risk Ranking.................................................................................................................................15
6.1.3 Severity Ranking...........................................................................................................................15
7. CONCLUSION..............................................................................................................................................16
8. APPENDICES...............................................................................................................................................17

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Abbreviations

MRB Hanoi Metropolitan Railway Management Board


PIC Project Implementation Consultant (SYSTRA S.A.)

Definitions

TERMS DEFINITION
Term used within this document Definition as described in project references

Contract Documents

Ref N° Ref ID number Ref description


1. DLM-IMP-PPG-ZSO-J00-00030 Preliminary Hazard Analysis

Standards

Ref N° Ref ID number Ref description


Specification & Demonstration of Reliability,
EN 50126
2. Availability, Maintainability & Safety (RAMS)
for Railway Applications

Project References

Ref N° Ref ID number Ref description


3. PIC-TEC-TRE-SAO-L00-74025 Systra Preliminary Hazard Analysis (Rev 1C)
4. DLM-IMP-PPG-ZSO-J00-00029 Civil Work Safety Assurance Plan (Rev 1A)
5. DLM-IMP-PPG-ZSO-J00-00003 Health and Safety Management Plan (Rev 5E)

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1. INTRODUCTION

1.1 PURPOSE
The purpose of the current document is to perform a Preliminary Hazard Analysis (PHA) for the CP01
scope of work based on the overall PHA performed by the Engineer (Systra) to ensure the proper
mitigations of any identified hazards when establishing the system requirements at Technical Design
stage.
This PHA is the starting point of the Safety Process to be put in place during the project life cycle to
achieve the demonstration of the safety of the system. The PHA will be updated to take into account
any evolution throughout the project.
The current Preliminary Hazard Analysis has been developed in accordance with the system life
cycle model defined in Civil Work Safety Assurance Plan.

1.2 SAFETY POLICY


The safety demonstration at system level is based on Hazard Analysis. Based on this analysis, hazards
will be identified, and mitigation measures defined to reduce the risk to ALARP.

1.3 PROJECT DESCRIPTION


Hanoi Pilot Light Metro Line, section Nhon - Hanoi Railway Station is a major project for Hanoi City.
According to the Hanoi Transportation Master Plan until 2020, total length of HPLML (Line 3) shall
reach 21,5km from Nhon to Hoang Mai. The first phase of this line, and part of this Contract is from
Nhon to Hanoi Railway Station, with about 8.5 km elevated section and 4.0 km underground section.
This line includes 12 stations as presented in Figure 1.1 (with 8 elevated and 4 underground stations).
The Depot is located at Nhon with area of 150,550m2.

The CP01 Contract’s work scope is Viaduct Line at Elevated Section, including the construction of
viaduct structures, which link along the National Road No32, Ho Tung Mau, Xuan Thuy, Cau Giay
and interfaces with underground section at the beginning of Kim Ma Street. The contract shall be
completed and within 30 months from the date of the Commencement Date.

Both metro and structure alignment follow the current and/or planned median road. Viaduct structures
are divided into standard viaducts which cover most of the elevated section and special viaducts where
long or special spans are required to pass over major constraints (2nd Ring Road, 3rd Ring Road,
Nhue River). Other non-typical structure consists in Crossover (metro line requires switches), ramps to
depot and underground sections and Y-bridge (branches off to depot). The overview of the project is
shown in Figure 1.1

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Figure 1

Relevant parties are as follows;

Project Proposing Entity (Hanoi People Committee)

HPC is the Owner, being responsible for approving the main works during the project implementation.

Project Implementation Entity (MRB)

Hanoi Metropolitan Railway Management Board (MRB) under HPC is assigned by HPC to be the
Client of the Project

Project Implementation Consultant

SYSTRA - France is a Consultant for implementing Project

Donors

French Government (DGTPE), French Agency for Development (AFD), Euro Investment

Bank (EIB) and Asian Development Bank (ADB).

1.4 SCOPE OF WORKS


This PHA addresses hazards at overall system level that pose a potential risk to passengers, O&M staff
and the public along the line.
It does not address hazards linked to Health and Safety during construction which are addressed by the
Health and Safety Management Plan.
Thus, the scope of work for the CP01 concerns the following systems:
 The civil work for the line – elevated section,
 The walkway at viaduct,

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 The earthing system at viaduct.

2. ORGANISATION & RESPONSIBILITIES

2.1 SAFETY ORGANISATION STRUCTURE


ORGANIZATION CHART

PROJECT MANAGEMENT

HEAD OFFIC ↑
S ITE OFFICE ↓

PROJECT MANAGER

PLANNING DEPARTMENT

INDEPENDENT S AFETY AS S ES S OR
PLANNING M ANAGER

S AFETY ASS URANCE DEPARTMENT CONS TRUCTION DEPARTMENT QA / QC DEPARTMENT

SAFETY ASSUARANCE M ANAGER CONSTRUCTION M ANAGER QUALITY ASSURANCE M ANAGER

ASSITANT CONSTRUCTION M ANAGER

ADMINIS TRATION DEPARTMENT CHIEF CIVIL ENGINEER DES IGN DEPARTMENT

ADM INISTRATION M ANAGER TYPICAL AND SPECIAL BRIDGE DESIGN MANAGER

M&E INTERFACE TEAM

M &E ENGINEER INTERFACE M ANAGER

2.2 ROLES AND RESPONSIBILITIES


The Contractor shall develop and maintain a management list of roles and responsibilities. Roles and
responsibilities shall not be restricted to safety staff but shall also include other members of the
Contractor’s team who have safety responsibilities e.g. Risk Manager, Managers, Foremen, Engineers,
and Agents. The Civil Work Safety Assurance Plan further defines the roles and responsibilities in
more detail.

3. HAZARD ANALYSIS

3.1 PRELIMINARY HAZARD IDENTIFICATION


Hazard identification process is the first stage of the PHA. It is a systematic and structured assessment
of potential accident. During the assessment, consideration will be given to all potential hazards /
accidents that might occur regardless of their likelihood, and regardless of how the system will be
operated in practice so will include the potential for operator errors.

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The assessment is based on the experience gained on other metro projects but also takes into account
the specificities of the project, indeed earlier experience” is used according to the project specificities
and conditions of use. It is verified, as requested by the CENELEC standards, that reused safety
analysis shall be done only when it is relevant e.g. same environment, condition of use.

3.2 IDENTIIFICATION OF MITIGATIONS


Mitigations are written in two ways:
 Justification that the hazard is mitigated because of high level features included in the
preliminary design,
 Requirement to be take into account when carrying out technical design.
In order to ensure an efficient follow-up of the mitigating provisions throughout the Technical
Design of each subsystem, the mitigating provisions are classified according to the subsystems.

3.3 IDENTIFICATION OF THE CAUSE/CONSEQUENCE OF HAZARDS


The consequences of hazards have been evaluated with respect to passengers, staff, and the general
public. A brief description of the possible consequence has been provided for each hazard.
The description of possible consequence is based upon a pessimistic judgement of the most severe
consequence which may credibly result from the occurrence of the hazard.

4. RISK ASSESSMENT CRITERIA


Risk is defined as a combination between the frequency of occurrence of hazard(s) and severity of the
corresponding hazard(s). Hazards shall be categorised according to both their frequency of occurrence
and their severity as per the EN50126 approach.

4.1 FREQUENCY OF OCCURRENCE OF HAZARDS


The following categories shall be used to classify the frequency of occurrence of hazards. When a
hazard is identified, an assessment on the likely frequency of occurrence is made based on the
frequency guide given in Table 1.
Frequency of Hazard Occurrence
Probabilities
Category Description
(per hour)
Likely to occur frequently. The hazard will be almost
A Frequent F > 10-5
continually experienced.
Will occur several times. The hazard can be expected to
B Probable 10-6 < F < 10-5
occur often.
Likely to occur several times. The hazard can be
C Occasional 10-7 < F < 10-6
expected to occur several times.
D Remote 10-8 < F < 10-7 Likely to occur sometimes in the system life cycle. The
hazard can be reasonably expected to occur a few times

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over the system life.


Unlikely to occur but possible. It can be assumed that the
E Improbable 10-9 < F < 10-8
hazard may exceptionally occur during the system life.
Extremely unlikely to occur. It can be assumed that the
F Incredible F < 10-9
hazard may not occur during the whole system life.
Table 1 – Frequency of Hazard Occurrence

4.2 SEVERITY OF HAZARDS


The severity of the hazard is also ranked based on the definitions given in Table 2. The following
levels shall be used to classify the severity of the consequences of the hazards. Consequences taken
into account are consequences for people, system and environment.
Hazard Severity Levels
Consequences to Persons or
Severity Level Consequences for system
Environment
Fatalities and/or multiple severe injuries
1 Catastrophic and/or major damage to the
environment.
Single fatality and/or severe injury
2 Critical and/or significant damage to the Loss of train or of a major system
environment.
Minor injury and/or significant threat to
3 Marginal Severe system(s) damage
the environment.
4 Insignificant Possible minor injury. Minor system damage
Table 2 – Hazard Severity Levels

4.3 RISK ASSESSMENT MATRIX


As shown in the matrix below, frequency of occurrence and severity of the consequences are
combined together in order to further process the risks.
This matrix presents the possible combinations of frequency of occurrence and severity of the
consequences of the hazards. It also presents the various zones of acceptability of the risk.
Hazard Severity Level
1 2 3 4
Catastrophic Critical Marginal Insignificant
Frequency of Hazard

A Frequent R1 R1 R1 R2
B Probable R1 R1 R2 R3
C Occasional R1 R2 R2 R3
D Remote R2 R2 R3 R4
E Improbable R3 R3 R4 R4
F Incredible R4 R4 R4 R4

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Table 3 – Risk Matrix

R1 to R4 are defined in the following table.

Risk Hazard Severity Level


R1 Intolerable Unacceptable. Shall be eliminated.
R2 Undesirable Shall only be accepted when risk reduction is impracticable and with the
agreement of Employer or the local Safety Authority
R3 Tolerable Acceptable with adequate control and the agreement of the Client
R4 Negligible Acceptable
Table 4 – Risk Definitions

Each risk shall be assessed to determine the zone to which it belongs.

4.4 RISK MITIGATION STRATEGY


According to the level of the acceptability identified in the risk assessment, the risks shall be managed
in different ways.

According the level of their acceptability in accordance with Table 4, the risks shall be managed as
follows:
 Intolerable risks (R1) are those which have:

o Catastrophic consequences with a frequency greater than Remote

o Critical consequences with a frequency greater than Occasional

o Marginal consequences with a frequency greater than Probable

Further risk reduction is essential through system design.


 Other risks (R2 and R3) are those risks which have:
o Insignificant consequences with Frequent frequency
o Marginal or Insignificant consequences with Probable frequency
o Catastrophic, Critical or Marginal consequences with Remote frequency

o Critical, Marginal or Insignificant consequences with Occasional frequency

o Catastrophic or Critical consequences with Improbable frequency

These risks need to be discussed in writing and submitted to the Client and or the Safety Authority for
approval of both the risks and the corresponding prevention / mitigation measures.

 Negligible risks (R4) are those which are:


o Of an Incredible frequency

o Of an Improbable frequency with consequences less than Critical

o Of a Remote frequency with consequences less than Marginal


Additional mitigation of these risks is not required.
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4.5 REVIEW ON THE HAZARD IDENTIIFACTION AND RISK ASSESSMENT


The results of preliminary hazard identification and risk assessment are included in Appendix 3. All
hazards included in PHA will be registered into the Hazard Log.

5. PRELIMINARY HAZARD ANALYSIS RESULTS

5.1 PHA FORMAT


The format of the PHA table, including definitions is as per Table 5.

Column Heading Definition


1. Source ID Hazard ID reference in originating document (i.e.
Systra PHA)
2. PHA Ref Unique reference within PHA
3. Accident The potential consequences associated with the
occurrence of the hazardous event
4. Hazard Description of the conditions or features that could
cause an accident
5. Mode The mode(s) of operation when the hazardous event
may be expected to occur
6. Location The location(s) where the hazardous event may be
expected to occur
7. Cause The underlying reasons for the occurrence of the
hazardous event
8. Exposed Group The person(s) affected by the occurrence of the
hazardous event
9. Initial Risk Assessment - The degree of severity (expressed in hazard severity
Severity levels) of the harm caused by a hazardous event
10. Initial Risk Assessment – The probable rate of occurrence of a hazardous event
Frequency (expressed in a time interval) causing harm
11. Initial Risk Assessment – Risk The probable rate of occurrence of a hazard (expressed
in a time interval) causing harm combined with the
degree of severity (expressed in hazard severity levels)
of the harm.
12. Mitigating Provisions Safeguards and controls identified to reduce the risk of
the hazardous event
13. Resp. The entity identified as being the owner of the
identified mitigation provision(s)
Table 5 – PHA Table Definitions

5.2 HAZARD STATUS


Each hazard will be given a status in accordance with Table 6 below.
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Hazard Status
New Hazards added to the database but still under review for agreement with the hazard
owner
Open Hazards reviewed and agreed with hazard owner; safety requirements and mitigation
identified but not verified or transferred to the relevant third party
Closed Safety requirements have been verified, and mitigation measures transferred to the
relevant third party. The risk assessment is considered credible and the residual risk as
low as reasonably practicable
Deleted The hazard is no longer relevant to this system, but is retained in the database for
traceability.
Table 6 – Hazard Status

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6. HAZARD SUMMARY

6.1.1 Hazards

A PHA workshop was carried out on XX November 2019 and identified a total of 95 hazards
applicable to CP01 scope of work. A list of attendees is included in Appendix A.

Of these hazards, the mitigations allocated to third parties as identified in the Systra PHA, have been
maintained in this analysis for further hazard analysis (i.e. during development of hazard log).

If further analysis identifies any additional mitigations to be implemented by third parties, these will
be exported to the appropriate entities in accordance with PIC hazard transfer process.

Assumption
Mitigations already included in the Systra PHA and allocated to third parties (i.e. systems or O&M)
will be included in their own respective hazard analyses and will not be included as hazard transfer
items by CP01.

A breakdown of the hazards and mitigations assessed during the PHA process is included in Table 7
and Table 8.

6.1.2 Risk Ranking

Risk No of hazards No of hazards


Ranking (CW) (Others)
R1 17 20
R2 21 36
R3 0 1
R4 0 0
Total 38 57
Table 7 – Risk Ranking Summary

6.1.3 Severity Ranking

Severity No of hazards No of hazards


Ranking (CW) (Others)
S1 34 39
S2 4 17
S3 0 1
S4 0 0
Total 38 57
Table 8 – Severity Ranking Summary

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7. CONCLUSION
The Preliminary Hazard Analysis has identified a total of 95 hazards relevant to the scope of CP01
scope of works. Further analysis to be conducted during the development of the hazard log will
include the provision of traceability between the identified mitigations and the as-built design.

A complete list of hazards is contained within Appendix B.

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8. APPENDICES

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Appendix A - PHA Workshop


Attendance Sheet

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Appendix B - Preliminary Hazard Analysis
Source ID Ref Accident Hazard Mod Location Cause Expose Initial Risk Mitigating Provisions Resp
e d Assessmen .
Group t
                S F R      
01.02.01.1 CP01 Head-on, Conflicting OP Main Line Loss of brake or Fatalitie 1 B R1 CW- Drainage shall be CW
8 - Side-on and movement of insufficient s or C008 designed to avoid
PHA- Rear-end two trains braking multiple accumulation of
0001 collision (face to face, performance severe water at track
side-on, injuries level in case of
distance too decennial rain
short between (survey rainfall
two trains) data)
01.02.01.1 CP01 Head-on, Conflicting OP Main Line Loss of brake or Fatalitie 1 B R1 E&M Dewatering of the E&M
9 - Side-on and movement of insufficient s or -C012 main line shall be
PHA- Rear-end two trains braking multiple designed to avoid
0002 collision (face to face, performance severe accumulation of
side-on, injuries water at track
distance too level
short between
two trains)
01.02.01.4 CP01 Head-on, Conflicting OP All Overspeed Fatalitie 1 C R1 OM- The Maintenance O&
5 - Side-on and movement of s or M001 of the Railway M
PHA- Rear-end two trains multiple system shall
0003 collision (face to face, severe guarantee the
side-on, injuries braking
distance too performance
short between (cleaning of the
two trains) track, wheels of
Rolling Stock)
01.02.01.5 CP01 Head-on, Conflicting OP All Inadequate Fatalitie 1 B R1 OM- The Maintenance O&
2 - Side-on and movement of braking s or M001 of the Railway M
PHA- Rear-end two trains distance multiple system shall
0004 collision (face to face, severe guarantee the
side-on, injuries braking
distance too performance
short between (cleaning of the
two trains) track, wheels of
Rolling Stock)
01.02.01.6 CP01 Head-on, Conflicting OP All Loss of brake or Fatalitie 1 B R1 CW- Drainage shall be CW
0 - Side-on and movement of insufficient s or C008 designed to avoid
PHA- Rear-end two trains braking multiple accumulation of
0005 collision (face to face, performance severe water at track
side-on, injuries level in case of
distance too decennial rain
short between (survey rainfall
two trains) data)
01.02.01.6 CP01 Head-on, Conflicting OP All Loss of brake or Fatalitie 1 B R1 E&M Dewatering of the E&M
1 - Side-on and movement of insufficient s or -C012 main line shall be
PHA- Rear-end two trains braking multiple designed to avoid
0006 collision (face to face, performance severe accumulation of
side-on, injuries water at track
distance too level
short between
two trains)
01.02.02.1 CP01 Head-on, Collision with OP, All Loss of brake or Fatalitie 1 D R2 OM- The Maintenance O&
4 - Side-on and a runaway MTA insufficient s or M001 of the Railway M
PHA- Rear-end train braking multiple system shall
0007 collision performance of severe guarantee the
the stabled train injuries braking
performance
(cleaning of the
track, wheels of
Rolling Stock)
01.02.04.0 CP01 Head-on, Collision with OP, All Track Fatalitie 1 C R1 CW- The subgrade CW
5 - Side-on and a train on an MTA movement s or C001 shall be designed
PHA- Rear-end adjacent track multiple in order to ensure
0008 collision severe a permanent
injuries conformance with
the alignment
profile
01.02.04.0 CP01 Head-on, Collision with OP, All Track Fatalitie 1 C R1 CW- The structure CW
6 - Side-on and a train on an MTA movement s or C007 supporting the
PHA- Rear-end adjacent track multiple subgrade shall be
0009 collision severe designed in order
injuries to ensure a
permanent
conformance with
the alignment
profile tolerance
01.03.01.0 CP01 Collision Collision with OP, Main Line Part of Civil Fatalitie 1 D R2 CW- The CW shall be CW
1 - with a fixed a fixed part MTA Work in the s or C002 designed and
PHA- part gauge of train multiple built in order to
0010 severe guarantee the
injuries respect of the
gauge
01.03.01.0 CP01 Collision Collision with OP, Main Line Part of Civil Fatalitie 1 D R2 CW- Maintenance of CW
2 - with a fixed a fixed part MTA Work in the s or M001 the CW and
PHA- part gauge of train multiple Infrastructures
0011 severe
injuries
01.03.01.0 CP01 Collision Collision with OP, Main Line Infrastructure Fatalitie 1 D R2 CW- The Infrastructure CW
5 - with a fixed a fixed part MTA (platform, s or C003 (platform,
PHA- part walkways) in multiple walkways) shall
0012 the gauge of the severe be designed and
train injuries built in order to
guarantee the
respect of the
gauge
01.03.01.0 CP01 Collision Collision with OP, Main Line Infrastructure Fatalitie 1 D R2 CW- Maintenance of CW
6 - with a fixed a fixed part MTA (platform, s or M001 the CW and
PHA- part walkways) in multiple Infrastructures
0013 the gauge of the severe
train injuries
01.03.01.1 CP01 Collision Collision with OP, Main Line Equipment in Fatalitie 1 C R1 CW- The Civil Work CW
0 - with a fixed a fixed part MTA the gauge of the s or C016 shall be designed
PHA- part train multiple to withstand the
0014 severe inferred
injuries constraints of
equipment
01.04.01.1 CP01 Collision Collision with OP, Main Line Equipment of Fatalitie 1 D R2 CW- The Civil Work CW
3 - with an an object MTA the system s or C016 shall be designed
PHA- object along along the fallen on the multiple to withstand the
0015 the track track track severe inferred
injuries constraints of
equipment
01.04.01.2 CP01 Collision Collision with OP, Main Line Piece of Fatalitie 1 D R2 CW- Infrastructure CW
7 - with an an object MTA Infrastructure s or C004 shall be designed
PHA- object along along the fallen on the multiple and built with the
0016 the track track track severe adequate
injuries soundness
01.04.01.2 CP01 Collision Collision with OP, Main Line Piece of Fatalitie 1 D R2 CW- Periodic check of CW
8 - with an an object MTA Infrastructure s or M002 infrastructure and
PHA- object along along the fallen on the multiple civil work
0017 the track track track severe
injuries
01.04.01.3 CP01 Collision Collision with OP, Main Line Piece of CW Fatalitie 1 D R2 CW- Civil work shall CW
7 - with an an object MTA fallen on the s or C005 be designed and
PHA- object along along the track multiple built with the
0018 the track track severe adequate
injuries soundness
01.04.01.3 CP01 Collision Collision with OP, Main Line Piece of CW Fatalitie 1 D R2 CW- Periodic check of CW
8 - with an an object MTA fallen on the s or M002 infrastructure and
PHA- object along along the track multiple civil work
0019 the track track severe
injuries
01.04.01.5 CP01 Collision Collision with OP, Main Line Object coming Fatalitie 1 D R2 CW- The line shall be CW
6 - with an an object MTA from the outside s or C006 protected against
PHA- object along along the multiple intrusion of
0020 the track track severe heavy objects
injuries
02.01.03 CP01 Derailment Loss of OP, Main Line Vehicle Fatalitie 1 B R1 CW- Drainage shall be CW
- guidance MTA instability s or C008 designed to avoid
PHA- multiple accumulation of
0021 severe water at track
injuries level in case of
decennial rain
(survey rainfall
data)
02.01.04 CP01 Derailment Loss of OP, Main Line Vehicle Fatalitie 1 B R1 E&M Dewatering of the E&M
- guidance MTA instability s or -C012 main line shall be
PHA- multiple designed to avoid
0022 severe accumulation of
injuries water at track
level
02.01.22 CP01 Derailment Loss of OP, Main Line Loss of brake or Fatalitie 1 B R1 CW- Drainage shall be CW
- guidance MTA (Curve, insufficient s or C008 designed to avoid
PHA- point braking multiple accumulation of
0023 machine) performance severe water at track
injuries level in case of
decennial rain
(survey rainfall
data)
02.01.23 CP01 Derailment Loss of OP, Main Line Loss of brake or Fatalitie 1 B R1 E&M Dewatering of the E&M
- guidance MTA (Curve, insufficient s or -C012 main line shall be
PHA- point braking multiple designed to avoid
0024 machine) performance severe accumulation of
injuries water at track
level
02.01.24 CP01 Derailment Loss of OP, Main Line Loss of brake or Fatalitie 1 B R1 OM- The Maintenance O&
- guidance MTA (Curve, insufficient s or M001 of the Railway M
PHA- point braking multiple system shall
0025 machine) performance severe guarantee the
injuries braking
performance
(cleaning of the
track, wheels of
Rolling Stock)
02.01.31 CP01 Derailment Loss of OP, All Vehicle Fatalitie 1 B R1 CW- Drainage shall be CW
- guidance MTA instability s or C008 designed to avoid
PHA- multiple accumulation of
0026 severe water at track
injuries level in case of
decennial rain
(survey rainfall
data)
02.01.33 CP01 Derailment Loss of OP, All Vehicle Fatalitie 1 B R1 E&M Dewatering of the E&M
- guidance MTA instability s or -C012 main line shall be
PHA- multiple designed to avoid
0027 severe accumulation of
injuries water at track
level
02.01.47 CP01 Derailment Loss of OP, All (Curve, Overspeed Fatalitie 1 C R1 OM- The Maintenance O&
- guidance MTA point s or M001 of the Railway M
PHA- machine) multiple system shall
0028 severe guarantee the
injuries braking
performance
(cleaning of the
track, wheels of
Rolling Stock)
02.01.52 CP01 Derailment Loss of OP, All (Curve, Inadequate Fatalitie 1 C R1 CW- Drainage shall be CW
- guidance MTA point braking s or C008 designed to avoid
PHA- machine) distance multiple accumulation of
0029 severe water at track
injuries level in case of
decennial rain
(survey rainfall
data)
02.01.54 CP01 Derailment Loss of OP, All (Curve, Inadequate Fatalitie 1 C R1 E&M Dewatering of the E&M
- guidance MTA point braking s or -C012 main line shall be
PHA- machine) distance multiple designed to avoid
0030 severe accumulation of
injuries water at track
level
02.01.58 CP01 Derailment Loss of OP, All (Curve, Inadequate Fatalitie 1 C R1 OM- The Maintenance O&
- guidance MTA point braking s or M001 of the Railway M
PHA- machine) distance multiple system shall
0031 severe guarantee the
injuries braking
performance
(cleaning of the
track, wheels of
Rolling Stock)
02.01.63 CP01 Derailment Loss of OP, All (Curve, Loss of brake or Fatalitie 1 B R1 CW- Drainage shall be CW
- guidance MTA point insufficient s or C008 designed to avoid
PHA- machine) braking multiple accumulation of
0032 performance severe water at track
injuries level in case of
decennial rain
(survey rainfall
data)
02.01.65 CP01 Derailment Loss of OP, All (Curve, Loss of brake or Fatalitie 1 B R1 E&M Dewatering of the E&M
- guidance MTA point insufficient s or -C012 main line shall be
PHA- machine) braking multiple designed to avoid
0033 performance severe accumulation of
injuries water at track
level
02.01.67 CP01 Derailment Loss of OP, All (Curve, Loss of brake or Fatalitie 1 B R1 OM- The Maintenance O&
- guidance MTA point insufficient s or M001 of the Railway M
PHA- machine) braking multiple system shall
0034 performance severe guarantee the
injuries braking
performance
(cleaning of the
track, wheels of
Rolling Stock)
02.01.69 CP01 Derailment Loss of OP, Main Line Track Fatalitie 1 C R1 CW- The subgrade CW
- guidance MTA movement s or C001 shall be designed
PHA- multiple in order to ensure
0035 severe a permanent
injuries conformance with
the alignment
profile
02.01.70 CP01 Derailment Loss of OP, Main Line Track Fatalitie 1 C R1 CW- The structure CW
- guidance MTA movement s or C007 supporting the
PHA- multiple subgrade shall be
0036 severe designed in order
injuries to ensure a
permanent
conformance with
the alignment
profile tolerance
02.02.01 CP01 Derailment Collapse of OP, Viaduct Pile hit by a Fatalitie 1 D R2 CW- The pile of the CW
- the structure MTA road vehicle s or C017 viaduct shall be
PHA- of the viaduct multiple designed to resist
0037 severe collisions with a
injuries vehicle (train,
cars, boat)
02.02.02 CP01 Derailment Collapse of OP, Viaduct Earthquake Fatalitie 1 D R2 CW- the viaduct shall CW
- the structure MTA s or C018 be designed
PHA- of the viaduct multiple considering the
0038 severe risk of earthquake
injuries
02.02.03 CP01 Derailment Collapse of OP, Viaduct Vibrations Fatalitie 1 C R1 CW- The viaduct shall CW
- the structure MTA s or C019 be designed to
PHA- of the viaduct multiple resist vibrations
0039 severe and load due to
injuries the worst
operational
conditions
02.02.04 CP01 Derailment Collapse of OP, Viaduct Wear of the Fatalitie 1 C R1 CW- The viaduct shall CW
- the structure MTA structure s or C020 be designed
PHA- of the viaduct multiple taking into
0040 severe account the local
injuries climatic
conditions
02.02.05 CP01 Derailment Collapse of OP, Viaduct Fire Fatalitie 1 C R1 CW- Fire resistance of CW
- the structure MTA s or C021 the viaduct shall
PHA- of the viaduct multiple be calculated in
0041 severe compliance with
injuries the international
state of the art
and local rules
03.01.02 CP01 Fall of the Fall of the OP, Viaduct Derailment Fatalitie 1 C R1 CW- The girder of the CW
- train from train from the MTA s or C022 viaduct resist the
PHA- the viaduct viaduct multiple worst possible
0042 severe derailed train
injuries
04.02.08 CP01 Collision Person on the Evac, Track The line is put Fatalitie 1 D R2 SYS- The evacuation SYS
- with a track MTA back into s or C010 walkways shall
PHA- person operation with multiple allow the
0043 persons severe canalization of
remaining on injuries the movements of
the tracks evacuated
passengers
05.01.03 CP01 Fall of a Fall of person All Main Line Vehicle Single 2 B R1 CW- Drainage shall be CW
- person in the train instability fatality C008 designed to avoid
PHA- and/or accumulation of
0044 severe water at track
injury level in case of
decennial rain
(survey rainfall
data)
05.01.04 CP01 Fall of a Fall of person All Main Line Vehicle Single 2 B R1 E&M Dewatering of the E&M
- person in the train instability fatality -C012 main line shall be
PHA- and/or designed to avoid
0045 severe accumulation of
injury water at track
level
05.01.10 CP01 Fall of a Fall of person Evac All Panic during Single 2 D R2 OM- Procedures of O&
- person in the train evacuation fatality E022 evacuation shall M
PHA- and/or be set in order
0046 severe avoid panic of
injury people
05.02.11 CP01 Fall of a Fall of person Evac All Panic during Fatalitie 1 D R2 OM- Procedures of O&
- person in the station evacuation s or E022 evacuation shall M
PHA- multiple be set in order
0047 severe avoid panic of
injuries people
05.04.04 CP01 Fall of a Fall of person Evac Track Hazardous Fatalitie 1 D R2 SYS- Walkways along SYS
- person to the track walkways s or C004 the line shall be
PHA- surface multiple designed to
0049 severe comply with
injuries NFPA 130 v2007
requirements
(slope, ramp,
continuity,
materials,
handrail/guardrail
)
05.04.05 CP01 Fall of a Fall of person Evac Track Lack of Fatalitie 1 D R2 SYS- Means of egress SYS
- person to the track visibility s or C005 along the line
PHA- multiple shall be lighted
0050 severe thanks to a fail
injuries safe designed
lighting in
compliance with
NFPA 130 v2007
requirements
05.04.07 CP01 Fall of a Fall of person Evac All Panic during Single 2 D R2 OM- Procedures of O&
- person to the track evacuation fatality E022 evacuation shall M
PHA- and/or be set in order
0051 severe avoid panic of
injury people
05.05.01 CP01 Fall of a Fall of person All Technical Hazardous Single 2 D R2 SYS- Walkways in SYS
- person in Technical areas walkways fatality C009 technical areas
PHA- areas surface and/or shall be designed
0052 severe to avoid the risk
injury of fall
05.05.02 CP01 Fall of a Fall of person All Technical Hazardous Single 2 D R2 OM- Access to track O&
- person in Technical areas walkways fatality E008 and technical M
PHA- areas surface and/or areas and
0053 severe movements in
injury these areas shall
be governed by
safe rules and
procedures
05.05.03 CP01 Fall of a Fall of person All Technical Lack of Single 2 D R2 E&M Ambient lighting E&M
- person in Technical areas visibility fatality -C003 along the
PHA- areas and/or walkway shall be
0054 severe designed to
injury comply with the
international
standards and the
local rules
05.05.07 CP01 Fall of a Fall of person Evac Technical Panic during Single 2 D R2 OM- Procedures of O&
- person in Technical areas evacuation fatality E022 evacuation shall M
PHA- areas and/or be set in order
0055 severe avoid panic of
injury people
05.06.01 CP01 Fall of a Fall of person All Viaduct Lack of Fatalitie 1 D R2 CW- Viaduct CW
- person from the stability/collaps s or C015 walkway's
PHA- walkway e of evacuation multiple structures shall be
0056 down to the means severe designed in order
street injuries to ensure a safe
evacuation way to
persons
05.06.02 CP01 Fall of a Fall of person All Viaduct Hazardous Fatalitie 1 D R2 SYS- Walkways along SYS
- person from the walkways s or C004 the line shall be
PHA- walkway surface multiple designed to
0057 down to the severe comply with
street injuries NFPA 130 v2007
requirements
(slope, ramp,
continuity,
materials,
handrail/guardrail
)
05.06.03 CP01 Fall of a Fall of person All Viaduct Lack of Fatalitie 1 D R2 SYS- Means of egress SYS
- person from the visibility s or C005 along the line
PHA- walkway multiple shall be lighted
0058 down to the severe thanks to a fail
street injuries safe designed
lighting in
compliance with
NFPA 130 v2007
requirements
05.06.04 CP01 Fall of a Fall of person All Viaduct Panic during Fatalitie 1 D R2 OM- Procedures of O&
- person from the evacuation s or E022 evacuation shall M
PHA- walkway multiple be set in order
0059 down to the severe avoid panic of
street injuries people
05.07.01   Fall of a Fall of a All All All (see here Fatalitie 1 B R1 OM- Training of O&M O&
person person above), s or E024 staff to First Aid M
including multiple
faintness severe
injuries
05.07.02 CP01 Fall of a Fall of a All All All (see here Fatalitie 1 B R1 OM- An Emergency O&
- person person above), s or E025 plan shall be set M
PHA- including multiple up in order to
0060 faintness severe manage
injuries emergency cases
06.02.01 CP01 Person Person Evac Track Gap too high or Fatalitie 1 B R1 SYS- The maximum SYS
- trapped or trapped too large s or C008 gap between the
PHA- dragged between the between the multiple walking surface
0061 train and the threshold of the severe of the rolling
walkway train and the injuries stock and the
walkway walkway shall be
designed in order
to be as low as
possible,
considering local
rules and the
worldwide state
of the art
06.02.03 CP01 Person Person Evac Track Gap too high or Fatalitie 1 B R1 RS- The RS shall RS
- trapped or trapped too large s or C035 provide specific
PHA- dragged between the between the multiple devices allowing
0062 train and the threshold of the severe to fill the gap
walkway train and the injuries between the
walkway threshold and the
walkway
06.02.06 CP01 Person Person Evac Track Panic during Fatalitie 1 D R2 OM- Procedures of O&
- trapped or trapped evacuation s or E022 evacuation shall M
PHA- dragged between the multiple be set in order
0063 train and the severe avoid panic of
walkway injuries people
06.05.01 CP01 Person Foot trapped MTA Track Person walking Single 2 D R2 CW- The walkways CW
- trapped or on a point on the point fatality C009 shall not cross the
PHA- dragged machine machine and and/or track at point
0064 movement of severe machine location
the point injury
machine
06.05.04 CP01 Person Foot trapped Evac Track Person walking Fatalitie 1 D R2 CW- The walkways CW
- trapped or on a point on the point s or C009 shall not cross the
PHA- dragged machine machine and multiple track at point
0065 movement of severe machine location
the point injuries
machine
06.05.05 CP01 Person Foot trapped Evac Track Person walking Fatalitie 1 D R2 SYS- Walkways along SYS
- trapped or on a point on the point s or C004 the line shall be
PHA- dragged machine machine and multiple designed to
0066 movement of severe comply with
the point injuries NFPA 130 v2007
machine requirements
(slope, ramp,
continuity,
materials,
handrail/guardrail
)
06.05.06 CP01 Person Foot trapped Evac Track Person walking Fatalitie 1 D R2 SYS- The evacuation SYS
- trapped or on a point on the point s or C010 walkways shall
PHA- dragged machine machine and multiple allow the
0067 movement of severe canalization of
the point injuries the movements of
machine evacuated
passengers
06.05.07 CP01 Person Foot trapped Evac Track Person walking Fatalitie 1 D R2 OM- Evacuation shall O&
- trapped or on a point on the point s or E009 be governed by M
PHA- dragged machine machine and multiple safe rules and
0068 movement of severe procedures
the point injuries (Evacuation Plan)
machine
06.05.08 CP01 Person Foot trapped Evac Track Panic during Fatalitie 1 D R2 OM- Procedures of O&
- trapped or on a point evacuation s or E022 evacuation shall M
PHA- dragged machine multiple be set in order
0069 severe avoid panic of
injuries people
06.06.02 CP01 Person Person All All All (see here Fatalitie 1 B R1 OM- An Emergency O&
- trapped or trapped or above), s or E025 plan shall be set M
PHA- dragged dragged including multiple up in order to
0070 faintness severe manage
injuries emergency cases
07.05.05 CP01 Contact or Collapse of All Elevated Pile heart by a Fatalitie 1 D R2 CW- The pile of the CW
- chock with a the structure Station vehicle s or C017 viaduct shall be
PHA- sharp or of the station multiple designed to resist
0071 prominent severe collisions with a
object injuries vehicle (train,
cars, boat)
07.07.02 CP01 Contact or Contact or All All All (see here Fatalitie 1 B R1 OM- An Emergency O&
- chock with a chock with a above), s or E025 plan shall be set M
PHA- sharp or sharp or including multiple up in order to
0072 prominent prominent faintness severe manage
object object injuries emergency cases
08.01.01 CP01 Electrocutio Direct contact All Main Line Earthing not Single 2 D R2 CW- Earthing of CW
- n with an well designed fatality C027 installations of
PHA- electrified and/or the main line
0073 item severe shall be designed
injury considering
equipment
requirements and
complying with
the international
state of the art
08.01.27 CP01 Electrocutio Direct contact All Technical Lack of Single 2 D R2 OM- Access to track O&
- n with an areas insulation fatality E008 and technical M
PHA- electrified and/or areas and
0074 item severe movements in
injury these areas shall
be governed by
safe rules and
procedures
08.01.28 CP01 Electrocutio Direct contact All Technical Earthing defect Single 2 D R2 SYS- Earthing of SYS
- n with an areas fatality C012 equipment and
PHA- electrified and/or metallic part
0075 item severe (cable tray,
injury gangway, ...)
shall comply with
the international
state of the art
08.01.29 CP01 Electrocutio Direct contact All Technical Earthing defect Single 2 D R2 OM- Procedures of O&
- n with an areas fatality E018 operation shall M
PHA- electrified and/or ensure the safety
0076 item severe of person against
injury risk of
electrocution
08.01.30 CP01 Electrocutio Direct contact All Technical Earthing defect Single 2 D R2 OM- Procedures of O&
- n with an areas fatality M002 maintenance shall M
PHA- electrified and/or ensure the safety
0077 item severe of person against
injury risk of
electrocution
08.01.31 CP01 Electrocutio Direct contact All Technical Earthing defect Single 2 D R2 OM- Access to track O&
- n with an areas fatality E008 and technical M
PHA- electrified and/or areas and
0078 item severe movements in
injury these areas shall
be governed by
safe rules and
procedures
08.01.52 CP01 Electrocutio Direct contact All Track A person Single 2 D R2 OM- Access to track O&
- n with an touches the fatality E008 and technical M
PHA- electrified third rail and/or areas and
0079 item severe movements in
injury these areas shall
be governed by
safe rules and
procedures
08.02.04 CP01 Electrocutio Direct contact All Track Flooding Single 2 D R2 CW- Drainage shall be CW
- n with an fatality C008 designed to avoid
PHA- electrified and/or accumulation of
0080 item severe water at track
injury level in case of
decennial rain
(survey rainfall
data)
08.02.05 CP01 Electrocutio Direct contact All Track Flooding Single 2 D R2 E&M Dewatering of the E&M
- n with an fatality -C012 main line shall be
PHA- electrified and/or designed to avoid
0081 item severe accumulation of
injury water at track
level
08.02.07 CP01 Electrocutio Direct contact All Track Flooding Single 2 D R2 OM- Specific O&
- n with an fatality E012 operational M
PHA- electrified and/or procedure in case
0082 item severe of flooding:
injury evacuation and
stopping of
revenue service
08.02.12 CP01 Electrocutio Direct contact All Track, Stray currents Minor 3 D R3 SYS- Protection against SYS
- n with an Depot injury C021 stray current shall
PHA- electrified comply with the
0083 item international
standard
10.02.05 CP01 Burn Fire of All Main Line Equipment Fatalitie 1 D R2 CW- Infrastructures CW
- equipment of defect s or C011 and materials
PHA- the railway multiple shall de designed
0084 system along severe in compliance
the line injuries with international
state of the art
and local rules to
avoid starting and
spreading of fire
10.02.06 CP01 Burn Fire of All Main Line Equipment Fatalitie 1 D R2 OM- Evacuation shall O&
- equipment of defect s or E011 be governed by M
PHA- the railway multiple safe rules and
0085 system along severe procedures
the line injuries (Evacuation Plan)
10.02.08 CP01 Burn Fire of All Main Line Maintenance Fatalitie 1 D R2 OM- Evacuation shall O&
- equipment of operation s or E011 be governed by M
PHA- the railway multiple safe rules and
0086 system along severe procedures
the line injuries (Evacuation Plan)
10.03.01 CP01 Burn Fire of All Viaduct Maintenance Single 2 C R2 OM- Evacuation shall O&
- external operation fatality E011 be governed by M
PHA- equipment and/or safe rules and
0087 (located in the severe procedures
neighbourhoo injury (Evacuation Plan)
d of the line)
along the line
10.07.02 CP01 Burn All kind of All All All (see here Fatalitie 2 D R2 OM- An Emergency O&
- Burn above) s or E025 plan shall be set M
PHA- multiple up in order to
0088 severe manage
injuries emergency cases
12.01.02 CP01 Flooding Person All Undergroun Decennial rain Fatalitie 1 D R2 CW- Drainage shall be CW
- trapped or d s or C008 designed to avoid
PHA- captive by the multiple accumulation of
0089 water severe water at track
injuries level in case of
decennial rain
(survey rainfall
data)
12.01.03 CP01 Flooding Person All Undergroun Decennial rain Fatalitie 1 D R2 E&M Dewatering of the E&M
- trapped or d s or -C012 main line shall be
PHA- captive by the multiple designed to avoid
0090 water severe accumulation of
injuries water at track
level
12.01.04 CP01 Flooding Person All Undergroun Decennial rain Fatalitie 1 D R2 CW- Adequate CW
- trapped or d s or C010 drainage shall be
PHA- captive by the multiple designed to avoid
0091 water severe accumulation of
injuries water in the
station, especially
around electrical
machines
13.01.15 CP01 Delay in People Evac Viaduct Design of the Fatalitie 1 D R2 SYS- Walkways along SYS
- Evacuation delayed in means of egress s or C004 the line shall be
PHA- evacuation multiple designed to
0092 severe comply with
injuries NFPA 130 v2007
requirements
(slope, ramp,
continuity,
materials,
handrail/guardrail
)
13.01.17 CP01 Delay in People Evac Viaduct Design of the Fatalitie 1 D R2 SYS- Means of egress SYS
- Evacuation delayed in equipment s or C005 along the line
PHA- evacuation multiple shall be lighted
0093 severe thanks to a fail
injuries safe designed
lighting in
compliance with
NFPA 130 v2007
requirements
13.01.19 CP01 Delay in People Evac Viaduct Wrong Fatalitie 1 D R2 OM- Evacuation shall O&
- Evacuation delayed in behaviour of s or E011 be governed by M
PHA- evacuation Operator staff multiple safe rules and
0094 severe procedures
injuries (Evacuation Plan)
13.01.20 CP01 Delay in People Evac Viaduct Panic during Fatalitie 1 D R2 OM- Procedures of O&
- Evacuation delayed in evacuation s or E022 evacuation shall M
PHA- evacuation multiple be set in order
0095 severe avoid panic of
injuries people

Note
Where cause shows “See here above” this is taken from Systra PHA and assumes that cause is all causes of a person falling as detailed under hazard scenario
“5 – Fall of a Person” All hazards with this cause description have allocated mitigations for O&M and therefore have not been further analysed in this
document.

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