RISK ASSESSMENT FORM - ‫نــمــوذج تــقييمـ اــلمخاطــــر‬

Date : 11-03-2015 ‫ التاريخ‬: Ref No: RA/AK/34 ‫ رقم المرجع‬:

Project Name : Roads and Infrastructure in Al Kheesa North and East ‫ اسم المشروع‬:
Assessment location : Site locations for pipeline works ‫ موقــع التقييـم‬:
Description of work : Hydro pressure testing ‫وصـف العمـل‬:
‫الخطــر األولي‬ ‫ الخطــر المتبقي‬RESIDUAL
Initial Risk RISK
Hazard / Conditions that could Who Might be
Activity Safety precautions needed to control the Risk to ALARP * Responsible Person
develop hazard Harmed

Consequences

Consequences
Risk Rating

Risk Rating
Likelihood

Likelihood
SR #

‫معدل الخطر‬

‫معدل الخطر‬
‫العواقب‬
‫العواقب‬

‫األرحجية‬
‫األرحجية‬
‫ الظروف‬/‫الخطر‬ ‫من قد يتعرض‬ ‫الشخص‬
‫النشاط‬ ‫"اإلحتياطيات الالزمة لضبط الخطر وتقليصه الى الحدود المقبولة عمليا‬
‫التي قد تفاقم وتطور الخطر‬ ‫للخطر‬ ‫المسؤول‬
1 Manual Works inside Improper accesses to trenches / workers, public in Provide proper access into the trench.Ladders shall be securred by 1 1 1 Gen. Foreman,
trenches No access to come out in case of the vicinity. 3 3 9 tying against sliding. There shall be one ladder at minimum 50 mtr Foreman
an emergency. apart.
Falling of loose materials from Workers inside the Clear loose materials including stones from the edges trenches 1 1 1 Gen.Foreman,
3 3 9
the sides of trenches - injury trench Install and secure green mesh at the walls of trench. ,Foreman
Fatigue / Heat stress while Conduct TBT on heat stress symptoms and Precaustions.Ask 2 1 2 Gen.Foreman,
working inside trench. workers to come out of trench at frequent intervals on rotation Foreman
Involved workers 4 3 12 basis, breathe fresh air and to cool down their body. Drink cool
water. Avoid each man remain for long time inside trench.Report
any symptoms of heat stress immediately.
*ALARP - As Low As Reasonably Practicable
Assessed By: Eng.Enrique Fajardo ‫ معد التقييم‬: Reviewed by : Eng.Salameh Haddadin (Project Manager) ‫ المراجعة من قبل‬:
Date: 11/3/2015 ‫التاريخ‬: Date: 11/3/2015 ‫التاريخ‬:

Signature : ‫ التوقيع‬: Signature: ‫ التوقيع‬:

Likelihood
Likelihood / ‫اــإلحتماــلية‬ Severity / ‫اــلشدة‬ 4 3 2 1
Severity
1 Remote / ‫مستبعـد‬ Minor /‫طفيف‬ 4 16 12 8 4
2 Unlikely / ‫غير مرجح‬ Major /‫اـساسي‬ 3 12 9 6 3
3 Likely / ‫مرجح‬ Severe / ‫حـاد‬ 2 8 6 4 2
4 Frequent / ‫متكرر‬ Fatality / ‫اــلوفاة‬ 1 4 3 2 1

HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012 Page No. 1 of 7]
 ‫الخطــر األولي‬ ‫الخطــر المتبقي‬
Initial Risk RESIDUAL RISK

Consequence
Hazard / Conditions that could Who Might be

Consequence

Risk Rating

Risk Rating
Activity Safety precautions needed to control the Risk to ALARP * Responsible Person

Likelihood

Likelihood
develop hazard Harmed

‫معدل الخطر‬

‫معدل الخطر‬
SR #

‫العواقب‬

‫العواقب‬
‫األرحجية‬

‫األرحجية‬
s

s
‫ الظروف‬/‫الخطر‬ ‫من قد يتعرض‬ ‫الشخص‬
‫النشاط‬ ‫"اإلحتياطيات الالزمة لضبط الخطر وتقليصه الى الحدود المقبولة عمليا‬
‫التي قد تفاقم وتطور الخطر‬ ‫للخطر‬ ‫المسؤول‬
working near Slip / Trip and Fall
2 dewatering area. 1. Area to be barricaded and signs to be displayed

2. Sides of excavation to be stepped or protected against collapse

while doing dewatering.

3. Ensure proper illumination during night. Engineer, Gen.Foreman,

Foreman, HSE
4. Ensure operators are trained and work is under close
Involved workers, supervision.ocedure. No unauthorized / job related personnel
others nearby should be on site

5. Proper usage of PPE’S

6. Good house keeping.

7. Proper access to the dewatering area. Engineer, Gen.Foreman,

1 1 1
Foreman
6. Good house keeping.
*ALARP - As Low As Reasonably Practicable
Assessed By: Eng.Enrique Fajardo ‫ معد التقييم‬: Reviewed by : Eng.Salameh Haddadin (Project Manager) ‫ المراجعة من قبل‬:
Date: 11/3/2015 ‫التاريخ‬: Date: ‫التاريخ‬:

Signature : ‫ التوقيع‬: Signature: ‫ التوقيع‬:

11/3/2015
Likelihood
Likelihood / ‫اــإلحتماــلية‬ Severity / ‫اــلشدة‬ 4 3 2 1
Severity
1 Remote / ‫مستبعـد‬ Minor /‫طفيف‬ 4 16 12 8 4
2 Unlikely / ‫غير مرجح‬ Major /‫اـساسي‬ 3 12 9 6 3
3 Likely / ‫مرجح‬ Severe / ‫حـاد‬ 2 8 6 4 2
4 Frequent / ‫متكرر‬ Fatality / ‫اــلوفاة‬ 1 4 3 2 1

HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012 Page No. 2 of 7]
FORM - ‫نــمــوذج تــقييمـ اــلمخاطــــر‬
Date: 11-03-2015 ‫ التاريخ‬: Ref No: ‫ رقم المرجع‬:
Project Name : Roads and Infrastructure in Bani Hajer North . Phase 1 & 2 RA/AK/34 ‫ اسم المشروع‬:
Assessment location : Site locations for potable water works ‫ موقــع التقييـم‬:
Description of work : Potable water works ‫وصـف العمـل‬:
‫الخطــر األولي‬ ‫الخطــر المتبقي‬
Hazard / Conditions that could Who Might be Initial Risk RESIDUAL RISK
Activity Responsible Person

Conseq

Conseq
uences
uences

Likelih

Likelih
Rating

Rating
develop hazard Harmed

Risk

Risk
SR #

‫العواقب‬

‫العواقب‬
‫األرحجية‬

‫األرحجية‬
‫الخطر‬

‫الخطر‬
‫معدل‬

‫معدل‬
ood

ood
Safety precautions needed to control the Risk to ALARP *
‫ الظروف‬/‫الخطر‬ ‫الشخص‬
‫النشاط‬ ‫من قد يتعرض‬
‫التي قد تفاقم وتطور الخطر‬ ‫المسؤول‬
Electric shock / Over Heated Use pressure testing equipments of appropriate capacity and hose,
Machineries. Involved workers, fittings etc of adequate pressure rating. Assign trained
2 3 6 workers.Barricade the area and Locations
Prevent unauthorised 1 1 1 Gen.Foreman, Foreman
others .Barricade the pressurising area. of pipe joints,entry.
valves
etc to be barricaded and watchman to be posted.
Involved workers,
Releasing pressurised water / Instruct and ensure nobody tamper with, or tighten any fittings,
others in the 2 3 6 1 1 1 Gen.Foreman, Foreman
draining valves,hoses, guage etc.) during pressurising/under pressure.
vicinity
Location of pressure releasing should be barricaded and ensure
*ALARP - As Low As Reasonably Practicable unauthorised entry. Water should be drained into prepared sumps
Assessed By: Eng.Enrique Fajardo ‫ معد التقييم‬: Reviewed by : Eng.Salameh or into a tanker(Project
Haddadin to prevent flowing around.
Manager) ‫ المراجعة من قبل‬:
Date: 11/3/2015 ‫التاريخ‬: Date: ‫التاريخ‬:
Signature : ‫ التوقيع‬: Signature: 11/3/2015 ‫ التوقيع‬:
Likelihood
Likelihood / ‫اــإلحتماــلية‬ Severity / ‫اــلشدة‬ 4 3 2 1
Severity
1 Remote / ‫مستبعـد‬ Minor /‫طفيف‬ 4 16 12 8 4
2 Unlikely / ‫غير مرجح‬ Major /‫اـساسي‬ 3 12 9 6 3
3 Likely / ‫مرجح‬ Severe / ‫حـاد‬ 2 8 6 4 2
4 Frequent / ‫متكرر‬ Fatality / ‫اــلوفاة‬ 1 4 3 2 1

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