SimOps/ JHA ON-SITE OBSERVATION(S)

Notification Form: LSDO Bunkering from Bunker Ship to GIMI Onboard Date:
JHA-CA-C021 5DB MGO Service Tank Rev No:01
1. Hazard Identification 2. Risk Evaluation
1a 1b 1c 1d 2a 2b 2c 2d

Likelihoo
Severity
Work Activity

Level
Risk Control

Risk
No. (From Work Method Hazard Possible Injury / Ill health

d
(Transfer to Job Briefing Card)
Statement)

Conducted by:

Name Designation Signature Remarks

1.

2.
Note: Does the above constitute a change that needs to be escalated to the next level?

SimOps+JHA On-Site Observation Rev 5, Dated: 03 April 2017