ForEs G

4
RISK ASSESSMENT FORM Code:
Vessel Version 0
Task Category: Work Activity: Issue Date:
RiskAssessment COnditions Next Review Date:
Impotant Instructions Analysis of expressions used to calcuate Risk
Work Authorlsetlon Work Activity is High Risk Risk LIKELIH00D (L)
Work has heen auttozel (uptoard) Yet (S) Severity (L) LIkelihood Risk Rating SEVERITY(S)
Rating 1 3
Work hae teen authonzed (oue Mneeted) YON Indicate ReleVhnt SNS Sections: Negligible 1 Improbabe SaL RF 1 1 2
No Fatlgue 2 Minor Rernote RF Risk 2 6 10
aff is atleuately rested Unplanned Occurrences N
(ldentify scenarlos thal unfyyeseevents 3 Significant Possible Low 3 6 9 12
Use of propsrPPE present new hararde)
4 Critical Likely M Medium 4 8 12
Faperieced etaff
aff has task evpeiene Catastrophic 5 Certain High 5 10
Ralevant Permitto Work flled YN
(Inde ate he nane ot ompany toms) O How to assese Risk : 0 Select Severty expresson that apples to hazard wITH NO Controts 0 Select aporopiate lkeihood with NO
Controls O Apply contros and RECALCULATE risk
MAZARD DESCRIPTION InitialRisk Rating
No HAZARD FFECTS Risk CONTROL MEASURES TO BE TAKEN Residual Risk Rating
(Assume NO CONTROLS (SxL RR)
to initlally assess lsks) (What nay happen) L/M/H (To Reduce the Risk and calculate the Residual Risk Rating) (SxL = RR)
RR
Wate lentayen | e s e i water quantity lliny T M losely monitor any unwanted leakayes fron pumps and other pipe lines 2 1
nerense in wale quntity llinp D11T M Make filling in manual and monitor while filling water and monito consumption of water 4
closely in every watch
Avilenptio ofwater o |ease in wates quantity illiny 91|| 1 M lose and lock the unwanted consumption and usage of water
aily eainng water lo ilye
wella
4,

12

14,

Item Additlonal actions to reduce Residual Risk

Action Due Completion Date Risk Assessment Review & Approval
Date
Meetiuy ondueted And explain the tiak to all the orew of leakages and consequence I8 04.2023 8 04.2023
Prepared by; 2 E Reviewed by: CE

Shipboard Approval Date:18.04.2023 Date:18.04.2023

5. Approved By (Name & Rank):

6
Ofice Approval Date:
Nave any alternate methods with lesser risks ldentifled to accompllsh this Yes No
task

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