HSE Risk Assessment Number:

Health and Safety Risk Assessment Template Revision

Issue date: June 2023

Assessment title : Health and Safety Risk Assessment -Excavation & Backfilling work

Facility / Region : Malanpur Department : Project- Pragati, Mondelez

Assessment carried out by: Mr. Shamshad Ahamed

Assessment date: 14/ 06/2023

Purpose for update : First Assessment

Assessment checked by: Mr.Prasanna Vijaya Kumar

Assessment approved by: Mr. Raghvendra

Risk Assessment Unmitigated RRN Existing Control Measure Recommended Control Measure
Final RRN Interim Control Measure
Activity (Job/Task Hazard Description (Add Unmitigated risk
S Area
Description)
Hazard
photo)
General Comments Probability (P) Severity (S) Frequency (F) NP (No Persons)
score
Risk Level Describe Control Measure Effective Independent Auditable Valid or Not Valid Control Initial (Mitigated) RRN Risk Level Recommended Control Measure Due dates Responsible Status Control

1. Only Trained /authorized Person should be Deployed for

work
2. Induction process covers all identified hazards &
precautions to be given 3.
Tool box talk Shall be conducted before Start of the work
Activity. 4.
Machinery / Vehicles to be checked before each use.
5.
Trained and Experienced operator deployed for the work.
Mass Making Excavation manual handling & Sharp Unauthorized person and Heard in
Minor injuries, Less than 6. Administrative control OR Engineering control plus
1
AREA
Work(Cleaning of
edges equipment entering at the site
industry OR at 2 scratch, bruise 0.1
once a year 0.2 3 – 7 Persons 2 0 (D) Low Follow Covid-19 Health & Safety measures at the work 1 1 1 Valid Eng Controls that require 0.6 0 (D) Low Not Required Open training and PPE as 0.2 0
working area) risk place. 7. Admin required
Tested and approved hand tools and power operated tools
will be allowed. 8.
Cranes / Tools and tackles valid documents shall be checked
before using at site. 9. All the material
should be store in proper place with provision of
barricading and sign boards. 10. Work permit should be
taken before start of the work.
11. Use of required PPEs such as Mask,
Helmet, Jacket and Safety shoes.

1.Covered all exposed bar with provide rebar

cap/protective cloth.
2. Ensure that
UG clearance prior start of the work.

3. Avoid vertical bars for marking;

it should be U type Shape & Wrap with
cloth/Caution tape/Cap.
4.
Insect Bites, Heard in Cut (laceration), Machinery / Vehicles(JCB) to be checked Engineering control plus
Mass Making Excavation Work Once a before use.
2
AREA (Layout the work area)
Slips & Trips Hit by protruding steel industry OR at 2 mild (usual 0.5 year 0.5 3 – 7 Persons 2 1 (D) Low
5. Provide signalman
1 1 1 Valid training and PPE as 0.2 0 (D) Low Not Required Open Substitution 0
risk disease) required
for controlling the vehicle movements.
6. Provide
barricading or marking for all identified
working areas.
7. Provide close
supervision for all work activities at the
workplace.
8. PTW has to be taken.

9. PPE’S
to be provided to the all worker’s.

1.Provision of barrrication & signage.

2.Provision of safety net
around the hoist lift.
Excavation Work (Site Heard in 3.Cover the debris bag while shifting Administrative control OR
Mass Making Proper supervision&Use 2 Minor injuries, Less than through lift. 4. Provide training
3
AREA Clearance for Others
proper ppes industry OR at scratch, bruise
0.1
once a year
0.2 3 – 7 Persons 2 0 (D) Low
and awarness in 5s principle.
1 1 1 Valid Eng Controls that require 0.6 0 (D) Low Not Required PPE 0.9 0
excavation work) risk 5.Involving trained Admin
operator for lift .
6.Providing Suitable PPE (Hand gloves, Nose
mask,goggles).

1. Site logistics plan to be prepared to

identify the UG cable and pipline.
2.Take the clearance by concern authority
person.
3. Toolbox talk shall be conducted before
Excavation Work Hit to the workers or toppled start of the work.
4
Mass Making (Vehicle access and contact with moving machinery & damage of UG Utilities like Heard in industry OR
2
Temporary disability
1 Once a year 0.5 3 – 7 Persons 2 2 (D) Low 1 1 1 Valid
Engineering control plus training
0.2 0 (D) Low 0
AREA at risk (Body portion <9%) and PPE as required
placing at work spot) cables, pipe lines 4. Work permit should be taken before start
of the work from the concern person.

5.Used job specific ppe such

mask,Helmet,Reflective jacket,and Safety
shoes.

1. Vehicle should be checked as per the

checklist.
2. Operator having valid driving license's.
3. Vehicle movement should be seperated
powered mechanical from pedestrian walkway.
Excavation Work (Start
5
Mass Making Excavation by equipment Injury to operator & workers Heard in industry OR
2
Cut (laceration), mild
0.5 Once a year 0.5 3 – 7 Persons 2 1 (D) Low 4.Follow speed limit 15km/hrs. 1 1 1 Valid
Engineering control plus training
0.2 0 (D) Low 0
AREA Excavator & Manually) / electrical power
at risk (usual disease) and PPE as required
distribution
5. Placing of vehicle needs to be
ensure properly leveled.
6. Deploy
banks man at working place
1. Tool box talk Shall be conducted before Start of the work Activity.
2. Work permit should be taken
before start of the work .
3. Use of required PPEs such as mask, Helmet, Jacket and
Safety shoes. 4. All the
Machinery / Vehicles to be checked before use.
5. Provide signalman for controlling the
vehicle movements. 6.
Ensure that UG clearance prior start of the work.
7. Followed speed limit at 10 km/Hr.
8.
Excavation to be done with safe method. Up to 1.5mtr Depth.
9. Excavate soil shall not be
Access and egress, Water placed at the edge of the pit,1 meters away from the pit.
Stagnate ,Soil Collapse barricading to be done for excavated area.
10. Hard

Excavation Work Electrical Shock Fall of 11. Appropriate method should be done if the soil
condition is very loose. 12.
Mass Making moving objectives person/Material Heard in industry OR Temporary disability Engineering control plus training
6
AREA (Loading of excavated Poor illumination, at risk 2 (Body portion <9%) 1 Once a year 0.5 3 – 7 Persons 2 2 (D) Low Appropriate ladder shall place or steps shall be made for access.
13, Ensure provide proper vehicle access. Avoid overload of material in
1 1 1 Valid and PPE as required 0.2 0 (D) Low 0
soil in vehicle) Machinery /Vehicle slip, Hit by vehicle . 14. Work area should be barricading.
Awareness should be created among the workmen to ensure no one
excavator etc. should cross/run across the moving vehicles.
15.No person shall be allowed near
by the levelling area by deputing a separate flag man for this activity
while marching or reversing the machines.
16. Provide proper access
and exit to the vehicle movement.

1. The swing area should be

restricted for other work.
2.
Overload Banks man to be provided.
Mass Making Excavation Work Worker movement Never heard of in the
Cut (laceration), mild Engineering control plus training
7 (Dumping / Disposal of moving objectives industry OR 1 0.5 Once a year 0.5 1 – 2 Persons 1 0 (D) Low 3. Avoid unauthorised person 1 1 1 Valid 0.2 0 (D) Low 0
AREA the excavated soil) Machinery / Vehicle slip Improbable
(usual disease) and PPE as required
Hit by excavator entry at working place.
4. Avoid
overloaded for dumper/Hyva.
5. Safe access root shall be defined .

6. Vehicle parking
only at designated place.
7.
1.
AllOperator should
appropriate PPE'Sbewill
valid
belicense & to all
provided
authorised
workers. to drive vehicle.
2. Prohibited man 8.
movement at way
Mobile phones willofnot
machine
allowedattoplace.
workers.
3.
Provide signalman at working.

Mass Making Excavation Work Traffic Accident,Unsafe Never heard of in the

Minor injuries, Less than once a 4. Place Avoid overcrowding Engineering control plus training
8 noise & vibration industry OR 1 0.1 0.2 1 – 2 Persons 1 0 (D) Low at working place. 1 1 1 Valid 0.2 0 (D) Low 0
AREA (Compaction work) guarding, Hearing loss Improbable
scratch, bruise year and PPE as required
5. Maintain speed
limited 15km/hr at workplace.

6. Provided
proper guarding for all rotating parts.
7.
Provided ear plug.
 HSE Risk Assessment Number:

Health and Safety Risk Assessment Template Revision

Issue date: June 2023

Assessment title : Health and Safety Risk Assessment -Excavation & Backfilling work

Facility / Region : Malanpur Department : Project- Pragati, Mondelez

Assessment carried out by: Mr. Shamshad Ahamed

Assessment date: 14/ 06/2023

Purpose for update : First Assessment

Assessment checked by: Mr.Prasanna Vijaya Kumar

Assessment approved by: Mr. Raghvendra

Risk Assessment Unmitigated RRN Existing Control Measure Recommended Control Measure
Final RRN Interim Control Measure
Activity (Job/Task Hazard Description (Add Unmitigated risk
S Area
Description)
Hazard
photo)
General Comments Probability (P) Severity (S) Frequency (F) NP (No Persons)
score
Risk Level Describe Control Measure Effective Independent Auditable Valid or Not Valid Control Initial (Mitigated) RRN Risk Level Recommended Control Measure Due dates Responsible Status Control
1. Water should never be pumped directly into
slopes.
2. Discontinue dewatering if the area shows signs
of instability or erosion.
3. Channels used for dewatering need to be steady
and protected by grass and vegetation.
4. ever dewater during heavy rains. The water and
infiltration rate will be slower during the
dewatering process or it will not function entirely.
5. Never discharge water that contains oil, grease,
or chemical products.
6. Inspect pumps and cords for defects,
Personnel being hit by heavy and repair or replace as necessary prior to
equipment,Falling or tripping , use
9
Mass Making Excavation Work Falling objects (slips, trips and falls), Heard in industry OR 2 Temporary disability 1 Once a year 0.5 1 – 2 Persons 1 1 (D) Low 7. Trained electrician should be handle these types 1 1 1 Valid Engineering control plus training 0.2 0 (D) Low 0
AREA (Dewatering work) Electrical shock from
at risk (Body portion <9%)
of work
and PPE as required

pumps/cords 8. Only trained electricians may repair cords

9. Do not lift electric pumps by cords

1. Only trained person should be deploy at work.

2. Toolbox talk shall be
conducted before start of the work.
3. Use of required ppe's such as helmet,Reflective
jacket, and safety shoes. 4.
Required work permit to work system should be taken before
start of the activity. 5. Work shall be
carriout under close supervision.
6. MSDS displayed at working place.
7. Provided job specific ppe such as white goggle, Mask, PVC.
Gloves etc.8. Provide barricades to avoid unauthorised entry.
9. Display
sign board at working place.
Mass Making Never heard of in the 10. All container should be lebeled.
10 ATT WORK harmful substances / Provied all the required PPE. industry OR 1 Minor injuries, 0.1 Once a year 0.5 1 – 2 Persons 1 0 (D) Low 1 1 1 Valid PPE 0.9 0 (D) Low 0
AREA chemicals & gases
Improbable
scratch, bruise
11. Avoid overcrowding at work place.
12. Avoid
ignition source at work place.
13. Chemical shall be
stored in gowdown with restricted entry and properly accounted.
14. Required permit to work
system should be taken before start of the activity.
15- Availability of fire extinguisher
media at working place.

1. Use of dust mask for handling dry cement.

2. Throughly was the
exposed body parts with fresh water and soap
after the work.
3. Work area should be barricades .
4. Safe access
clear without any obstruction.
11
Mass Making Civil work (PCC) Slips & Trips
Skin Irritation, Personal injury and Heard in industry OR
2
Minor injuries,
0.1 Daily 2.5 3 – 7 Persons 2 1 (D) Low Not Valid 0 0
AREA property damaged at risk scratch, bruise 5. Checklist should be fullfill
before start of the mixing work activity.

6. Use job specific ppe such as Safety

helmet,Reflective jacket, Safety shoes, Goggle,
Rubber gloves, Dust mask Gumboot etc.

7. Work shall be carriout under close

supervision.
1. Work shall be carriout by under close
supervision.
2. Ensure
safe access should be clear for unwanted and
slippery materials.
3. Ensure long steel
should be shifted by sufficient no of workmen.

12
Mass Making Civil-Rainforcement Slips & Trips Cut slip, Injury Impact
Heard in industry OR
2
Cut (laceration), mild
0.5 Daily 2.5 16 – 50 Persons 8 20
(C ) Medium, 4. Working area should be barricades to 1 1 1 Valid
Engineering control plus training
0.2 4 (D) Low 0
AREA at risk (usual disease) Acceptable prevent unauthorised entry. and PPE as required

5. Ensure steel should be shifted trough shifting

platform from ground to work platform.
6. Ensure
rainforcement should be safe stack 1.5 mtr away
from the working area.
7. Use job specific ppe at all
times.
1. Only skilled trained person allowed to the work .

2. Provided safety
harnes above 1.8 mtr work at height .

3.Working personal should be physically and

mentally fit for work.
4. Use safe
manually material handling method.

5. Check tools and equipment's &

scaffolding material before start the work .

Scaffolding 6. Explain the WMS to working personal for

Mass Making Personal Injury, Property dimaged, Heard in industry OR Temporary disability (C ) Medium, prepaid the base of scaffold at work place. Engineering control plus training
13 activity(Erection of Slips & Trips 2 1 Daily 2.5 3 – 7 Persons 2 10
7.
1 1 1 Valid 0.2 2 (D) Low 0
AREA scaffolding)
Personal injury, Body injury at risk (Body portion <9%) Acceptable and PPE as required
Provided compacted ground surface to base of
pipe.
8.Scaffold secure with base
plate an mud seal.
9. Provided ladder for approach on scaffold.

10. Use MS greeting

with tied both side.

11.While
1. Explain erecting
the WMS the scaffold
to working provided
personal for red
Tag.
prepaid the base of scaffold .
12.
2. After
Check the
erectingscaffold
proper of scaffold
and inspect
workingand put Green
stability tag on it.
of scaffold.
3. Provied Proper access for
scaffolding .

4. Only Trained Person should be Deployed for

work.
5. Provided
safety belt above 1.5 mtr work at height.
6. Use Ms greeting with tied both
Scaffolding side .
14
Mass Making activity(Dismantal of falls from height > 2 m Personal injury and property damages, Heard in industry OR 2 Temporary disability 1 Daily 2.5 3 – 7 Persons 2 10 (C ) Medium,
7. 1 1 1 Valid Engineering control plus training 0.2 2 (D) Low 0
AREA scaffolding)
Electrical shock , Cut injury, at risk (Body portion <9%) Acceptable
Use nylon rope for release the material from top to
and PPE as required
bottom.(If Required )
8. Use safe
manually material handling method.
9. Use safe anchorage point for
anchored the harness.
10. Maintain Good housekeeping after
complete the job.
11. Electrical clearance should be 10 feet away
from the scaffold frame .(ALARP).
12. Provided
proper PPE'S .
1. Night work permit to be taken from concern
engg.and safety dept.
2. Ensure proper
Scaffolding illumination during dark hours.
15
Mass Making activity(Work in during Slips & Trips Personal injury, damage to property Heard in industry OR 2 Minor injuries, 0.1 Daily 2.5 3 – 7 Persons 2 1 (D) Low 1 1 1 Valid Engineering control plus training 0.2 0 (D) Low 0
AREA dark hours )
at risk scratch, bruise
3.Electrical cable should lead min 2.5 mtr. height.
and PPE as required
No exposed electrical wire.Earthing.
1. Take work permit & tool box talks before4. state
Access
of Route shall be illuminated.
the work.
2.Avoid handling the
material with sharp edge side.
3.Use Hand gloves.

Shuttering Activity 4. Remove nails before reuse.

Mass Making (Handling of wooden Never heard of in the Minor injuries, Engineering control plus training
16 Slips & Trips Personal injury, damage to property industry OR 1 0.1 Daily 2.5 3 – 7 Persons 2 1 (D) Low 1 1 1 Valid 0.2 0 (D) Low 0
AREA planks ,Plywood and Improbable
scratch, bruise 5. Secure the pieces and PPE as required
supports ) properly in stack.
6.
Maintain good Housekeeping.
7. Use Proper PPE’S.

1. Checkcarpenter
for properwill
operation 8.Skilled
all the tools &&
Trained bestart
deployed.
cutting machine before of the job.
2. Display
9. Maintain good Housekeeping
Inspection Sticker.
Shuttering Activity
17
Mass Making ( Cutting wood/ply to contact with moving machinery Cut Injury
Heard in industry OR
2
Cut (laceration), mild
0.5 Daily 2.5 3 – 7 Persons 2 5 (D) Low
3.Guard moving parts of the machines. 1 1 1 Valid
Engineering control plus training
0.2 1 (D) Low 0
AREA required size. )
at risk (usual disease) and PPE as required
4. Wear safety goggles.
5.
Supply Through ELCB 30mA. 6. Electrical Cable
good Condition & Proper Insulated.
 HSE Risk Assessment Number:

Health and Safety Risk Assessment Template Revision

Issue date: June 2023

Assessment title : Health and Safety Risk Assessment -Excavation & Backfilling work

Facility / Region : Malanpur Department : Project- Pragati, Mondelez

Assessment carried out by: Mr. Shamshad Ahamed

Assessment date: 14/ 06/2023

Purpose for update : First Assessment

Assessment checked by: Mr.Prasanna Vijaya Kumar

Assessment approved by: Mr. Raghvendra

Risk Assessment Unmitigated RRN Existing Control Measure Recommended Control Measure
Final RRN Interim Control Measure
Activity (Job/Task Hazard Description (Add Unmitigated risk
S Area
Description)
Hazard
photo)
General Comments Probability (P) Severity (S) Frequency (F) NP (No Persons)
score
Risk Level Describe Control Measure Effective Independent Auditable Valid or Not Valid Control Initial (Mitigated) RRN Risk Level Recommended Control Measure Due dates Responsible Status Control
1. Conduct tool box talk to be given before start of
work.
2.Skilled & Trained carpenter will be
deployed.
3. Work Permit to
be taken before start of the work.

Shuttering Activity 1. 4.
AllProper support
Concrete to Shuttering
machinery shall be .checked before
18
Mass Making (Shuttering Fixing work manual handling & Sharp edges Personal injury, damage to property
Heard in industry OR
2
Cut (laceration), mild
0.5 Daily 2.5 3 – 7 Persons 2 5 (D) Low
use. 1 1 1 Valid
Engineering control plus training
0.2 1 (D) Low 0
AREA at risk (usual disease) 5.Use of safe Scaffolding
2. Proper – proper
alignment and PPE as required
) base,positioning
and support,bracing,cross bracing,
of Mixer Machine to hand rill, .Safe
be done
platform,
Area access.
barricade to restrict entry.
6. Display Inspection Sticker.
2. Ensure safety
7. Full body safety harness
belt anchor by each workmen.
should be provided.
3.Engaged trained & experienced person8.on PPE’S
the
should be provided.
job.
4.
Maintain good house keeping at work site.

5. Conduct tool box talk

before starting the work.
6. Ensure recommended PPE
should be worn the worker such as safety shoes,
helmet, hand gloves goggles & nose mask.
7.Use of
armored cable with ELCB power connection 1.
Personal Injury, Electrocution ,burn, Cable Should not lay on ground and adequate
Injury, Machinery, Injury,Fall of clearance shall be maintained from ground.
19
Mass Making Concrete Slips & Trips
materials, Personal Injury,Skin contact Heard in industry OR
2
Minor injuries,
0.1 Daily 2.5 8 – 15 Persons 4 2 (D) Low
2. Cable laying 1 1 1 Valid
Engineering control plus training
0.2 0 (D) Low 0
AREA with cement material, fall of person / at risk scratch, bruise above 2.mtr.Drop from lowest part of work. and PPE as required
material,Electric shock,Electrical fire due
to short circuit,Trip and fall 3. Work shall be carried out under
supervision.
4. If PVC
insulated body for that single earthing should
provided.
5. If Metal insulated body
for that double earthing should provided.

6. Shall be provided On/ Off switch.

7. Proper
connection through MCB+ELCB with and ensure
plug top shall be provided.
1. Cable Should not lay on ground8.and Damaged
adequatecable
shall not be
clearance used
shall beand proper cable
maintained fromjoints shall be
ground.
made if necessary. 2. Cable laying
above 2.mtr.Drop from lowest 9. part
Fire extinguisher
of work. &
sand bucket should be kept at working area.
3. Work shall be carried out under
10. Checklist should be fill before starting the
supervision.
mixing work. 4. If PVC
insulated body for that single earthing11. Proper
should
housekeeping of work place.
provided.
5. If Metal insulated body
for that double earthing should provided.
Mass Making Fall of material, Nail Piercing, Personnel Heard in industry OR Cut (laceration), mild 6. Shall be provided On/ Off switch. Engineering control plus training
20
AREA D'Shuttring manual handling & Sharp edges injury, cut/penetration, Personal Injury at risk 2 (usual disease) 0.5 Daily 2.5 3 – 7 Persons 2 5 (D) Low 1 1 1 Valid and PPE as required 0.2 1 (D) Low 0
7. Proper
connection through MCB+ELCB with and ensure
plug top shall be provided.
8. Damaged cable
shall not be used and proper cable joints shall be
made if necessary.
9. Fire extinguisher &
sand bucket should be kept at working area.

10. Checklist should be fill before starting the

mixing work.
11. Proper
1. Remove Nails
housekeeping ofon Regular
work place.Basis.
2. All defective nails stored in
properly ( Made in box)
3. Avoid overcrowding at work place.
4. Proper
communication should be followed at work place.

Mass Making 5. Safe access to be provided. (Use Safe

Heard in industry OR Minor injuries, Engineering control plus training
21
AREA Backfilling Others Personal Injury and property damages
at risk
2
scratch, bruise
0.1 Once a year 0.5 1 – 2 Persons 1 0 (D) Low Ladder) 1 1 1 Valid
and PPE as required
0.2 0 (D) Low 0
6. Provide
Safe Access .
7. Do not cross barricading.

8. Use safe
manual material handling method.
9. Proper removing of material from
work place.
1.Prior start 10. Follows
of the workProper Lifting
physical & Shifting
condition of the
method. is in good condition.
equipment
2.Copetant Operator should operate the
equpment.
3.During the operation ensure no
workmen around the movement area 4.Ensure
Hand roller is being used
Mass Making for During the operation people may con in Emergency Button should be available and in
Heard in industry OR Minor injuries, Engineering control plus training
22 the compaction of GSB contact with moving machinery coontact with roller, if continues 2 0.1 Weekly 1.5 1 – 2 Persons 1 0 (D) Low working condition. 1 1 1 Valid 0.2 0 (D) Low 0
AREA & LOOSE SOIL opeation operator may cause HAVC at risk scratch, bruise and PPE as required
5.Valid permit to be taken
before start of the work.

1.. Before & after the completed of work

housekeeping is done.
2. Material
Mass Making Personal injury and property stacking in deferent type of material mood..
Heard in industry OR Minor injuries,
23 Housekeeping Slips & Trips 2 0.1 Daily 2.5 1 – 2 Persons 1 1 (D) Low 1 1 1 Valid PPE 0.9 0 (D) Low 0
AREA damages at risk scratch, bruise
3.Material storage is in
good place with display board.

4. All job specific ppe's must be worn

24 0 0 0 0 Not Valid 0 0

25 0 0 0 0 Not Valid 0 0

Never heard of in the

industry OR
1 Improbable
Heard in industry OR
2 at risk
Has happened in the
5 organization

Has happened more

than once per year in
8 the organization
Has happened in the
10 location

Has happened more

than once per year at
15 the location

Minor injuries, 0 Elimination 0 Elimination

0.1 scratch, bruise 0.2 Less than once a year 1 1 – 2 Persons
Cut (laceration), mild 0 Substitution 0 Substitution
0.5 (usual disease) 0.5 Once a year 2 3 – 7 Persons

Engineering Engineering
control plus control plus
0.2 training and 0.2 training and
PPE as PPE as
Temporary disability required required
1 (Body portion <9%) 1 Monthly 4 8 – 15 Persons

Administrative Administrative
control OR control OR
0.6 Eng Controls 0.6 Eng Controls
Temporary disability that require that require
(Body portion >9%) Admin Admin
OR Occupational
2 disease (temporary) 1.5 Weekly 8 16 – 50 Persons

Permanent disability
4 (Body portion <9%) 0.9 PPE 0.9 PPE
OR loss of one eye
OR occupational More than 50
disease (permanent) 2.5 Daily 12 persons

Permanent disability
(Body portion >9%)
8 OR loss of two eyes 1 None 1 None
OR Death causing
occupational disease
4 Hourly
15 Fatality
5 Many times an hour
 HSE Risk Assessment Template Number: HSE2-3B
Health and Safety Risk Assessment Template Revision
Issue date: August 2021
Hazard Category Number of people Residual Risk Number (RRN)
Hazard Description of the hazard Probability (P) Frequency (F) Severity (S) Control Measures (C) Example/ Notes
exposed (NP)
Biological hazards Allergies (dust, smells, food) Tetanus (rusted Never heard of in Less than once Minor injuries, scratch or bruise Inert area within 1 1-5. Very low
metals) Leptospirosis (drains, sewers) the industry OR a year (First Aid) boundary of Elimination or
Elimination_ Manual handling of minor
Legionella (cooling towers, air conditioning) highly facility. Or 1-2 substitution ingredient eliminated with reformulation
handling of infectious agents and blood borne improbable 1 0.2 0.1 people exposed. (Substitution 0 Elimination/ Substitution
replaces ingredient with another already
pathogens) requires a re-
Workplace health handled in bulk system
assessment)
hazard
Chemical (Corrosive) A chemical that, when it comes into contact Heard of in the Cut, laceration or mild ill-effect 3-7 2 5-10 low
with skin, metal, or other materials, damages industry OR at (Medical Treatment)
the materials. Acids and bases are examples risk Controls that Do - Guards with Cat 3 or 4 interlocks, restart by
of corrosives. Not require Admin separate button, (without line of sight) and
2 Once a year 0.5 0.5 intervention, 0.2 Pressure Sensing Devices or Trapped Key
Training, Signage system (if person is able to stay within cage
and PPE as reqd area)
- Physical barriers (fixed guards, cage, wall, Engineering Controls,
Ergonomics isolated aisles, etc.) Admin, PPE
Chemical (Flammable) A chemical that, when exposed to a heat Has happened in Temporary disability (Body 8-15 4 10-50 Medium (acceptable)
ignition source, results in combustion. the organization portion <9%), one limb or eye
Typically, the lower a chemical’s flash point Controls that Do
and boiling point, the more flammable the require Admin - LOTO
chemical. Check MSDS for flammability intervention OR - Guards with Cat 1 or 2 interlocks, 2 points of
information. 5 Monthly 1 1 0.6
Admin controls, inc. control and tool/PPE
training, signage - Guards with Cat 3 or 4 interlocks, with auto-
and PPE as reqd restart, 2 points of control and tools/PPE
Personal Safety - Energy isolation (pneumatic, hydraulic,
Hazards electrical, etc.) Admin, PPE
Chemical (Toxic) A chemical that exposes a person by Occurred more Temporary disability (Body 16-50 8 50-100 Medium (consider
absorption through the skin, inhalation, or than once per portion >9%) OR occupational controls)
through the blood stream that causes illness, year in the disease (temporary), multiple PPE as required to
disease, or death. (Toxic vapors / Toxic Dust organization 8 Weekly 1.5 limbs or both eyes 2 address physical 0.9 Gloves, bump cap, gloves, eyewear, etc.
Exposure ) hazards
Fire and explosion
Hazards PPE
Electrical (Fire) Use of electrical power that results in Has happened in Permanent disability (Body Impact outside 12 100-500 High (consider
electrical overheating or arcing to the point of this location portion <9%) OR loss of one eye the facility stopping task and
combustion or ignition of flammables, or OR occupational disease boundary or implement interim
electrical component damage. (overloaded (permanent) more than 50 controls)
outlets, non-approved equipment, defective people exposed.
or frayed cords, improper placement of cords
or electrical outlets near sinks or other water 10 Daily 2.5 4 No Controls 1
sources, uncontrolled Sources of ignition e.g.,
Static Electricity)

Other emergency
situations. No controls
Electrical (Loss of Power) Safety-critical equipment failure as a result of Has happened Permanent disability (Body 500 Unacceptable (stop
loss of power. (Utility Failures) more than once portion >9%) OR loss of two eyes task and implement
per year at the OR death causing occupational interim controls)
location OR 15 Hourly 4 disease 8
highly probable

Electrical (Static) The moving or rubbing of wool, nylon, other

synthetic fibers, and even flowing liquids can
generate static electricity. This creates an
excess or deficiency of electrons on the
surface of material that discharges (spark) to
the ground resulting in the ignition of Many times 5 Fatality 15
flammables or damage to electronics or the per hour
body’s nervous system.

Elevated work area hazards · (lack of safety railings, unsafe and untied
ladders and no fall restraint systems)

Ergonomics (Human Error) A system design, procedure, or equipment

Excavation (Collapse)
that is error-provocative. (A switch goes up to
turn something off).
Soil collapse in a trench or excavation as a
result of improper or inadequate shoring. Soil
type is critical in determining the hazard
likelihood.

Explosion (Over Pressurization) Sudden and violent release of a large amount

of gas/energy due to a significant pressure
difference such as rupture in a boiler or
compressed gas cylinder.

Explosion (Chemical Reaction) Self explanatory.

Fall Conditions that result in falls (impacts) from
(Slip, Trip) height or traditional walking
surfaces (such as slippery floors, poor
housekeeping, uneven walking surfaces,
exposed ledges, etc.)

Fire/Heat Temperatures that can cause burns to the

skin or damage to other organs. Fires require
a heat source, fuel, and oxygen.
Mechanical Skin, muscle, or body part exposed to
crushing, caught-between, cutting, tearing,
shearing items or equipment. (unguarded
moving parts, pinch points, pressure parts
etc)

Hazard Category
Hazard
Mechanical Failure
Mechanical/ Vibration
(Chaffing/fatigue)
HSE Risk Assessment Template Number: HSE2-3B
Health and Safety Risk Assessment Template Revision
Issue date: August 2021
Number of people Residual Risk Number (RRN)
Description of the hazard Probability (P) Frequency (F) Severity (S) Control Measures (C) Example/ Notes
exposed (NP)
Self explanatory; typically occurs when
devices exceed designed capacity or are
inadequately maintained
Vibration that can cause damage to nerve
endings, or material that results in a safety-
critical failure. (Examples are abraded slings
and ropes, weakened hoses and belts.)

Noise Noise levels (>85 dBA 8 hr TWA) that result in

hearing damage or inability to communicate
safety-critical information.
Nuisance Vapors / Nuisance dust exposure
Radiation (Ionizing) Alpha, Beta, Gamma, neutral particles, and X-
rays that cause injury (tissue damage) by
ionization of cellular components.

Radiation (Non-Ionizing) Ultraviolet, visible light, infrared, and

microwaves that cause injury to tissue by
thermal or photochemical means.
Struck Against Injury to a body part as a result of coming into
contact of a surface in which action was
initiated by the person. (An example is when
a screwdriver slips.)

Struck By (Mass Acceleration) Accelerated mass that strikes the body

causing injury or death. (Examples are falling
objects and projectiles.)
Temperature Extreme (Heat/Cold) Temperatures that result in heat stress,
exhaustion, or metabolic slow down such as
hypothermia.
Traffic/vehicle movement hazards (Facility roads, parking areas, truck receiving
areas and fork lift movement areas)

Visibility Lack of lighting or obstructed vision that

results in an error or other hazard.
Weather Phenomena Self explanatory. (Natural Disasters)
(Snow/Rain/ Wind/Ice)
<Other> Describe
 HSE Risk Assessment Template Number: HSE2-3B
Health and Safety Risk Assessment Template Revision
Issue date: August 2021

1
2
3
4
5

falls from height > 2 m

falls from height < 2 m
Slips & Trips
collapse (Buildings, steel structures ..
manual handling & Sharp edges
moving objectives
electricity > 480 V
electricity > 220 V
electricity< 110 V
contact with moving machinery
fire
harmful substances /
chemicals & gases
noise & vibration
Explosions
steam / pressurized fluids & gases
powered mechanical equipment
/ electrical power distribution
Falling objects
Others

Minor injuries, scratch, bruise

0.1 Or Minor assets damage or property lose
0.5 Cut (laceration), mild (usual disease)
1 Temporary disability (Body portion <9%)
Temporary disability (Body portion >9%) or
Occupational disease (temporary)
2 Or property loss > 1000 $

Permanent disability (Body portion <9%) or

Serious occupational disease (permanent)
Or Limited fire extinguished internally
Or Property loss >10,000 $
4
Permanent disability (Body portion >9%) Or
Death causing occupational disease
8 Or fire extinguished externally
Fatality
Or Explosions
15 Or Property loss >100,000 $