HSE Risk Assessment

Number:

Health and Safety Risk Assessment Template Revision

Issue date: July 2023

Assessment title : Health and Safety Risk Assessment - Concrete Floor Breaking work

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

Assessment carried out by: Shamshad Ahamed

Assessment date: 1/ 03/2024

Purpose for update : First Assessment

Assessment checked by: Vishal wasekar

Assessment approved by: Vishal wasekar

Risk Assessment Unmitigated RRN Existing Control Measure Recommended Control Measure
Final RRN Interim Control Measure
S Area Activity (Job/Task Description) Hazard Hazard Description (Add photo) General Comments Probability (P) Severity (S) Frequency (F) NP (No Persons) Unmitigated risk 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
score

1.Orientation - Safety Meetings – Tool box Talks. 2.Develop

1.Humen risk , Depute Only Trained
workers and oprators,
2. Needs to be provied proper
1 RM House 1ST Floor Mobilization of man power and
Equipment
Slips & Trips ,Hit
Hazard Personal Injury and safe access.
3. Unathorized operator.
4. failuer of machine,
equipment, vehicle
Traffic Control Plan and discuss it with everyone involved. Notify
the Traffic Management. 3. Safety Induction & information of
Site rules & regulation prior to enter work site.4 Medical
/physical fitness certify workers shall be deploy for this
activity.5.All equipmen, machine, vehicle must be inspected and 1. Safety Induction & information of Site rules &
tagged as per standard checklist, check the working condition of regulation prior to enter work site of employees.
machine/Equipment without fail before start of the job. Valid
Heard in industry OR
at risk 2 Minor injuries,
scratch, bruise 0.1 Once a year 0.5 3 – 7 Persons 2 0 (D) Low douments of equipment, machines and operator licence should 1 1 1 Valid Engineering control plus training
and PPE as required 0.2 0 (D) Low 2. Medical /physical fitness certify workers shall be Mandal RBIPL Administrative control OR Eng
Controls that require Admin 0.6 0
be submitted before start the work. JCB Operator should be deploy for this activity.
skilled and trained for demolation work/operating of JCB 3. Work should be done under supervision. 4. PTW
vehicle. 6.Electrical clearnace Should be taken from Electrical to be taken prior to start the work with Area
team .7.Povided ear plug. Take all the required work permit incharge issuer signature.
before start the job.Mandatory PPE-safety helemt, safety shoes
and reflected vest and Job specific PPE- Safety harness, nose
mask, face shield, ear plug, safety goggles, cut resistance hand
gloves should be provided as per job specific work.

1. All electrical connection should be disconnected before start

Manually Temprory structure
2 RM House 1ST Floor Demolition by using hand
tools/Power tools.
1. Invalid power tools used for
demolition work. 2. Unathorized
noise & vibration Personal Injury, Dust Hazard power tools operator.3. Personnel
injury
the work and apply LOTO as per Mondelez rules for iolation.
PTW and permition to be taken from area incharge/Mondelez 1. Safety Induction & information of Site rules &
authorized person.2.All hand tools should be inspected before regulation prior to enter work site of employees.
its use.Use right tool for the right job. Only trained and skilled
Heard in industry OR Temporary disability person deploy for demolition work.3. Povided ear plug. Engineering control plus training 2. Medical /physical fitness certify workers shall be Engineering control plus training
at risk 2 (Body portion <9%) 1 Once a year 0.5 3 – 7 Persons 2 2 (D) Low Mandatory PPE-safety helemt, safety shoes and reflected vest 1 1 1 Valid and PPE as required 0.2 0 (D) Low deploy for this activity. Mandal and PPE as required 0.2 0
and Job specific PPE- Double line yard full body Safety harness, 3. Work should be done under supervision. 4. PTW
nose mask, face shield, ear plug, safety goggles, cut resistance to be taken prior to start the work with Area
hand gloves should be provided as per job specific work. incharge issuer signature. Apply LOTO if required
4.Provied Falling material protection like Safety Net etc. for electric power isolation as per Mondelez rules.
Displayed safety sign board at work place. Depute Only Trained
Worker.

3 RM House 1ST Floor
Groove Cutting by Electric
Cutter
1-Work area must beBarricated. 2-All p[ersonal must use caution 1. Safety Induction & information of Site rules &
when in around saw cutting area. 3- Proper PPE shall be worn by regulation prior to enter work site of employees.
adjacent personnel, As required by their proximity to work
contact with moving Hit Hazard, Shock Hazard, Dust Hazard 1. Unathorized operator. 2-Use Only
Inspected equipment and electrical Heard in industry OR 2 Temporary disability 1 Once a year 0.5 3 – 7 Persons 2 2 (D) Low
task.4- All area must be scanned where cutting work planned. 5-
Follow work permit system. 6-All conection, gaurds and control 1 1 1 Valid Engineering control plus training 0.2 0 (D) Low 2. Medical /physical fitness certify workers shall be Mandal RBIPL Engineering control plus training 0.2 0
machinery cable at risk (Body portion <9%) on the equipment must be inspected prior to use. 7-Operator and PPE as required deploy for this activity. and PPE as required
must be trained to opreate the equipment. 8- Operator must 3. Work should be done under supervision. 4. PTW
wear all the required PPE. 9-All cable must be taken from to be taken prior to start the work with Area
overhead. incharge issuer signature.5 Provied all the required
PPE.

1. Safety Induction & information of Site rules &

Floor Breaking by using hilty
4 RM House 1ST Floor breaker
1. Unathorized operator. 2- breaker
collapse (Buildings, machine failuer during work.3-
steel structures .. Dust Hazard, Personal Injury Breaking below area needs to be
isolated.
Temporary disability
Heard in industry OR (Body portion >9%)
at risk 2 OR Occupational
disease (temporary)
1. Deploy trained Breaker Opreator, 2-Work area must be
barricaded 3. Isolate the RM house 1st floor and ground floor
area, No person allowed below the breaking area. 4.Check the
Breaker condition before start the work. 5. Mandatory PPE-
safety helemt, safety shoes and reflected vest and Job specific
PPE nose mask, face shield, ear plug, safety goggles, cut
2 Once a year 0.5 3 – 7 Persons 2 4 (D) Low resistance hand gloves should be provided as per job specific
work.6- Check the Cable and its top and joints conection. 7-
Avoid Unwanted Man Movment from breaking Area. 8- Check all
the lines and & utilities before work start like fire fighting ,
lighting fan etc, all needs to be secured before work start. 9-
Provied inspection tag on equipment. 10- Take cable conection
through cable stand. 11- Dust mask must be used by opreator.
regulation prior to enter work site of employees.
2. Medical /physical fitness certify workers shall be
deploy for this activity.
3. Work should be done under supervision. 4. PTW
Engineering control plus training to be taken prior to start the work with Area Administrative control OR Eng
1 1 1 Valid and PPE as required 0.2 1 (D) Low incharge issuer signature. 5. Deploy stand by Mandal Controls that require Admin 0.6 0
supervision for work. 6- Check all documents of
Breaker and opreator compitency.7 Provied all
reqired PPE(Mask and Safety goggle must). 8-
Check the Breaker body condition 9- No person
allowed to enter breaking area below location. 10-
Check the work procedure, its must me approved
by Client & Consultant. 11-If any obstucle or major
hazard identified stop work immediatly.

Heard in industry OR Minor injuries, 1. Follow 5S procedure for housekeeping and material stacking. Provied all the required PPE. Take tbt before start Administrative control OR Eng
7 RM House 1ST Floor Housekeeping Slips & Trips Personal Injury, Dust Hazard Personal injury involve at risk 2 scratch, bruise 0.1 Once a year 0.5 3 – 7 Persons 2 0 (D) Low 2. Provide job specific ppe.3. Housekeeping done under 1 1 1 Valid PPE 0.9 0 (D) Low the job. Deploy only trained worker in this job. Mandal Controls that require Admin 0.6 0
supervision.

8 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

9 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

10 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

11 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

12 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

13 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

14 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

15 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

16 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

17 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

18 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

19 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

20 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

21 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

 HSE Risk Assessment
Number:

Health and Safety Risk Assessment Template Revision

Issue date: July 2023

Assessment title : Health and Safety Risk Assessment - Concrete Floor Breaking work

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

Assessment carried out by: Shamshad Ahamed

Assessment date: 1/ 03/2024

Purpose for update : First Assessment

Assessment checked by: Vishal wasekar

Assessment approved by: Vishal wasekar

Risk Assessment Unmitigated RRN Existing Control Measure Recommended Control Measure
Final RRN Interim Control Measure
S Area Activity (Job/Task Description) Hazard Hazard Description (Add photo) General Comments Probability (P) Severity (S) Frequency (F) NP (No Persons) Unmitigated risk 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
score

22 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

23 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

24 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

25 FALSE FALSE FALSE FALSE Not Valid FALSE FALSE

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 $