Instructions for using the Risk Assessment form

Column 1b Describe the work activity to be carried out. Not

not fill in names of machines/equipment to be used. Therefore, a compute
activity, but working on a computer is

Column 1c Identify hazard(s) and its risks associated with the activity to be carried out.
Examples of hazards include chemical, biological, electrical, mechanical, physical, ergonomics, psychosocial, sl
Identify possible accidents/ill health associated with each identified hazard. Ex
possible accidents/ill health include fires, explosions, cuts, burns, frost bites, fractures etc.

Column 1d Group exposed

List who might be harmed such as patients, staff, visitors.
Note: Vulnerable such as pregnant lady, disabled, children etc.to be considered.

Column 1e Risk Area:

Hospital Premises ( both interior and exterior) where the risk is present.

Column 2b Inherent risk

L=Likelihood of occurrence of an accident, incident or ill health is defined as the probability that the s
incident or ill health will happen. Choose the likelihood from a value between 1 and 5. Consider the re
such events happening in the past when deciding on the likelihood. Refer to the Ri
tab for the likelihood table.

Column 2c S=Severity is the degree or extent of injury or harm caused by the hazards, or as a result of an acciden
the most likely severity from a value between 1 and 5, rather than the most extreme. Refer t
Matrix tab for the severity table

Column 2d Risk Rating

Risk Rating = Combination of Likelihood X Severity.

Column 3a Existing control measures

Indicate risk control measures that are already in place to eliminate or minimize risks.
Elimination of the hazard should take first priority while PPE should be the last line of defense.
- Elimination
- Substitution

-Engineering Controls
- Administrati

Protective Equipment
Column 3b Residual Risk Rating
The residual risk is the amount of risk or danger associated with an action or event remaining after inherent ri
reduced by risk controls
L=Likelihood
L may reduce upon introduction of existing control measures

Column 3c S=Severity Sm
upon introduction of existing control measures

Column 3d Risk Rating =Severity X Likelihood

Will reduce upon introduction of existing control measures

Column 3e Additional risk control measures are required when the Risk Rating indicated in column 2d exceeds 6.
6 or less, enter "NA" in the column

Column 3f Enter the name of the person appointed to oversee the implementation of the control measures.
Enter the frequency of implementation.
 Note: Please do
Therefore, a computer is not an

al, ergonomics, psychosocial, slip & fall etc.

Examples of
actures etc.

d.

d as the probability that the said accident,

ween 1 and 5. Consider the records of
Refer to the Risk Matrix

s, or as a result of an accident. Choose

ost extreme. Refer to the Risk

e risks.
line of defense.

- Substitution

- Administrative Controls
- Personal
ent remaining after inherent risks have been

S may reduce

ated in column 2d exceeds 6. If the RPN is

control measures.
 Risk Assessment Matrix
Overall Risk = Likelihood x Severity

Likelihood Table Severity Table

Score 5 4 3 2 1 Score 5 4 3 2 1
Severity level Frequent Moderate Occasional Remote Unlikely Likelihood level Critical Very Serious Serious Marginal Negligible
Multiple Fatalities Single Fatality Serious injuries Injuries Minor injuries,
requiring off-site requiring on-site which may
treatment by treatment by require self-
medical or medical administered
immediate practitioner. first aid. Injured
evacuation to Personnel personnel can
hospital. Potential unable to continue to
Occurs several times a Has occurred in Never occurred in long term or continue to perform normal
Occurs several times a Has occurred at
year in healthcare Healthcare facility healthcare facility permanently perform duties. duties
year in India least once in India
facilities in India (Worldwide) (Worldwide) disabling effects.

Risk level Determination - 5 x 5 Matrix Risk Category and Action

SEVERITY Colour code Score Risk catogory Action

Critical Very Serious Serious Marginal Negligible Operation not Permissible

(5) (4) (3) (2) (1) 15 - 25 Extreme Stop operation & review controls.

25 20 15 5 High priority remedial action

Frequent 10 Proceed with extreme caution. Implement
(5) Operation not Operation not Operation not
High priority
Review at 8 - 14 High additional controls immediately. Emergency control
permissible permissible permissible appropriate time measures shall be in place.

20 16 4
Moderate 12 8 Take remedial action at appropriate time
(4) Operation not Operation not
High priority High priority
Review at 4 -6 Medium Proceed with care. Additional control is advised.
permissible permissible appropriate time
LIKELIHOOD

6
15
Occasional 12 9 Review at 3
Operation not
(3) High priority High priority appropriate Risk acceptable Risk acceptable: Residual risk
permissible If possible, risk reduction should be further
time
considered, particularly severity.
1-3 Low Risk There are no imminent dangers. Frequent review
4 shall be in place especially changes in procedures,
6
Remote 10 8 Review at 2 materials or environment.
Review at
(2) High priority High priority appropriate Risk acceptable
appropriate time
time

4
5
Unlikely Review at 3 2 1
Review at
(1) appropriate Risk acceptable Risk acceptable Risk acceptable
appropriate time
time
 FMS RISK ASSESSMENT- UTILITY SYSTEMS

RISK SCORE RISK CATEGORY ACTION Risk Assessment Reference No:

1-3 Low There are no imminent dangers. Frequent review shall be in place especially changes in procedures, materials or environment. Facility Name: Yashoda Hospitals, Hitec City
Take remedial action at appropriate time
4-6 Medium Proceed with care. Additional control is advised. Review at appropriate time. FMS Program: Utility Systems

8-12 High High priority remedial action Proceed with extreme caution. Implement additional controls immediately. Emergency control measures shall be in place. Date of Assessment:

15-25 Extreme Operation not Permissible. Stop operation & review controls. Next Review Date:

HAZARD IDENTIFICATION RISK EVALUATION RISK CONTROL

Residual
Inherent risk Rating
1. Ensure an exclusion zone is set up around the Risk Rating
Sl No. Process / Activity Hazard and its risk Groups Exposed Risk Area
preparation work area and all plants
Existing Control Measures Additional Control measures
Responsible person (Action/Monitored
movement and checked by supervisor by)
L S RR Traffic light batons shall be provided for L S RR
banks man at night
2. Ensure access routes are sufficient and safe to
POWER DISTRIBUTION SYSTEMS, PROCESS
use. & ACTIVITIES (HT & LT POWER DISTRIBUTION & UPS SYSTEMS)
3. Do not rest in or under vehicles
4. Proper barricade and safety signboard
provided on open excavation
5. All vehicles must be fitted with a reverse alarm
/ Flashing lights.
6. Delivery drivers shall be subject to
Delivering 1.Run over by Yashoda management induction/Training with regards to
unloading and vehicle / Chiller Safety management.7..The forklift must be tested and certified by
storing of fresh plant 3
air handling 2.Hit by reversing party.
Ensure the Redundancy of
units equipment Hospital , 8. Daily Checklist to be maintained by operator.
Vehicle operators Before
Chillers/CT/VRV 3.Overhead Project Chiller plant 9. Strictly to be followed safe working load.
1 /DX/Split starting work, check the Site Eng,Supervisor &
obstructions Supervisiors/OperativeSu & Low side 4 4 Medium 10. No unloading activity will carr 4 4 Medium
work area for thepresence of HSE Officer
units/CHW Pipe 4.Vechile break pervisors plant room y if high wind,
aerial hazards (if any) and
lines using pick down areas rain or poor visibility.
other obstructions
up and 5.Property damage 11. Forklift operator, rigger and banksman's
unloading by 6.Collision with must be competent and certified by 3rd
boom loder / another vehicle party.
mobile crane 7.Over load 12. Mobile Crane must be certified by 3rd party.
13. Mobile Crane operators must be trained and
certified by 3rd party
14. Lifting plan must be in place with lifting
supervisor.
15. Crane checklist to be maintained by
1. Ensure grinding/cutting disks are appropriate for
operator.
the application
16. Ensure safeand do not
working loaduseand if date is expired. 2. Ensure that
no overhead
wheel speed marked on disk should be greater than the grinder
obstruction
machine
17. Before crane setup , lifting supervisor must
3.Ensure
inspect thethat grinder
soil haveand
condition safetyfloorguard
leveling.
4.
18.Operatives
Crane must must use face
be setup shield
without and eye
rigger and protection
Ensure that be
rigger must thecommunicate
grinding/cutting witharea is free from combustible
operator Fire watcher must ensure
1.Grinder/Cutter materials
during the lifting operation. hot work area have no fume
Installation of 2.Eye injury 6. Hot work permit must be obtained for any type of hot work. or spark or any smoke
Duct jointing 3.Fragile Duct 7. Fire blanket must use for any grinding/cutting before leaving thework
work.
2 with materials
Involved all work force 8. Ensure Fire Extinguisher and sand bucket in place. 9. Ensure
area.Ensure that operative’s
AHU/VRF/Split/ 4.Noise cloths not to entanglement
Package unit 5.Metal waste all electrical cables are in good condition and away from hot work with rotating tools and
using ladder 6.Electric shock area. injury. Work area must
7.Fire 10. Use proper hand gloves to protect finger during using clean and tidy to avoid slip
threading die set. trip or fire .
11. Use ear protection for noise control
12. Ensure there is no loose connection and no
damage electrical cable or socket for prevent electric shock.
13. Ensure proper earthing and use of industrial socket only

1.Do not allow any hot work activity at the site unless it is necessary.
1.Grinder/Cutter
2.Eye injury 2.Hot work permit must be obtained for any type of hot work.
Welding,
3.Fragile Duct
Welding cutting
3 and materials 3.Ensure Fire PPE Kit at the work place.
Staff, visitors, & Vendors Hospital wide
grinding(source
5.Metal waste 4. At the work place surrounding area should be clean ( like remoive
of ignition).
6.Electric shock the unwated electrical cables, oil traces ect......
7.Fire
5.Eye clean sink or wash better to arrange
 FMS RISK ASSESSMENT- UTILITY SYSTEMS

RISK SCORE RISK CATEGORY ACTION Risk Assessment Reference No:

1-3 Low There are no imminent dangers. Frequent review shall be in place especially changes in procedures, materials or environment. Facility Name: Yashoda Hospitals, Hitec City
Take remedial action at appropriate time
4-6 Medium Proceed with care. Additional control is advised. Review at appropriate time. FMS Program: Utility Systems

8-12 High High priority remedial action Proceed with extreme caution. Implement additional controls immediately. Emergency control measures shall be in place. Date of Assessment:

15-25 Extreme Operation not Permissible. Stop operation & review controls. Next Review Date:

HAZARD IDENTIFICATION RISK EVALUATION RISK CONTROL

Residual
Inherent risk Rating Risk Rating
Responsible person (Action/Monitored
Sl No. Process / Activity Hazard and its risk Groups Exposed Risk Area Existing Control Measures Additional Control measures by)
L S RR L S RR

1. Chemicals 1.Eye clean sink or wash better to arrange

2. Fire hooter,
speakers and fire 2.Fire all type of auto alert equipments need to extend to 16th floor .
push button
4 3. emergency lift Hospital chiller 3.Cover with cameras with more for more focus
Fire sefety Involved all work force
4. cameras plant area
5. Rooftop door 4. Roof top doors acess better to arrange avoide the un authorised
access persons or works to start
6. all roof area
emergency lighting 5. better to arrage emergency lights to cover the terrace area

Cooling Tower Workers may be Hospital chiller

5 Involved all work force Need to arrange pathway
pathway chance to fell down plant area

Fire exit doors

not working Fire exit doors not
6 Staff, visitors, & Vendors Hospital wide Incase of the fire, the smoke will not moive
locks and working
handles

incase of emergency switching of the AHU, but near by no emergency

stop button.
No emergency off
7 AHU & TFA Involved all work force Hospital wide
button

Fire Booster
Incase of the fire, if Power falure supporting Booster pump will not
8 pump @ Staff, visitors, & Vendors Hospital wide
work
Terrace

Hot water tank Hot water tank abobe stage and railing required due to while
9 cleaning time Involved all work force
at terrace maintance time its cause of danger

10

11
 FMS RISK ASSESSMENT- UTILITY SYSTEMS

RISK SCORE RISK CATEGORY ACTION Risk Assessment Reference No:

1-3 Low There are no imminent dangers. Frequent review shall be in place especially changes in procedures, materials or environment. Facility Name: Yashoda Hospitals, Hitec City
Take remedial action at appropriate time
4-6 Medium Proceed with care. Additional control is advised. Review at appropriate time. FMS Program: Utility Systems

8-12 High High priority remedial action Proceed with extreme caution. Implement additional controls immediately. Emergency control measures shall be in place. Date of Assessment:

15-25 Extreme Operation not Permissible. Stop operation & review controls. Next Review Date:

HAZARD IDENTIFICATION RISK EVALUATION RISK CONTROL

Residual
Inherent risk Rating Risk Rating
Responsible person (Action/Monitored
Sl No. Process / Activity Hazard and its risk Groups Exposed Risk Area Existing Control Measures Additional Control measures by)
L S RR L S RR

12
 FMS RISK ASSESSMENT- UTILITY SYSTEMS

RISK SCORE RISK CATEGORY ACTION Risk Assessment Reference No:

1-3 Low There are no imminent dangers. Frequent review shall be in place especially changes in procedures, materials or environment. Facility Name: Yashoda Hospitals, Hitec City
Take remedial action at appropriate time
4-6 Medium Proceed with care. Additional control is advised. Review at appropriate time. FMS Program: Utility Systems

8-12 High High priority remedial action Proceed with extreme caution. Implement additional controls immediately. Emergency control measures shall be in place. Date of Assessment:

15-25 Extreme Operation not Permissible. Stop operation & review controls. Next Review Date:

HAZARD IDENTIFICATION RISK EVALUATION RISK CONTROL

Residual
Inherent risk Rating Risk Rating
Responsible person (Action/Monitored
Sl No. Process / Activity Hazard and its risk Groups Exposed Risk Area Existing Control Measures Additional Control measures by)
L S RR L S RR
 FMS RISK ASSESSMENT- UTILITY SYSTEMS

RISK SCORE RISK CATEGORY ACTION Risk Assessment Reference No:

1-3 Low There are no imminent dangers. Frequent review shall be in place especially changes in procedures, materials or environment. Facility Name: Yashoda Hospitals, Hitec City
Take remedial action at appropriate time
4-6 Medium Proceed with care. Additional control is advised. Review at appropriate time. FMS Program: Utility Systems

8-12 High High priority remedial action Proceed with extreme caution. Implement additional controls immediately. Emergency control measures shall be in place. Date of Assessment:

15-25 Extreme Operation not Permissible. Stop operation & review controls. Next Review Date:

HAZARD IDENTIFICATION RISK EVALUATION RISK CONTROL

Residual
Inherent risk Rating Risk Rating
Responsible person (Action/Monitored
Sl No. Process / Activity Hazard and its risk Groups Exposed Risk Area Existing Control Measures Additional Control measures by)
L S RR L S RR

26
 FMS RISK ASSESSMENT- UTILITY SYSTEMS

RISK SCORE RISK CATEGORY ACTION Risk Assessment Reference No:

1-3 Low There are no imminent dangers. Frequent review shall be in place especially changes in procedures, materials or environment. Facility Name: Yashoda Hospitals, Hitec City
Take remedial action at appropriate time
4-6 Medium Proceed with care. Additional control is advised. Review at appropriate time. FMS Program: Utility Systems

8-12 High High priority remedial action Proceed with extreme caution. Implement additional controls immediately. Emergency control measures shall be in place. Date of Assessment:

15-25 Extreme Operation not Permissible. Stop operation & review controls. Next Review Date:

HAZARD IDENTIFICATION RISK EVALUATION RISK CONTROL

Residual
Inherent risk Rating Risk Rating
Responsible person (Action/Monitored
Sl No. Process / Activity Hazard and its risk Groups Exposed Risk Area Existing Control Measures Additional Control measures by)
L S RR L S RR

27

28

29

30

Prepared by: Signature: Date:

Reviewed by : Signature: Date:

Approved by: Signature: Date: