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
RISK SCORE RISK CATEGORY ACTION Risk Assessment Reference No:
There are no imminent dangers. Frequent review shall be in place especially changes in procedures, materials or
1-3 Low environment. Facility Name:
Take remedial action at appropriate time
4-6 Medium Proceed with care. Additional control is advised. Review at appropriate time. FMS Program:
High priority remedial action Proceed with extreme caution. Implement additional controls immediately. Emergency
8-12 High 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
Process / Groups
Sl No. Hazard and its risk Risk Area Existing Control Measures Additional Control measures Responsible person (Action/Monitored by)
Activity Exposed
L S RR L S RR

If power fails, or the

Alternate Electricity Board power
Incoming VCB fails in
Effects the DG sets are available as a back up power source to feed the Hospital in supply is available, if the power is not
Incoming the RMU panel,
1 Property and Hosptial 5 3 15 case of Electricity Board power fails. And all critical loads are on the 3 2 6 resumed for longer duration with the Senior Manager/Shift Engineer
Power Supply power will not be
Patients UPS power consultantion of EB authorities we will
available for the
switch over to alternate source
Hospital

PLC programming will be going to

Power will not be Effects the done for the Main LT panels, incase of
Transformer That particular DG sets will feed the power which is available as back
2 available for the part Property and Hosptial 3 3 9 3 2 6 any power transformer fail, healthy Senior Manager/Shift Engineer
fails up source
of the Hospital Patients transformer of other bus will be feed
the power by closing the Bus coupler

PLC programming will be going to

done for the Main LT panels, incase of
Power will not be any DG sets fail, healthy DG sets of
Effects the We can switch ON the BUS COUPLER and feed the power from healthy
available for the part other bus will be feed the power by
3 Dg set fails Property and Hosptial 3 3 9 DG sets BUS manully. If power fails and DG sets all are not healthy due 3 2 6 Senior Manager/Shift Engineer
of the Hospital, in closing the Bus coupler. In each Main
Patients to any natraul calamities.
case of EB supply fails LT panel we are having 2500A spare
input Breaker to feed the power to
the hospital with rental DG sets

Every Sub distribution Panels are

having the Dual Source with the Bus
couplers and in Auto mode. Any one
Incoming source is fails, through the bus coupler
Power will not be Effects the
Breaker or We can switch ON the BUS COUPLER and feed the power from healthy closing other section will be charged.
4 available for the part Property and Hosptial 2 5 10 2 3 6 Senior Manager/Shift Engineer
ATS fails in BUS manully, If Bus coupler is also fails And we are having two Raising mains
of the Hospital, Patients
Main LT panel to each electrical room those are
coming from two panels. We can
manully change the source at each
electrical room
 Every Sub distribution Panels are
having the Dual Source with the Bus
couplers and in Auto mode. Any one
source is fails, through the bus coupler
closing other section will be charged.
And we are having two Raising mains
Any fire 1.Fire Supression system is available in the Main LT and Emergency to each electrical room those are
Power will not be Effects the
occurs in one panel. This fire supression system will be activated and extinguish the coming from two panels. We can
5 available for the part Property and Hosptial 1 5 5 1 3 3 Senior Manager/Shift Engineer
of the Main fire. manully change the source at each
of the Hospital, Patients
LT panel 2. If unforuntly two panels are have occurred the fire. electrical room.
2. Emergency panel will be there to
feed the critical loads in the hospital,
this we need to connect directly with
one of the DG sets. So that we can
feed the power to the hosptial critical
loads

We have provided the GI tray where

Water Power will not be Effects the With the help of civil team, the shed is arranged to avoid the rain this water is leaking and through the
6 leakage in LT available for the part Property and Hosptial 4 3 12 water on top of the panel room. And water proofing also done. If 3 2 6 pipe this leaking water will be Senior Manager/Shift Engineer
panel room of the Hospital, Patients water enter on it and water proofing fails transferred to drain and the panels
will not effect

We have done the parallel operation

of the UPS, Now if any UPS in that
paritcular Zone is fails. The load will be
transferred automatically to the
adjacent UPS without interuption. And
Critical Power will not Effects the We have procured the UPS which is having the fecility of going in to alarm will come. IF both the UPS have
Any UPS will
7 be available for the Property and Hosptial 3 5 15 static BYPASS without power interuption and it will give alarm. If this 2 5 10 got fail, those will be go static BYPASS Senior Manager/Shift Engineer
fail
part of the Hospitals Patients condition EB power fails the power will not be there for a while without interuption, alarm will
give.We have connected all the three
sets of UPS to BMS. there we are
monitoring 24/7 and sounders are
provided if any alarms will raise,
accordingly our team will act

We have provided each and every individual circuits Raw power RCBO
Any faulty 30mA, which will trip that particular Circuit and save the persons and
it may experience the
equipment/ connected equipmens. For UPS circuits we are having only MCB We are having the Annual
electric shock to that Effects the
instrument is That particular protection, as it is an emergency source we are not using RCBOs. For maintenance PM plan, we will check
8 person who is Property and 4 4 16 2 2 4 Senior Manager/Shift Engineer
connected to effected area all Operation theraters we are having the Isolation transfomers and the DBs, panels, for there healthy
using/operating/touc Patients
the power RCBOs with leakage current monitoring alarming, if exceeds the limit it condition
h
sockets will trip. In this case they will use either the Raw power or other
Operation theater and inform to our team for further action

it may experience the that particular

Performing We are using proper insulated tools, while perfoming. Rubber mats
electric shock to that Effects the DB/panel and We have procured the ARC flash suite
the PM on are provided at panels area and electric shock proof shoes will be
9 person who is Property and its connected 2 4 8 1 3 3 to avoid effect on the person who is Senior Manager/Shift Engineer/Engineering staff
load of critical weared while performing this activity with approved standard pracitse
using/operating/touc Patients equipments/ performing this activity
DBs/panels operation
h users
 We have provided the Danger Boards
with self illumated for the Electrial
it may experience the that particular
Operating the All the panels and equipments are connected with proper earthing. All Panels area to avoid unauthorised
electric shock to that Effects the DB/panel and
electrical the equipments are having the insulated leavers or push buttons are entry. And we have provided the chart
10 person who is Property and its connected 2 4 8 1 3 3 Senior Manager/Shift Engineer/Engineering staff
equipments there. Tested IS standard rubber mats are provided. Calibrated and of electric shock to do the first aid
using/operating/touc Patients equipments/
and panels proper insulated tools will be used with the BOX. And we have provided
h users
number in case of medical emergency
to activate the code

The hospital will feed the power through the DG sets, if power not
If the power
come for days together, For the running of Diesel we need to have And parallelly we have arranged the
is not Power will not be Effects the
sufficient diesel in our Hospitals. For this we are having day tanks of HSD storage, the laisoning is in
11 available for available for the Property and Hosptial 1 5 5 1 3 3 AGM/Senior Manager
capacity each 990 liters and storage upto 2000 litres. And we are progress at the earliest we will get this
longer Hospital, Patients
having the MOM with the supplier, they will arrange within 2 hours in to operational
duration
once we placed the request.

Lighting is not In day time, we are having natural ventilation. And we have taken in to We are preparing the area wise
Effects the
available in The entire hospitals two parts that is all common areas 30% of the lighting from the UPS(2 checklist for the preventive
12 Property and Hosptial 1 5 5 1 2 2 Senior Manager/Shift Engineer/Engineering staff
the Hospitals will become dark are in parallel) and closed areas/room we have taken minimum one maintenance of Light fixtures to
Patients
building light from the UPS(2 are in parallel) ensure proper working of the same.

Prepared by: Balakrishna G Signature: Date : 05-Mar-2024

Reviewed by : Signature: Date:

Approved by: Signature: Date: