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ANGLOGOLD ASHANTI: Mine Waste Solution CCIX

RISK ASSESSMENT RECORD

RA NO: 006

CONTRACTOR: Fibre-Wound Company (Pty) Ltd DATE: 2013-05-17

BRIEF DESCRIPTION OF SCOPE OF WORK/ACTIVITY: Fire Prevention LOCATION: Mine Waste Solution: Stilfontein

RISK ASSESSMENT TEAM:

Title/Appointment
Contractors: Approved: Yes/ No
Initials & Surname Signature
Project Manager :
Chris Swart Project Coordinator
Name: ______________Signature: _____________
Engineering Manager :
Andrè Gerber Project Engineer Name: ______________ Signature: ____________

Anton van Zyl CR 6.(6) Safety Officer:

Title/Appointment
Client representative
COMMENTS:

Vaughan Swart
Safety Coordinator

Discipline Coordinator
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REQUIRED AND EXISTING CONTROL MEASURES: (SUBMIT AND ATTACH TO RISK ASSESSMENT)

Available Adequate Changes Remarks

Required
Yes No Yes No Yes No

Scope of work (Logical steps on

how task will be performed )
Procedures: (W I / SOP / X X X
Vendor spec's)
Training (induction) / Competency X X
certificates/ Specific training X
identified / Other (Instructions)
Special Permits required (specify) X X X Hot work –; Confined Space – and Access permits
Equipment /Tool registers / others X X X
(specify)
Code of Practice: X X X
Other:
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Frequency Scale Severity Scale: Probability Scale

Frequent Occurrence/ daily Catastrophic (Many Fatalities />10 Million damage)

Has happened before (3)
(3) (8)

It has happened/ Monthly Disaster (Fatal injury / >1 Million damage ) Quite possible (2)
(2) (7)
Unusual but possible
Could occur/ Yearly Very Serious (Reportable Accident/ >R 100,000 (1)
(1) damage (6)

Serious ( Disability Injury (LTI) />R10000 damage

(5)

Important (Non Disabling Injury/<R1000 damage)

(4)

Of Concern (Minor Injury />R100 Damage)

(3)

RISK RANKING / PRIORITY FACTOR

If score is 61 to 72 AA Potentially Disaster, action needed immediately
If score is 49 to 60 A Potentially Major, action to be taken within 8 hours – during the shift
If score is 37 to 48 B Potentially Serious, action to be taken within 16 hours – during the second shift
If score is 20 to 36 C Potentially Minor, action to be taken within 7 days
If score is 0 to 19 D Potentially Tolerable, action to be taken within 1 month
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RISK ASSESSMENT

N LIST TASK WITH POTENTIAL AND PROB SEV OF FREQ SCOR RISK PREVENTATIVE PERSON RESPONSIB
O ALL TASK STEPS EXISTING HAZARDS OF OCCUR OF E RANK / MEASURES AND RESPONSIBLE LE
(WHO WILL DO  INJURY OCCU 3/4/5/6/7/ OCCU TOTA PRIORIT CONTROLS TO ENSURE PERSON’S
WHAT, WHERE R 8 R L Y  ELIMINATE RISK PREVENTATIVE SIGNATURE
 HEALTH 1/2/3 1/2/3 FACTOR MEASURES ON
AND WHEN) PXSX
 PROCESS  CONTROL AT SOURCE AND COMPLETIO
F
 MATERIAL  PUT/FOLLOW CONTROLS ARE N DATE
PROCEDURE IN PLACE
 ENVIRONMENT
 PROVIDE PPE
1. Responsible Sec  Tools and 3 8 3 72 AA All equipment that are Responsible
6(1) to ensure all equipment will going to be used with GMR2.(7)(a)
tools and not be identified their registers shall be
equipment numbered and checked by the site’s
(Personal inspected and responsible person and
protective couldn’t comply signed off before work
equipment etc) with legal shall commence
to be used are requirements/sit (Electrical Machinery
identified e standards Reg.9+10 & driven
numbered which can result Machinery Reg 20
inspected and on in legal liability /General Safety Reg
register claims. 14a (5)(b)
Responsible
3 8 3 72 AA Where any certification GMR2.(7)(a)
 People could be is required this will form
exposed to part of the register to
injury due to ensure failure of
failure of equipment is kept to a
equipment. minimum
2. Responsible Sec  Personnel may 3 8 3 72 AA Responsible 6(1) to Responsible
6(1) will ensure be exposed to ensure Works GMR2.(7)(a)
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N LIST TASK WITH POTENTIAL AND PROB SEV OF FREQ SCOR RISK PREVENTATIVE PERSON RESPONSIB
O ALL TASK STEPS EXISTING HAZARDS OF OCCUR OF E RANK / MEASURES AND RESPONSIBLE LE
(WHO WILL DO  INJURY OCCU 3/4/5/6/7/ OCCU TOTA PRIORIT CONTROLS TO ENSURE PERSON’S
WHAT, WHERE R 8 R L Y  ELIMINATE RISK PREVENTATIVE SIGNATURE
 HEALTH 1/2/3 1/2/3 FACTOR MEASURES ON
AND WHEN) PXSX
 PROCESS  CONTROL AT SOURCE AND COMPLETIO
F
 MATERIAL  PUT/FOLLOW CONTROLS ARE N DATE
PROCEDURE IN PLACE
 ENVIRONMENT
 PROVIDE PPE
all his/her hazards not Instruction WI – 19 –
personnel go known to him 04 – 2/1 is followed to
through the the letter.
medical  Possible Health
surveillance and related issues
attend induction will not be
before work will identified that
commence could result in
injury

 Possible Health
related issues will
not be identified
that could result in
injury or legal
liability claims
3. Responsible Sec  Exposures to 3 8 3 72 AA Responsible 6(1) to
6(1) will ensure unknown ensure no job will
that all relevant hazards commence before all
permits and necessary permits are
clearance to  Exposure to obtained and clearance
work will be legal liability to work has been given
obtained before by the responsible
the work will  Possible person of the section
commence process work is to be performed
interruptions (Occ H&S Act Const
Reg 7 )

4. Responsible 6(1)  Exposures 3 8 3 72 AA  All

workers to sign the Responsible
to ensure risk to unknown workman’s GMR2.(7)(a)
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N LIST TASK WITH POTENTIAL AND PROB SEV OF FREQ SCOR RISK PREVENTATIVE PERSON RESPONSIB
O ALL TASK STEPS EXISTING HAZARDS OF OCCUR OF E RANK / MEASURES AND RESPONSIBLE LE
(WHO WILL DO  INJURY OCCU 3/4/5/6/7/ OCCU TOTA PRIORIT CONTROLS TO ENSURE PERSON’S
WHAT, WHERE R 8 R L Y  ELIMINATE RISK PREVENTATIVE SIGNATURE
 HEALTH 1/2/3 1/2/3 FACTOR MEASURES ON
AND WHEN) PXSX
 PROCESS  CONTROL AT SOURCE AND COMPLETIO
F
 MATERIAL  PUT/FOLLOW CONTROLS ARE N DATE
PROCEDURE IN PLACE
 ENVIRONMENT
 PROVIDE PPE
assessment is hazards declaration.
discussed;  Working on
understood and wrong equipment
signed prior to and machinery
work is
commenced  People can
be exposed to
Injury
5. Ensure that the  Unsafe 2 6 3 36 C  Supervisor to ensure Responsible
work permit activities can lead that activities to be GMR2.(7)(a)
received is to fires, injuries executed are clearly
signed by the causing loss of life understood and the
responsible and damage to the possible fire hazards
supervisor and equipment and and dangers have
that the permit is property been pointed out.
discussed/
understood and
signed by the co-
workers
6. Proper  Unsafe 3 6 2 36 C  Supervisor to ensure Responsible
preparation activities can lead that the following is in GMR2.(7)(a)
must be done to fires, injuries place before work
before causing loss of life starts: Tank Guard,
commencement and damage to the Vessel entry register,
of work, the equipment and P.P.E. worn by the
inspection of property workers. Ensure that 8
work area to hourly environment
ensure it is clear monitoring is done and
of combustibles copies are available at
and that proper the vessel
housekeeping is
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N LIST TASK WITH POTENTIAL AND PROB SEV OF FREQ SCOR RISK PREVENTATIVE PERSON RESPONSIB
O ALL TASK STEPS EXISTING HAZARDS OF OCCUR OF E RANK / MEASURES AND RESPONSIBLE LE
(WHO WILL DO  INJURY OCCU 3/4/5/6/7/ OCCU TOTA PRIORIT CONTROLS TO ENSURE PERSON’S
WHAT, WHERE R 8 R L Y  ELIMINATE RISK PREVENTATIVE SIGNATURE
 HEALTH 1/2/3 1/2/3 FACTOR MEASURES ON
AND WHEN) PXSX
 PROCESS  CONTROL AT SOURCE AND COMPLETIO
F
 MATERIAL  PUT/FOLLOW CONTROLS ARE N DATE
PROCEDURE IN PLACE
 ENVIRONMENT
 PROVIDE PPE
done
7. Discuss  Lack of 2 5 3 30 C  Supervisor to Responsible
emergency knowledge can “tell and show” the GMR2.(7)(a)
rescue lead to fires, injury workers in using of fire
procedures and and/or fatality of extinguishers and
apparatus such workers and inspect for expiry date
as fire damage to when drawing from the
extinguishers equipment and store. Discuss the
and emergency property. various evacuation
evacuation routes to the assembly
procedures area
8. Pre-use  Failure of 2 7 2 28 C  Replace faulty Responsible
inspection of all equipment can equipment GMR2.(7)(a)
fire cause injury to immediately
extinguishers, workers and
tools and damage to
equipment to be equipment
used
9. Pre-use  Failure of 2 5 2 20 C  Replace faulty Responsible
inspection of safety apparatus safety apparatus GMR2.(7)(a)
safety apparatus will lead to serious immediately
to be used injury and/or
fatalities
10. Barricade work  Ignoring the 3 4 3 36 C Supervisor to adhere to Responsible
area off and barricading and barricading and to GMR2.(7)(a)
place the cheese symbolic signs can ensure the “No
board with the cause unsafe Smoking” and “Open
required warning activities that can Flames” are clearly
signs in lead to fires, visible and adhered to
conspicuous injuries causing by all workers in the
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N LIST TASK WITH POTENTIAL AND PROB SEV OF FREQ SCOR RISK PREVENTATIVE PERSON RESPONSIB
O ALL TASK STEPS EXISTING HAZARDS OF OCCUR OF E RANK / MEASURES AND RESPONSIBLE LE
(WHO WILL DO  INJURY OCCU 3/4/5/6/7/ OCCU TOTA PRIORIT CONTROLS TO ENSURE PERSON’S
WHAT, WHERE R 8 R L Y  ELIMINATE RISK PREVENTATIVE SIGNATURE
 HEALTH 1/2/3 1/2/3 FACTOR MEASURES ON
AND WHEN) PXSX
 PROCESS  CONTROL AT SOURCE AND COMPLETIO
F
 MATERIAL  PUT/FOLLOW CONTROLS ARE N DATE
PROCEDURE IN PLACE
 ENVIRONMENT
 PROVIDE PPE
areas to ensure loss of life and vicinity.
that the other damage to the 
workers working equipment and
in the immediate property
vicinity can see
it.
11. Fire Watch to  Hazards 2 6 3 36 C Supervisor to ensure Responsible
ensure that no such as fires, eye that all the people GMR2.(7)(a)
hot work is injuries, skin burns, working with HCS has
allowed when inhalation and had the necessary
working ingestion of training and that it is on
overhead. To fumes/liquids/gass register
ensure a es/ vapors can
controlled cause injuries and
working environmental
environment pollution
12. Ensure Material  Unsafe 2 6 3 36 C Supervisor to ensure
Safety Data handling and that all the people
Sheets available useage can cause working with HCS has
Responsible
for all flammable fires, eye injuries, had the necessary
GMR2.(7)(a)
liquids and skin burns, training and that it is on
hazardous inhalation and register
chemical ingestion of
substances on fumes/liquids/gass
the cheese es/ vapours can
board cause injuries and
environmental
pollution
13. Discuss MSDS Mixing of resin and 2 6 3 36 C Supervisor to ensure Responsible
with workers catalyst is done in that all the people GMR2.(7)(a)
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N LIST TASK WITH POTENTIAL AND PROB SEV OF FREQ SCOR RISK PREVENTATIVE PERSON RESPONSIB
O ALL TASK STEPS EXISTING HAZARDS OF OCCUR OF E RANK / MEASURES AND RESPONSIBLE LE
(WHO WILL DO  INJURY OCCU 3/4/5/6/7/ OCCU TOTA PRIORIT CONTROLS TO ENSURE PERSON’S
WHAT, WHERE R 8 R L Y  ELIMINATE RISK PREVENTATIVE SIGNATURE
 HEALTH 1/2/3 1/2/3 FACTOR MEASURES ON
AND WHEN) PXSX
 PROCESS  CONTROL AT SOURCE AND COMPLETIO
F
 MATERIAL  PUT/FOLLOW CONTROLS ARE N DATE
PROCEDURE IN PLACE
 ENVIRONMENT
 PROVIDE PPE
handling/using/tr two quantities working with HCS has
ansporting/storin namely: 10 & 25 had the necessary
g the HCS Kg’s.Incorrect training and that it is on
substances. quantities can register
Explain safety cause multiple
precautions and injuries, health
P.P.E. hazards, fires and
requirements to explosions.
all involved
14. Select quantities Mixing of resin and 2 6 3 36 C Supervisor to ensure Responsible
and collect from catalyst is done in that all the people GMR2.(7)(a)
stores. Resin, two quantities working with HCS has
MEKP Hardner, namely: 10 & 25 had the necessary
300CSM, Kg’s. Incorrect training and that it is on
450CSM, quantities can register
600WR, Veil, cause multiple
Tissue, Glass injuries, health
string, Adhesive hazards, fires and
putty, Acetone, explosions.
Paint brushes,
rollers, and
mixing buckets.
15. Apply resin and  Incorrect 2 6 3 36 C  Correct PPE to Responsible
mat, to surface quantities can be worn. Rubber GMR2.(7)(a)
as per spec with cause multiple chemical gloves,
rollers/brushes. injuries, health respirators, No
hazards, fires and spillages – No
explosions. smoking/open flames
allowed. Well
ventilated area. Fire
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N LIST TASK WITH POTENTIAL AND PROB SEV OF FREQ SCOR RISK PREVENTATIVE PERSON RESPONSIB
O ALL TASK STEPS EXISTING HAZARDS OF OCCUR OF E RANK / MEASURES AND RESPONSIBLE LE
(WHO WILL DO  INJURY OCCU 3/4/5/6/7/ OCCU TOTA PRIORIT CONTROLS TO ENSURE PERSON’S
WHAT, WHERE R 8 R L Y  ELIMINATE RISK PREVENTATIVE SIGNATURE
 HEALTH 1/2/3 1/2/3 FACTOR MEASURES ON
AND WHEN) PXSX
 PROCESS  CONTROL AT SOURCE AND COMPLETIO
F
 MATERIAL  PUT/FOLLOW CONTROLS ARE N DATE
PROCEDURE IN PLACE
 ENVIRONMENT
 PROVIDE PPE
extinguishers at all
time available.
16. When hot work  Uncontained 2 7 2 28 C Supervisor to ensure Responsible
is done the sparks/flux can that the artisan has a GMR2.(7)(a)
Supervisor to cause fires leading serviceable fire
ensure that the to damage of extinguisher available
artisan has the equipment and and use the fire blanket
necessary fire property as well as when hot work is done.
blankets and fire injuries and loss of
extinguishers life.
(1..5 Kg)
available
17. Proper air  Uncontrolled 3 6 2 36 C  Supervisor to Responsible
ventilation is rise in ensure that there is GMR2.(7)(a)
required when temperatures can always adequate air
doing hot work lead to the ventilation if not, the
or lamination inhalation of fumes workers must be
especially in that can cause the removed from that
confined spaces workers to become area
incapacitated
18. Good house  Poor house 3 6 3 54 B  Supervisor to Responsible
keeping keeping leads to ensure that no work GMR2.(7)(a)
principles must uncontrolled fires will be done unless the
be applied at all causing damage to working area is free
times in order to property, flammable material
minimize the equipment and and clean.
threat of fire injuries or fatalities
hazards to the workers
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I the undersigned Responsible person: ________________________hereby declare that:

(Print name in full)

I have after consultation with my employees as far as reasonably practicable identified and recorded all the significant hazards and risks
associated with the task that I am to perform with regards to this Risk Assessment
I have determined all measures that needs to be in place for this task, including changing the organization of work and design of safe systems of
work, necessary to eliminate, control, minimise, or where the risk still remains provided the necessary personal protective equipment, and
implemented them.
I undertake to periodically review the hazards identified and the risk assessed, to determine whether further elimination, control and minimization
of risk is possible
I have provided every employee as part of this risk assessment with the necessary training, information, instruction or supervision to enable
them to perform their work without risk to his/her Safety and Health.

Signed on the _________/20…. at ANGLOGOLD ASHANTI by: ______________________

(Date) (Responsible person)

Employed by: FIBRE – WOUND (Name of Company)

I / we the undersigned hereby declare that the Responsible person in charge has made us familiar with the work-related hazards and risk and the
measures that must be taken to eliminate, control and minimise those hazards and risks:

PRINT NAME IN FULL SIGNATURE

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