AREA / PROJECT:Buffer Zone
ROYAL COMMISSION RISK ASSESSMENT FORM
Contract #:021-C05R
DATE Assessed:29/12/2014
Reviewed date: 29/12/2014
SPECIFIC LOCATION
TOOLS &
EQUIPMENT IN USE:
15
Uncontrolled releasing
Death, Fatality
of Energey or water
15
WITH CONTROLS
Current Controls / Safeguards (What do we
do to prevent incidents?)
1-Area Shall be demarcated
Properly.
2Display safety signboard for preventing
unauthorized Entrance.
3-Make sure all pipe supports
are in good condition and have been
inspected.
4-All hoses
must be tied down.
5-Water
temperature must be more than 60 F
6-The Hydrostatic
-presurizing pump is completed with
safety relief valve.
7-Wear Proper P P E .
8Ensure the gage meter is caliberated by
third party & Certificate should be keep
in site safety office.
9-Safety relief valve to be caliberated
1-Start depressurization by opening
gradually the vent valve.Do it slowly
2-Do not open the drain valve if the
vent valve if still closed.This is to
avoid vacum condition inside the Pipe
line.
3Open the lowest drain point to
completely remove water from the
pipe line.
5Ensure that no remaining presure
trapped inside the pipe line.
6-
6-
RISK RATING
Presure Pump
RISK SCORE
Death, Fatality
Hydro Test
Explosion
Harm / Consequence /
Parties affected (What can
happen / go wrong)
RISK SCORE
Hazards identified with
each task
(What can hurt one /
others?)
RISK RATING
Tasks
(What one does
in logical steps)
SEVERITY (S)
Hydro Test
PROBABILITY (P)
Responsible Person
Site engineer & Site
safety officers make
sure all safety
precuations
implemented before
start Job
Engineer/Safety
officer/ Forman.
Site engineer & Site
supervisors.
Engineer/Safety
officer/ Forman.
Additional & or Site Controls
(What additional
could we do to reduce the
risk?)
Additional PPE:
PROBABILITY (P)
Risk Rating =
Probability
x
Severity
1
SEVERITY
Unlikely
First Aid or slight injury
Rare
Recordable, medical and restricted work
Possible
Lost time injury or permanent disability
Likely
Single fatality or permanent disablity of 3 or more
person
Very Likely
multiple fatalities
Probability (P)
Ser No.
TASK /
OPERATION /
ACTIVITY
DESCRIPTION:
Instellation of water and Fire Line
SEVERITY (S)
RISK ASSESSMENT:
PROBABILITY (P)
RA No:
SEVERITY
1
1 - Low
2 - Low
3 Low
4 - Low
5 - Med
2 - Low
4 - Low
6 - Medium 8 - Medium
10 - High
3 Low
6 - Medium
9 - Medium
12 - High
15 - High
4
5
4 - Low
5 - Medium
8 - Medium
10 - High
12 - High
15 - High
16 - High
20- High
20- High
25 - High
Name
Designation
Date
Prepared by:
ROBY.K.THOMAS
H S E MANAGER
29/12/2014
Reviewed by:
MAGDY ELSHERIBING
CONSTRUCTION MANAGER
30/12/2014
Approved by:
KULDEEP TYAGI
PROJECT MANAGER
30/12/2014
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Safety