Mina Petroleum LLC

Raysut road. P.O. Box 1506

Zip code 211 Salalah, Sultanate of Oman
RISK ASSESSMENT FORM
QHSSE-FM-QA0003-REV01

Risk Assessment
AREA LOCATION WORK PERMIT NO NATURE OF WORK BEING CARRIED OUT EXACT LOCATION OF WORK
 JETTY Above ground GROUNDING OF PORTABLE EQUIPMENT AND CONTAINER
 BPS □ Below ground TERMINAL,BPS & JETTY
 TERMINAL □ Indoors
□ OTHER (specify): □ Outdoors

NOTE: Refer to overleaf for instructions on how to complete the table below

Column 1 Column 2 Column 3 Column 4/5 Column 6 Column 7 Column 8/9 Column 10 Column 11
Initial Risk Initial Risk Residual Risk Residual
Rating Factor Risk Control Measure(s) Rating Risk Factor Risk
Activity Potential Hazard Risks Identified
(Column 4 x Implemented (Column 8 x Acceptable?
Probability Severity Probability Severity
Column 5) Column 9)

USE OF
PORTABLE
EQUIPMENT
AND Static Charge -Fire 2 4 8 -Grounding/Earthing of 1 4 4 Acceptable
CONTAINER -Shock equipment at a place
-Anti-static plates are
available

Risk Assessment Methodology Probability Rating Guide Severity Rating Guide Risk Factor Matrix and Risk Category Table
 Mina Petroleum LLC
Raysut road. P.O. Box 1506
Zip code 211 Salalah, Sultanate of Oman
RISK ASSESSMENT FORM
QHSSE-FM-QA0003-REV01

1. List all activities associated with the work to be carried out in

Column 1.
4 – Probable (Likely to occur) 4 – Catastrophic (Death, Risk Factor Matrix
serious injury/illness, destruction
2. Identify the potential hazards associated with each activity in PROBABILITY
of or considerable damage to
Column 2. 3 – Reasonably probable property, infrastructure, or
3. Identify the risks associated with each potential hazard in Column
3.
(Occasional occurrence can be equipment) 4 3 2 1
expected)
4. Assign values in Columns 4 & 5 for each identified risk in
4 16 12 8 4
2 – Improbable ( Possible, but 3
accordance with the Probability Rating Guide and the Severity – Serious (Non-life-threatening
Rating Guide (see right). injury but potential LTI or illness,

SEVERITY
5. Multiply Probability and Severity ratings to obtain the Initial Risk unlikely to occur)
potential to render 3 12 9 6 3
Factor and enter in Column 6. property/equipment temporarily
6. Assess this Initial Risk Factor using the Risk Category Table to
determine whether any risk control measures are required.
1 – Remotely probable out of service) 2 8 6 4 2
(Extremely unlikely to occur)
7. Specify and implement the required risk control measures in
Column 7. 2 – Moderate (Minor 1 4 3 2 1
8. Repeat Steps 2 - 4 above, taking into account the implemented injury/illness, not likely to be an
risk control measures to obtain the Residual Risk Ratings in LTI, potential minor damage to Risk Category Table
Columns 8 & 9. property/equipment) Risk Factor Range Risk Category
9. Multiply Probability and Severity ratings to obtain the Residual
Risk Factor and enter in Column 10.
10. Assess this Residual Risk Factor using the Risk Factor Matrix and 1 – Negligible (Minor first-aid if 8 - 16 High Risk
Risk Category Table to determine whether the residual risk is anything, no threat to 4–6 Medium Risk
acceptable or if further risk control measures are required property/equipment)
(Column 11) 1–3 Low Risk

Risk Assessment completed by (print name) Oliver Torres QHSSE reviewer (print name) Musallam Almashani
Designation Operations Superintendent Designation Manager
Sign/Date Sign/Date