Hazard Identification and Task Risk Assessment (HITRA) Form

Date Risk Assessment no. PTW no.

Description of the Task Transport the scaffolding material by using pickup & Offloading and Scaffold erection
Work Location ☒ PS Site ☐ DM Site ☐ Pipeline/Valve Room System/Unit
HITRA Team Leader (Facilitator) Name: Mostafa Harby Performing Authority: Name: APM technician

Area Authority Representative Name: Amgad Maher HSE Dept. Representative Name: Ibrahem Abdellatif
☒ Process ☐ Mechanical ☐ Electrical ☐ Instrument
Other HITRA team members ☐ Engineering ☐ Chemical Lab ☐ Warehouse ☒ Projects
☐ Administration ☐ IMT ☐ Security ☐ Other: ………………………
Required specific assessments ☒ Manual Handling ☐ COSHH ☐ Critical Lift Plan ☒ Rescue Plan ☐ Other: ……….………
Site visit examination for the Work/Task location required by Risk Assessment Team ☒ Yes ☐ No
Population at Risk:
☒ Cold Work Permit ☐ Hot Work Permit ☒ Vehicle Entry Permit ☐ Radiation Certificate
Required Permit/Certificates: ☐ Ground Disturbance ☐ Override Conformity ☐ Isolation Conformity ☐ Confined Space Entry
Certificate Certificate Certificate Certificate

REVALIDATION AND APPROVAL OF ROUTINE ACTIVITIES (PREVIOUSLY ASSESSED) BEFORE EXECUTION

Assessment Reviewed By:
Name Position Signature Company Date
HITRA TL UGDCO 1-11-2017
Performing Authority UGDCO 1-11-2017
HSE Representative UGDCO 1-11-2017
Area Authority / Affected UGDCO 1-11-2017
HAZARD SCREENING CHECKLIST:
This table is an aid memoir for HITRA team to identify the hazards associated with the task. HITRA team should identify other hazards not listed
below.
Hazard Group Hazard ID
Critical Activity
☐ Activities with Initial Risk Rating (Blue, Purple and B+)

Biological ☐ Poisonous plants ☐ Large Animals ☐ Small Animals ☐ Food-borne bacteria ☐ Water-borne bacteria
☐ Human immune ☐ Disease-transmitting ☐ Other communicable
☐ Cold and flu viruses ☐ Parasitic insects
deficiency virus insects diseases
Body Mechanics
☐ Lifting ☐ Pushing ☐ Pulling ☐ Climbing ☒ Positioning

☐ Corrosive: ………………. ☐ Toxic Solid: …………….. ☐ Toxic Liquid: …………… ☐ Toxic Gas: ………………. ☐ Hydrocarbon gas

Chemical ☐ LPGs (e.g. propane) ☐ LNGs ☐ Condensate, NGL ☐ Wax, Lube and seal oil ☐ Hydraulic oil

☐ Diesel fuel ☐ Petroleum spirit ☐ Gasoline ☐ Cellulosic materials ☐ Pyrophoric materials

☐ Low O2 atmosphere ☐ Excessive CO2 ☐ Drowning ☐ Excessive N2 ☐ Smoke

Electrical
☐ Voltage > 50V to 440V ☐ Voltage > 50V to 440V
☐ Voltage > 440V ☐ Lightning discharge ☐ Electrostatic energy
in cables in equipment

Gravity ☒ People at height > 2m ☐ People at height < 2m ☐ Overhead equipment ☐ People below grade ☐ Excavation > 1.5m

☒ Fall from Height ☐ Dropped Objects ☐ Lifting ☐ People under water

☐ Engine and turbine ☐ Process piping & equip ☐ Process piping and
Thermal ☐ Steam piping ☐ Heaters with fire tube
exhaust systems between 60°C & 150°C equipment over 150 °C
☐ Temperatures ☐ Temperatures greater ☐ Process piping ☐ Process piping less
☐ Flares
between 100°C & 150°C than 150°C between −25°C & −80°C than −80°C
 ☐ Trapping ☐ Crushing ☐ Pressing ☐ Shearing ☐ Ejection
Mechanical
☐ Impact with mobile
☐ Puncture ☐ Cutting ☐ Friction or Abrasion ☐ Entanglement
equipment
☐ Equipment with ☐ Use of knives and ☐ Use of hazardous hand ☐ Objects under
☐ Objects under tension
moving or rotating parts other sharp objects tools (grinding, sawing) compression
Noise
☐ Loud steady noise >
☐ Intrusive noise ☐ Noise due to impact
85 dBA

☐ Bottled gases under ☐ Water under pressure ☐ Air under high ☐ Oil and hydrocarbon ☐ Non-hydrocarbon gas
Pressure
pressure in pipework pressure gas under pressure under pressure
☐ Hyperbaric operations ☐ Decompression
(diving) (diving)
☐ E/M radiation: high
Radiation ☐ Ultraviolet ☐ Infrared ☐ Microwaves ☐ Lasers
voltage AC cables
☐ Alpha, beta, open ☐ Gamma rays, open ☐ Naturally occurring ☐ Alpha, beta, closed ☐ Gamma rays, closed
source source ionizing radiation source source
☐ Hand-arm vibration ☐ Whole body vibration ☐ Lighting ☐ Workstations ☐ Work planning issues
☐ Long and irregular ☒ Manual materials ☐ Cold stress (low ☐ Heat stress (high ☐ Incompatible hand
Human Factors
working hours/shifts handling ambient temperatures) ambient temperatures) controls
☐ Awkward location of ☐ Mismatch of work to ☐ Mismatch of work to ☐ Poor organization and ☐ Indoor climate (too
workplace & machinery physical abilities cognitive abilities job design hot / cold / dry / humid)
☐ Medical unfitness ☐ Motion sickness ☐ Post-traumatic stress ☐ Fatigue ☐ Shift work
Weather
☐ High Wind:
☐ Rains ☐ Sea state/currents ☐ Tectonic
……………….
HAZARD IDENTIFICATION AND RISK ASSESSMENT PROFORMA:
HAZARD IDENTIFICATION INITIAL RISK EVALUATION CONTROL MEASURES ACTION RESIDUAL RISK (R)
JOB STEPS
Hazard Hazard Hazard Likelihoo
Hazard Description Likelihood Risk Rating List all Controls Required SPA Sign Off Risk Rating
Effect Severity Severity d
List the main task steps Describe all hazards Type of From From matrix, Classify risk Describe fully all controls applicable for each hazard Name / Signature From matrix, From Classify risk
required to complete the identified for each task effect (i.e. matrix, identify rating from according to Hierarchy of controls. Title of of SPA identify matrix, rating from
job/work detailed in Task (from Hazard Screening injury, identify likelihood matrix for All controls must be valid in that they reduce person when severity with identify matrix for
Description Checklist) damage or severity with no each hazard severity, likelihood or both Use Hierarchy of Control who will controls controls in likelihood each hazard
environme with no controls in HoC (L1, L2, L3, L4, L5, L6) put the are ready place for with
ntal controls in place for If PPE is used as a control, it must be specifically controls in each hazard controls in
impact) place for each hazard described place place for
each each
hazard hazard
1-Manual handling - Ensure that the pickup APM
Transport the 2-imapct with the
scaffolding material pickup Injury C 1 4 inspected and approved from E 1 2
inside the plant 3-falling objects HSE dept.
- safe position and good manual APM
handling as per UGDC- P-85
-secure the scaffold material APM
1-Manual handling through the transportation
2-imapct with the
Offloading the
pickup Injury C 1 4 - Good supervision.(‫)المراقبة الجيدة‬ Proces E 1 2
scaffolding material 3-falling objects - Competent persons. (‫)الكفاءة‬ s
-Use suitable gloves & goggle
and all mandatory PPE. APM
 -all scaffold materials used APM
should be same specification
Only to be used on firm, stable
level ground APM
-scaffold inspector shall be
develop scaffold design before APM
use
-HSE ensure that all scaffolders
are competent APM
-make a restricted area around APM
the workplace by warning tape
-Not overloaded APM
-APM HSE full supervision all
time APM
1-Wrong material
2-Unstable -secure the scaffold material
foundation through the erection to avoid UGDC
3-Improperly design any dropped object.
4-Improper erection
5-Overloading -make a restricted area around
Injury
Erect the scaffold 6-Hit by machinery
/Death
B 4 10 the workplace by warning tape E 4 7
7-Excessive
winds/rain
-Avail mean of communication APM
8-falling objects (walky-talky ) APM
9-Falling from -Rescue plan in place and Anchor
height
point if needed
-Watch the weather condition
and stop the work if heavy rains
or the wind speed over 20 knots.
-Working platform properly
fitted with guard rail and toe
board
- Good supervision.(‫)المراقبة الجيدة‬
-Use suitable gloves &safety
Harness and all mandatory PPE.
-All hand tools and safety
harness to be inspected by APM
HSE and approved from UGDC
HSE

REVIEW AND APPROVAL TO PROCEED

Assessment Completed By:
Name Position Signature Company Date
HITRA TL UGDCO
Performing Authority UGDCO
HSE Representative UGDCO
Area Authority / Affected UGDCO

LIKELIHOOD
SEVERITY 1 2 3 4 5
RESIDUAL RISK Required Approval Name Signature Date
A 6 8 10 11 12
B 5 7 9 10 11 ☐ White Area Authority (AA)
C 4 6 8 9 10 ☒ Turquoise Plant Manager/Delegated
D 3 5 7 8 9 ☐ Dark Blue Operations GM
E 2 4 6 7 8 ☐ Purple & B+ Activity Not Allowed