RISK ASSESSMENT FORM

NOTE: THIS DOCUMENT SHOULD BE ATTACHED TO THE METHOD STATEMENT. WHEN APPROVED IT
MUST BE KEPT AT THE WORKING PLACE FOR REFERENCE PURPOSES

PROJECT BIA –Modernization Program

TASK DESCRIPTION Installation of Fire Fighting Pipes in Confined Space

SUBCONTRACTOR Sonmez Metal
LOCATION Project wise
ASSESSMENT NO 069 REVISION NO 00 DATE 29/08/2017

RISK ASSESSMENT TEAM

NAME DESIGNATION SIGNATURE NAME DESIGNATION SIGNATURE

Tajummal Khan SONMEZ HSE Manager

SONMEZ Construction
Cenk Gencal
Manager

APPROVAL
DESIGNATION NAME APPROVED COMMENTS
RISK ASSESSMENT
ORIGINATOR
Tajummal Khan N/A
CONSTRUCTION / DİSCİPLİNE
MANAGER
Serkan Vanizor YES  NO
HSE MANAGER Ufuk EROL YES  NO
PROJECT ENGINEER YES  NO
REQUIRED AND EXISTING CONTROL AVAILABLE ADEQUATE ATTACH TO MS DOCUMENT
MEASURES YES NO YES NO REMARKS

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 RISK ASSESSMENT FORM

METHOD STATEMENT – STEPS OF THE TASK

PROCEDURES (WORK INSTRUCTION, VENDOR
SPECS.)
SPECIAL PERMITS REQUIRED
EQUIPMENT / TOOLS REGISTERS AVAILABLE
TRAINING REQUIRED
COMPETENCY CERTIFICATES REQUIRED

SEVERITY FREQUENCY OF LIKELIHOOD

1 1 2 3 4 5 1 Very Low (once in a year)
LIKELIHOOD

2 2 4 6 8 10 2 Low (once in three months)

3 3 6 9 12 15 3 Medium (once in a month)

4 4 8 12 16 20 4 High (once in a week)

5 5 10 15 20 25 5 Very High (Every day)

1 2 3 4 5 X
SEVERITY Serious (S) (Hospital
OF THE Very Low (VL) (first aid Low (L) (First aid is given, Medium (M) (Hospital Very serious (VS) (death,
treatment is needed, more
is given. Work may be 1 or 2 days of leave is treatment is needed, 3 days loss of limb, occupational
HAZARD carried on) given) leave is given)
than three days of leave is
diseases)
given)
Risk Class = Severity of the Hazard X Frequency of Likelihood
L Low Risk; No need to take emergency action, on-site training

M Medium Risk; Measure shall be taken, on-site training, warning signs, document

H High Risk; Stops the work, emergency measure shall be taken, strict measures, change in work schedule, training

Very High Risk: stops the work immediately, emergency measure shall be taken, inspection of site risks and decreasing the risk class with the new measures to be taken, drafting new work
VH schedule

Risk Analysis Control Measures Residual Risk Additional control

Description of Measures
No Activity Hazards (Hierarchy of Measures; Elimination, Scor
the Risk S L Score S L
Substitution, Engineering Controls, e

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 RISK ASSESSMENT FORM

Administrative Controls, PPE)

 Tidy site; clear defined walkways,
 Suitable and sufficient steps into huts and
kept in good condition,
 Aware of first aid station, site emergency
assembly point, drinking water station, toilet
rest shelter and temporary facilities. Construction
 Drinking water station or water cooler to be Manager /Site
provided. Engineer must
Genaral activity in Slip/Trip and Serious injury,  Periodically breaks in hot weather. ensure the
1 workplace and falls, extreme unconciusness/ 4 3 12 3 1 3 necessary welfare
 Awareness to workers to use plenty of
welfare facilities temprature fainting cooled drinking water and ORS – if required. arrangment.
 Work perform by buddy system (two or
more workers crew). Effective fulltime
 All necessary PPE worn as per project supervision
requirement.
 Adequate illumination (access & task) if any
work to be carried out after sunset.
 Mobilization/demobilization form to be used.
 Work perform by buddy system (two or
more workers crew).
 Drinking water station or water cooler to be
provided.
 Awareness to workers to use/ drink plenty
of cold drinking water and ORS – if required.
extreme  Periodically breaks in hot weather to be
temprature/ heat provided.
5 4 20 4 1 4
Work in Hot stress, lack of unconciusness/  Aware of first aid station, site emergency Pre-task briefing
weather welfare facilities, fainting, death assembly point, drinking water station, toilet to be conducted
2
no supervision, rest shelter and temporary facilities.
working alone  Tool box training to be conducted.
 Air fan and shaded rest place to be
provided.
 Emergency response plan to be
communicated.
5 3 15  Designated route to be determined by 3 1 3
Collision Contractor
3 Conflict between  Adequate traffic management plan
various users.  Back up alarm while reversing heavy

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 RISK ASSESSMENT FORM

Being hit by equipment

Plant movement moving Serious Injury  Trained flagmen
machinery and Property Damage  Follow Client’s guidelines. Toolbox Talk
vehicles. Risk of  Proper signage to be installed, Training
crushing when  Proper lighting will be installed (Ref:
heavy equipment BIA.HSE.PL01-section 26. PLANT AND
is reversing. EQUIPMENT INTEGRITY)
4  While manual lifting of material use proper
handling techniques.
(Manual  Use buddy system to lift the load.
handling)  Keep back straight and mold the knees
Serious injury, while manual lifting the load. Manual Handling
Poor handling Muscular skeletal  Maximum 20 Kg can be allowed to lift Training and Tool
3 3 9 3 1 3
techniques, fall of disease/ back manually. Box Talks
personnel, bone injury,
 Material shall be temporarily stored in
material from property damage
proper packing on flat area over wood
height
spacers to avoid damage
Manual Handling,  Use proper PPEs.
lifting & shifting
 Obtain lifting permit for HIAB truck.
by HIAB truck and
 Conduct pre-task briefing.
fork lifter
(Mechanical  HIAB truck and forklift to be appropriate for
Lifting) loads and situated so they do not over sail
adjacent buildings without necessary
precautions.
Topple of HIAB  Only trained workers to be engaged.
truck or forklift  Radius to be cleared from any movement.
4 3 12  Activity to be carried out according to MS 4 1 4
Collapse onto and Work should be stopped it there is any
buildings & over Serious injury deviation in work methodology.
sailing existing Property damage  Original 3rd party certificates to be verified
structures/public prior to engage any lifting equipment,
areas operator, riggers and all lifting gears. Toolbox Talk
 Daily inspection to be done by operator. Training and
Load droppings  Certified Rigger to be assigned. close monitoring
 Tag lines are used to control the load. by supervisor
Struck by moving  Lifts are not allowed with wind speed in
machinery or fix excess of 10 meter/ second.
object  Exclusion zone with caution signs.

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 RISK ASSESSMENT FORM

 Area shall be barricaded and personnel

entry shall be controlled where pipe or other
material being lifted.
 To be make sure that fire extinguisher is
mounted on the HIAB truck and forklift
 (Ref: BIA.HSE.PR14-Crane & Lifting
Procedure)

 For CSE work;
 BIA.HSE.PR12 Confined Space
Entry Procedure and Attached
Rescue Plan to be followed.
 Confined space permit to be obtained &
gas testing to be conducted.
 Explosive proof light to be provided inside
the tank for illumination.
 Milan rescue device and life line to be
inspected before use.
 Trained entry attendant must be assigned
and all personnel shall sign at in/out log.
Preparation and Work in  All personnel shall enter into confined space
Entry into excavation may wearing the full body harness (FBH).
Confined Space Unconciouseness
cause/ include  Workers shall never entered into tank/ Training,team
Physical Injury,
Fall hazard 4 4 16 Confined space if oxygen level is less than 4 1 4 briefing and
property damage,
Poor access to 19.5 %. Mechanical ventilation will be moniroting
fire,
the tank, oxygen arranged during work inside CSE.
deficiency  Environment test will be done after each 02
5
hours and reading will be recorded.
 Appropriate ladder for entry into confined
space for preparation of scaffolding and gas
testing to be used. Ladder to be secured
from top.
 Control un-authorized entry.
 Only trained operatives to be engaged.
 Proper access to be provided into and
outside the tank.
 Correct tools to be used.
 Work to be done as per approved MS.
 Proper PPE to be worn by workers

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 RISK ASSESSMENT FORM

6  Third party certificate for chain block to be

verified and secured.
 Store/ handle chain block correctly.
 Only trained operative to be engaged.
 Inspect chain block prior to use.
Failure of chain  Pipes shall be resting freely on supports and
block carefully aligned prior to final connection.
Serious Injury,
Fall of load  Check that the bottom hook will reach its Team briefing and
fatality and 5 4 20 4 1 4
Fall of load on lowest point without running the chain fully moniroting
property damage
working crew out.
 All temporary support shall be installed
carefully.
 Area to be cordoned off for unauthorized
Pipe Installation entry.
 Required PPE to be worn.

 Activity to be carried out according to MS

and Work should be stopped it there is any
deviation in work methodology.
 Scissor lift to be inspected by operator, third
party certificate to be verified and secured.
 Area to be barricaded and sign shall be
posted.
 The platform is properly guarded and not
Fall of material
Serious injury or altered/ damaged.
and personnel
fatality  All scaffolding to be erected and dismantled
from height, Pre-task briefing
5 4 20 by only certified scaffolders. 4 1 4
topple of mobile
Property damage  All scaffolding to be inspected by competent
scaffolding and
and certified scaffolding inspector and tag to
scissor lift
be installed.
 FBH must be used and anchored.
 Ensure scaffolding is safe to use prior to
start the work at height.
 All workers must be trained for confined
space entry.
 Don’t stay between pipe and tanks walls
when pipe is lifted.
4 3 12 4 1 4
 Only trained operator to be engaged/

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 RISK ASSESSMENT FORM

assigned.
Power tools  All tools to be inspected and color coded.
(cutter, drill  Area shall be inspected prior to start of
machine) work.
operation for  All flammable and combustible material shall
hangers and be removed from work area.
support cutting Serious Injuries  Suitable fire extinguisher to be placed.
and installation (eye and body),  Site portable electrical tools shall be 110V.
Toolbox Talk
may cause electrocution  All cables kept off the ground or
Training
electric Shock hearing underground to avoid tripping hazard.
Slip trip and fall impairment,  Work at height safety measures shall be
Sharp Edge property damage taken.
Flying objects,  All tools to be disconnected from power
noise, damaged source when not in service/ use.
grinding disk,  Combustible material to be removed and
proper housekeeping to be maintained.
 Suitable PPEs including ear muffs/ plugs
shall be worn by the operatives.
7 Hydrotesting Improper Seious Injury 4 3 12  Inspection and ensure proper connections 4 1 4 Toolbox talk and
(Pressurizing and connection of Water Logging before starting the work. close moniroting
depressurizing) hose and (Soil  Approved hydro testing procedure to be
accessories, Hose Contamination) followed.
rupture, Hose  Secure the hoses with whip checks and
leaks. safety pins
Un calibrated  Use only rated capacity hoses for the job.
pressure  Ensure that only trained and competent
gages/test personnel to arrange/fix the pipeline
manifold. pressure test equipment and instruments.
Defective  Ensure fittings and joints are appropriate for
pressure gage. the pressurization of unit.
Over  Follow the approved hydro testing
pressurizing. procedures/ method statements.
 Ensure the pressure monitoring device is
Spillage and slip installed at weakest portion of the segment
to be hydro-tested.
 Use calibrated pressure gauges.
 Use pressure gauges on its intended
purpose only.
 Monitor the pressure gauge from a safe

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 RISK ASSESSMENT FORM

distance away from the potential source of

high pressure jetting (Such as Flange Joint,
Spade, and Coupling etc.)
 Do not leave the pressurized hose or pump
unattended when the hydro-test is on-going.
 Isolate the equipment from all source of
energy when not in use.
 Pressurized the line maximum up to desired
pressure limit 14 Bars. (Ref. to Method
statement for the subject activity).
 Depressurized system before disconnecting
hoses and removal of any fittings.
 Use rated manifolds with test pressure
certificates
 Keep warning signs and testing area to be
Barricaded.
 Pressurizing to be done slowly and steadily
 Engage competent personnel on the job.
 Pressure fluid shall be drained according to
method statement.

Proper supervision
Slipping and Injury, property and
Wind-up and
8 Tripping, poor damage, air 3 3 9  All loose material to be secured and dispose 3 1 3 implementation of
housekeeping
housekeeping polution on regular basin in approved bins. housekeeping
policy

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 RISK ASSESSMENT FORM

RISK ASSESSMENT COMMUNICATIONS FORM

I, THE UNDERSIGNED HEREBY ACKNOWLEDGE THAT THIS RISK ASSESSMENT HAS BEEN DISCUSSED WITH ME AND THAT I UNDERSTAND THE CONTENTS
AND THE RISKS INVOLVED IN THE TASK TO BE PERFORMED. I HAVE ALSO BEEN INSTRUCTED ON THE SAFE METHODS TO PERFORM THIS TASK.

NAME COMPANY POSITION SIGNATURE

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