RISK ASSESSMENT FORM - ‫نــمــوذج تــقييمـ اــلمخاطــــر‬

Date : 1-2-2014 ‫ التاريخ‬: Ref No: 06/CGC/HSE/ RA/29 REV. 0 ‫ رقم المرجع‬:
Project Name : Roads and Infrastructure in Bani Hajer North. Phase 1 & 2 ‫ اسم المشروع‬:

Assessment location : Locations of storm water manholes on site. ‫ موقــع التقييـم‬:

Description of work : In-situ Joint Lamination in manhole systems (Benching and cover slabs) ‫وصـف العمـل‬:

‫الخطــر األولي‬ ‫ الخطــر المتبقي‬RESIDUAL

Hazard / Conditions that could Who Might be Initial Risk RISK
Activity Safety precautions needed to control the Risk to ALARP * Responsible Person
develop hazard Harmed

Consequen

Consequen
Likelihood

Likelihood
SR #

‫معدل الخطر‬

‫معدل الخطر‬
Rating

Rating
Risk

Risk
‫العواقب‬

‫العواقب‬
‫األرحجية‬

‫األرحجية‬
ces

ces
‫ الظروف‬/‫الخطر‬ ‫من قد يتعرض‬ ‫الشخص‬
‫النشاط‬ ‫"اإلحتياطيات الالزمة لضبط الخطر وتقليصه الى الحدود المقبولة عمليا‬
‫التي قد تفاقم وتطور الخطر‬ ‫للخطر‬ ‫المسؤول‬
1 Storing,handling and Lack of knowledge on the Engineer, Refer the MSDS of Epoxy Venyl Ester Resin and Polyster Resin Construction Manager,
application of Epoxy hazards of storing, handling and Supervisor, 4 4 16 (attached herewith). Explain hazards to Supervisor, involved 2 1 2 Site Engineer
Venyl Ester Resin application. workers workers. Take all precautions mentioned in MSDS .
(Crystic VE
671) and Polyster Incompetent supervision Supervisor, 3 4 12 Assign competent supervisor having experience in handling and 1 1 1 Construction Manager,
Resin (Crystic 272 E) Involved workers application of Venyl Ester Resin and Polyster Resin Site Engineer
Untrained workers / store Involved workers, 3 4 12 Select and train concerned workers including store personnel on 2 1 2 Site Engineer,
personnel Store personnel. the storage, handling and application of Venyl Ester Resin and Gen.Foreman,.Store
Polyster Resin as per the MSDS. keeper
Storage - Flammable, Store personnel, 4 4 16 Store below 30°C in closed containers. 2 1 2 Store keeper
Decomposition can lead to release Involved workers
Store in dark away from oxidizing materials.
of irritating gases and vapours.
Ensure no source of ignition at storage place. Ensure No Smoking
Rule. Prevent unauthorised access to storage.
Keeping / Handling at work Store personnel, 3 4 12 Bring only required quantity to work site and keep them protected 2 1 2 Gen.Foreman,Foreman
locations. Involved workers from sunlight .Ensure no source of ignition at locations of
application. Ensure No Smoking Rule.
Spillage - Environmental / Involved Keep containers closed always. Use drip-trays. Avoid spillage /
hygeinic aspects personnel / Others entry into drains, sewers and water courses. Avoid subsoil
in the vicinity penetration.
3 4 12 Keep people away from and upwind of spill / leak. 1 1 1 Gen.Foreman.Foreman
Spillage shall be soaked up with inert absorbant such as sand,
Gather into labelled containers and dispose thru' approved waste
disposal contractor.
*ALARP - As Low As Reasonably Practicable
Assessed by: Aaron Aaloosi Reviewed by : Mr. Radi Shunnar ( Operations Manager) ‫ المراجعة من قبل‬:
Date: 1/2/2014 ‫التاريخ‬: Date: ‫التاريخ‬:
Signature : ‫ التوقيع‬: Signature: ‫ التوقيع‬:
Likelihood / ‫اــإلحتماــلية‬ Severity / ‫اــلشدة‬ Likelihood 4 3 2 1
Remote / ‫مستبعـد‬ Minor /‫طفيف‬ Severity
1 4 16 12 8 4
2 Unlikely / ‫غير مرجح‬ Major /‫اساسي‬ 3 12 9 6 3
HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012 Page 1 of 6
 RISK ASSESSMENT FORM - ‫نــمــوذج تــقييمـ اــلمخاطــــر‬
Date : 1-2-2014 ‫ التاريخ‬: Ref No: 06/CGC/HSE/ RA/29 REV. 0 ‫ رقم المرجع‬:
Project Name : Roads and Infrastructure in Bani Hajer North. Phase 1 & 2 ‫ اسم المشروع‬:

Assessment location : Locations of storm water manholes on site. ‫ موقــع التقييـم‬:

Description of work : In-situ Joint Lamination in manhole systems (Benching and cover slabs) ‫وصـف العمـل‬:

‫الخطــر األولي‬ ‫ الخطــر المتبقي‬RESIDUAL

Hazard / Conditions that could Who Might be Initial Risk RISK
Activity Safety precautions needed to control the Risk to ALARP * Responsible Person
develop hazard Harmed

Consequen

Consequen
Likelihood

Likelihood
SR #

‫معدل الخطر‬

‫معدل الخطر‬
Rating

Rating
Risk

Risk
‫العواقب‬

‫العواقب‬
‫األرحجية‬

‫األرحجية‬
ces

ces
‫ الظروف‬/‫الخطر‬ ‫من قد يتعرض‬ ‫الشخص‬
‫النشاط‬ ‫"اإلحتياطيات الالزمة لضبط الخطر وتقليصه الى الحدود المقبولة عمليا‬
‫التي قد تفاقم وتطور الخطر‬ ‫للخطر‬
3 12 9 ‫المسؤول‬
3 Likely / ‫مرجح‬ Severe / ‫حـاد‬ 2 8 6 4 2
4 Frequent / ‫متكرر‬ Fatality / ‫اــلوفاة‬ 1 4 3 2 1
Storing,handling and Health hazard - Irritating to skin involved workers, 3 4 12 Ensure workers use PVC hand gloves,safety googles, Face shield, 1 1 1 Supervisor,
application of Epoxy and eyes Plastic apron, coverall, safety shoes, helmet. Avoid contact with Involved workers
Venyl Ester Resin skin and eyes.
(Crystic VE 671)
and Polyster Resin Take of contaminated cloth immediately. Report to First aider and
Crystic 272 E get medical attention if irritation persists..
(Contd…)
Health hazard - Inhalation - involved workers 3 4 12 Avoid inhalation of vapour / dust. Use heavy duty dust masks to 1 1 1 Supervisor,Involved
harmful to internal organs / cover nose and mouth. Avoid drinking, eating while handling VE workers
functions. Resin and Polyster resin. Advise involved workers to wash hands
and mouth before eating /drinking.

Unknown of First aid measures involved workers 3 4 12 Explain the First aid measures explained in the MSDS to involved 1 1 1 Gen,Foreman,
workers thru' Tool Box Talk. . Keep MSDS in site clinic, store and First sider /Site Nurse
work place for referring First aid measures

Lack of ventilation where applying Involved workers 3 4 12 VE Resins and Polyster Resins are supposed to be used only in 2 1 2 Gen.Foreman,Foreman
VE Resin and Polyster Resin well ventilated areas as per the MSDS.
Arrange local exhaust ventilation system like exhaust blowers of
suitable evacuation capacity with large dia exhaust hoses wherever
the venilation is not sufficient.
Keep the upstream and down stream manholes open and provide
fresh air supply through them into working manhole.
Handling/ applying Dust hazard 3 4 12 Ensure workers use thick dust masks to cover nose and 1 1 1 Gen.Foreman,Foreman
strand mats mouth ,safety googles,cover all,safetyhelmet,safety shoes.
*ALARP - As Low As Reasonably Practicable
Assessed by: Aaron Aaloosi Reviewed by: Mr. Radi Shunnar ( Operations Manager) ‫ المراجعة من قبل‬:
Date: 1/2/2014 ‫التاريخ‬: Date: ‫التاريخ‬:
Signature : ‫ التوقيع‬: Signature: ‫ التوقيع‬:
Likelihood 1
Likelihood / ‫اــإلحتماــلية‬ Severity / ‫اــلشدة‬ 4 3 2
Severity
1 Remote / ‫مستبعـد‬ Minor /‫طفيف‬ 4 16 12 8 4

HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012 Page 2 of 6

 RISK ASSESSMENT FORM - ‫نــمــوذج تــقييمـ اــلمخاطــــر‬
Date : 1-2-2014 ‫ التاريخ‬: Ref No: 06/CGC/HSE/ RA/29 REV. 0 ‫ رقم المرجع‬:
Project Name : Roads and Infrastructure in Bani Hajer North. Phase 1 & 2 ‫ اسم المشروع‬:

Assessment location : Locations of storm water manholes on site. ‫ موقــع التقييـم‬:

Description of work : In-situ Joint Lamination in manhole systems (Benching and cover slabs) ‫وصـف العمـل‬:

‫الخطــر األولي‬ ‫ الخطــر المتبقي‬RESIDUAL

Hazard / Conditions that could Who Might be Initial Risk RISK
Activity Safety precautions needed to control the Risk to ALARP * Responsible Person
develop hazard Harmed

Consequen

Consequen
Likelihood

Likelihood
SR #

‫معدل الخطر‬

‫معدل الخطر‬
Rating

Rating
Risk

Risk
‫العواقب‬

‫العواقب‬
‫األرحجية‬

‫األرحجية‬
ces

ces
‫ الظروف‬/‫الخطر‬ ‫من قد يتعرض‬ ‫الشخص‬
‫النشاط‬ ‫"اإلحتياطيات الالزمة لضبط الخطر وتقليصه الى الحدود المقبولة عمليا‬
‫التي قد تفاقم وتطور الخطر‬ ‫للخطر‬
4 16 12 8 ‫المسؤول‬
2 Unlikely / ‫غير مرجح‬ Major /‫اـساسي‬ 3 12 9 6 3
3 Likely / ‫مرجح‬ Severe / ‫حـاد‬ 2 8 6 4 2
4 Frequent / ‫متكرر‬ Fatality / ‫اــلوفاة‬ 1 4 3 2 1
2 Works inside deep Lack of monitoring Works inside Monitor the work through PTW system for works inside confined
manholes confined space. space, ensure precautionary measures as per PTW.
Construction Manager,
Worker inside Take gas test,ensure oxygen presence of 21.8 %, no hazardous Site Engineer,
4 4 16 gases. Ensure no wastes,contaminations inside. 3 1 3
manhole Gen.Foreman, Foreman
Conduct pre-task talk on hazards and precautions required. Safety Officer
Ensure full time presence of competent Supervision.
Access and egress Involved workers 3 4 12 Provide safe and seccured access ladder.Ladder should extended 2 1 2 Site Engineer,Supervisor
Lack of Emergency rescue 1 mtr above
Keep ready the groud level.
emergency rescue equipments such as tripod stand
arrangements with pulling equipments. Ensure Self-contained breathing
apparatus available.
Worker going inside should wear safety harness which shall be
attached with the lifeline /pulling rope of rescue pulling equipment.
The life line shall be hold by hole-watch and use for signalling
between him and the worker inside manhole. Construction Manager,
Hole watch person trained on emergency rescue should keep Site Engineer,
Involved workers 4 4 16 3 1 3
watch outside. Maintain personnel Entry- Exit log. Self-contained Gen.Foreman,Foreman
breathing apparatus to be kept ready in place.

Establish a system for communication / signalling between the

worker
Throughinside manhole and
the established the hole-watch
signal, person. of
the safe condition (Signal thru'
the worker
number of pulls onshould
inside manhole lifeline be
& sounds
checkedeach other)
and ensured at frequent
intervals by the hole watch and supervisor
The worker can convey his status to hole watch thru' lifeline.
*ALARP - As Low As Reasonably Practicable
Assessed by: Aaron Aaloosi Reviewed by: Mr. Radi Shunnar ( Operations Manager) ‫ المراجعة من قبل‬:
Date: 1/2/2014 ‫التاريخ‬: Date: ‫التاريخ‬:
Signature : ‫ التوقيع‬: Signature: ‫ التوقيع‬:
Likelihood
HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012 Page 3 of 6
Severity
 RISK ASSESSMENT FORM - ‫نــمــوذج تــقييمـ اــلمخاطــــر‬
Date : 1-2-2014 ‫ التاريخ‬: Ref No: 06/CGC/HSE/ RA/29 REV. 0 ‫ رقم المرجع‬:
Project Name : Roads and Infrastructure in Bani Hajer North. Phase 1 & 2 ‫ اسم المشروع‬:

Assessment location : Locations of storm water manholes on site. ‫ موقــع التقييـم‬:

Description of work : In-situ Joint Lamination in manhole systems (Benching and cover slabs) ‫وصـف العمـل‬:

‫الخطــر األولي‬ ‫ الخطــر المتبقي‬RESIDUAL

Hazard / Conditions that could Who Might be Initial Risk RISK
Activity Safety precautions needed to control the Risk to ALARP * Responsible Person
develop hazard Harmed

Consequen

Consequen
Likelihood

Likelihood
SR #

‫معدل الخطر‬

‫معدل الخطر‬
Rating

Rating
Risk

Risk
‫العواقب‬

‫العواقب‬
‫األرحجية‬

‫األرحجية‬
ces

ces
‫ الظروف‬/‫الخطر‬ ‫من قد يتعرض‬ ‫الشخص‬
‫النشاط‬ ‫"اإلحتياطيات الالزمة لضبط الخطر وتقليصه الى الحدود المقبولة عمليا‬
‫التي قد تفاقم وتطور الخطر‬ ‫للخطر‬ ‫المسؤول‬
Likelihood / ‫اــإلحتماــلية‬ Severity / ‫اــلشدة‬ Likelihood 4 3 2 1
1 Remote / ‫مستبعـد‬ Minor /‫طفيف‬ Severity
4 16 12 8 4
2 Unlikely / ‫غير مرجح‬ Major /‫اساسي‬ 3 12 9 6 3
3 Likely / ‫مرجح‬ Severe / ‫حـاد‬ 2 8 6 4 2
4 Frequent / ‫متكرر‬ Fatality / ‫اــلوفاة‬ 1 4 3 2 1
Lamination Works Assigning untrained workers to Only workers trained for working inside confined spaces and on
inside deep work inside confined space.(inside Worker going using of self contained / air-supplied breathing apparatus shall to Site Engineer,
manholes. (contd..) manhole) 4 4 16 work inside the manhole. Explain him the hazards and to give 3 1 3
inside manhole. Gen.Foreman,Foreman
signal to hole watch on suffering any abnormality.
Lack of air flow / ventilation inside Worker inside 3 4 12 Keep Open the the nearest manholes at upstream and down 2 1 2 Site Engineer,
the manhole manhole stream of the manhole in which work is to be done. Gen.Foreman,Foreman.
Provide Air supply through the upstream / down stream manholes
using air blowers. Provide air supply into the bottom of working
manhole at normal pressure, if sufficient air circulation is not
available.

Substandard mounting / unsafe 3 4 12 Air-blowers and air-compressor should be kept on level surfaces 3 1 3 Site Engineer,
condition of air blower, air and safe distance away from the edges of manhole. Gen.Foreman.Foreman.
compressor and air-hose
Ensure safe operating condition of air compressor and
blower.Ensure whip arrestor at air hose end connection
Air hose line inserted into bottom of manhole should be secured
well.It should not obstruct the manhole entrance.
Air supply into manhole is to be provided at a minor/normal
pressure only, monitored thru' control valve referring pressure
guage by an assigned person.
Lack of lighting inside manhole- Provide enough light inside the manhole using intrinsically safe / Site Engineer,
Poor visibilty to do work , Injuries worker inside spark proof lighting at 24 volt.The lighting should be well fixed Gen.Foreman,Foreman
3 4 12 inside manhole against undesired hanging / movement and 2 1 2
manhole
interference with worker.
*ALARP - As Low As Reasonably Practicable
Assessed by: Aaron Aaloosi (HSE Manager) Reviewed by : Mr. Radi Shunnar ( Operations Manager) ‫ المراجعة من قبل‬:
Date: 1/2/2014 ‫التاريخ‬: Date: ‫التاريخ‬:
HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012 Page 4 of 6
 RISK ASSESSMENT FORM - ‫نــمــوذج تــقييمـ اــلمخاطــــر‬
Date : 1-2-2014 ‫ التاريخ‬: Ref No: 06/CGC/HSE/ RA/29 REV. 0 ‫ رقم المرجع‬:
Project Name : Roads and Infrastructure in Bani Hajer North. Phase 1 & 2 ‫ اسم المشروع‬:

Assessment location : Locations of storm water manholes on site. ‫ موقــع التقييـم‬:

Description of work : In-situ Joint Lamination in manhole systems (Benching and cover slabs) ‫وصـف العمـل‬:

‫الخطــر األولي‬ ‫ الخطــر المتبقي‬RESIDUAL

Hazard / Conditions that could Who Might be Initial Risk RISK
Activity Safety precautions needed to control the Risk to ALARP * Responsible Person
develop hazard Harmed

Consequen

Consequen
Likelihood

Likelihood
SR #

‫معدل الخطر‬

‫معدل الخطر‬
Rating

Rating
Risk

Risk
‫العواقب‬

‫العواقب‬
‫األرحجية‬

‫األرحجية‬
ces

ces
‫ الظروف‬/‫الخطر‬ ‫من قد يتعرض‬ ‫الشخص‬
‫النشاط‬ ‫"اإلحتياطيات الالزمة لضبط الخطر وتقليصه الى الحدود المقبولة عمليا‬
‫التي قد تفاقم وتطور الخطر‬ ‫للخطر‬ ‫المسؤول‬

Signature : ‫ التوقيع‬: Signature: ‫ التوقيع‬:

Likelihood / ‫اــإلحتماــلية‬ Severity / ‫اــلشدة‬ Likelihood 4 3 2 1
1 Remote / ‫مستبعـد‬ Minor /‫طفيف‬ Severity
4
4 16 12 8
2 Unlikely / ‫غير مرجح‬ Major /‫اساسي‬ 3 12 9 6 3
3 Likely / ‫مرجح‬ Severe / ‫حـاد‬ 2 8 6 4 2
4 Frequent / ‫متكرر‬ Fatality / ‫اــلوفاة‬ 1 4 3 2 1
Lamination Works Possibility of accumulation of Worker inside 4 3 12 Use exhaust blowers to evacuate the vapour that may accumulate 3 1 3 Site Engineer,
inside deep vapours of Epoxy Venyl Ester manhole inside manhole while applying mortar and paint. Gen.Foreman,Foreman..
manholes. (contd..) Resin and Polyster Resin while
applying them on manhole internal Take gas test frequently to ensure safe conditions inside.
surfaces. Ensure rotation of workers to minimise duration of exposure.
If accumulation of epoxy vapour observed during work , the worker
should be called out immediately. Resume work only after ensuring
full evacuation of vapour and ensuring safe conditions by taking
gas test.
Using breathing apparatus to work Involved workers 4 4 16 Work using breathing apparatus should be done only if it is a must 3 1 3 Site Engineer,
inside manhole. to complete the initiated task due to technical reasons. Gen.Foreman,Foreman..
Duration of work using self contained breathing apparatus should
be limited to 20% less than than the time prescribed for using the
air cylinder by the supplier. Ensure the worker is well- trained on
using breathing apparatus.
Safe condition of the worker should be ensured frequently by hole-
watch through the signalling system (thru' lifeline) established
between the hole watch and the worker inside.
Rescue equipments ( Tripod stand with pulley / lifting equipment)
should be kept ready with the life line attached to it to lift / rescue
the person in case of emergency. Competent supervisor and
persons trained on rescue operation should be present on site
during the work.

*ALARP - As Low As Reasonably Practicable

Assessed by: Aaron Aaloosi (HSE Manager) Reviewed by : Mr. Radi Shunnar ( Operations Manager) ‫ المراجعة من قبل‬:
Date: : 1/2/2014 ‫التاريخ‬: Date: ‫التاريخ‬:
HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012 Page 5 of 6
 RISK ASSESSMENT FORM - ‫نــمــوذج تــقييمـ اــلمخاطــــر‬
Date : 1-2-2014 ‫ التاريخ‬: Ref No: 06/CGC/HSE/ RA/29 REV. 0 ‫ رقم المرجع‬:
Project Name : Roads and Infrastructure in Bani Hajer North. Phase 1 & 2 ‫ اسم المشروع‬:

Assessment location : Locations of storm water manholes on site. ‫ موقــع التقييـم‬:

Description of work : In-situ Joint Lamination in manhole systems (Benching and cover slabs) ‫وصـف العمـل‬:

‫الخطــر األولي‬ ‫ الخطــر المتبقي‬RESIDUAL

Hazard / Conditions that could Who Might be Initial Risk RISK
Activity Safety precautions needed to control the Risk to ALARP * Responsible Person
develop hazard Harmed

Consequen

Consequen
Likelihood

Likelihood
SR #

‫معدل الخطر‬

‫معدل الخطر‬
Rating

Rating
Risk

Risk
‫العواقب‬

‫العواقب‬
‫األرحجية‬

‫األرحجية‬
ces

ces
‫ الظروف‬/‫الخطر‬ ‫من قد يتعرض‬ ‫الشخص‬
‫النشاط‬ ‫"اإلحتياطيات الالزمة لضبط الخطر وتقليصه الى الحدود المقبولة عمليا‬
‫التي قد تفاقم وتطور الخطر‬ ‫للخطر‬ ‫المسؤول‬
Signature : ‫ التوقيع‬: Signature: ‫ التوقيع‬:
Likelihood / ‫اــإلحتماــلية‬ Severity / ‫اــلشدة‬
1 Remote / ‫مستبعـد‬ Minor /‫طفيف‬
Likelihood 4 3 2 1
Severity
2 Unlikely / ‫غير مرجح‬ Major /‫اساسي‬ 4 16 12 8 4
3 12 9 6 3
3 Likely / ‫مرجح‬ Severe / ‫حـاد‬
2 8 6 4 2
4 Frequent / ‫متكرر‬ Fatality / ‫اــلوفاة‬ 1 4 3 2 1
Working inside Continuos work inside by a single Workers who work 3 4 12 Provide rotation between trained workers to work inside the 2 1 2 Site Engineer,
manhole (contd..) worker - Fatigue,Heat stress etc. inside manhole manhole;so that they get intervals for rest,coming out to open air to Gen.Foreman,Foreman.
cool down their body and to breathe fresh air . Ensure washing
water and drinking water at work place
3 Power supply for Substandard mounting of Ensure generator is mounted on level ground at safe distance from
lighting inside Generator on site / it's Unsafe manhole entrance,safe and secured cables, spark proof switches.
manhole and water condition - Interruption of lighting Use industrial connectors.
pump. inside manhole / power supply, Site Engineer,
overturning of generator, Involved workers 3 4 12 Cable to manhole should be fixed with clamp so that it will not 2 1 2
interfere with workers manhole entrance and inside. Gen.Foreman,Foreman
damages, Injuries.
Ensure presence of electrician at work location to ensure
interrupted lighting inside manhole and electrical safety.
4 Grinding works to Generation of spark / fore inside Grinding work shall be done thru' hotwork permit only. Take gas
abrade the surfaces manhole test and ensure no flammable gases present inside the manhole. Site Engineer,
for lamination Involved workers 4 4 16 Check whether grinding shall be replaced with abrading using rough 3 1 3
Gen.Foreman,Foreman.
emery paper.
Unsafe grinder machine Ensure the grinder have safety guard, proper grinding wheels.
Involved workers 3 4 12 1 1 1 Gen.Foreman, Foreman

Evacuate dust from manhole by exhaust blower.

Ensure the worker use dust mask, safety googles, face cover, Site Engineer,
Dust emission, Heat stress Involved workers 3 4 12 helmet,disposable cover all, helmet and safety shoes. 1 1 1
Gen.Foreman,Foreman.
Rotate workers to prevent continuos exposure to dust / stress
*ALARP - As Low As Reasonably Practicable
Assessed by: Aaron Aaloosi (HSE Manager) Reviewed by : Mr. Radi Shunnar ( Operations Manager) ‫ المراجعة من قبل‬:
Date: 1/2/2014 ‫التاريخ‬: Date: ‫التاريخ‬:
HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012 Page 6 of 6
 RISK ASSESSMENT FORM - ‫نــمــوذج تــقييمـ اــلمخاطــــر‬
Date : 1-2-2014 ‫ التاريخ‬: Ref No: 06/CGC/HSE/ RA/29 REV. 0 ‫ رقم المرجع‬:
Project Name : Roads and Infrastructure in Bani Hajer North. Phase 1 & 2 ‫ اسم المشروع‬:

Assessment location : Locations of storm water manholes on site. ‫ موقــع التقييـم‬:

Description of work : In-situ Joint Lamination in manhole systems (Benching and cover slabs) ‫وصـف العمـل‬:

‫الخطــر األولي‬ ‫ الخطــر المتبقي‬RESIDUAL

Hazard / Conditions that could Who Might be Initial Risk RISK
Activity Safety precautions needed to control the Risk to ALARP * Responsible Person
develop hazard Harmed
Consequen

Consequen
Likelihood

Likelihood
SR #

‫معدل الخطر‬

‫معدل الخطر‬
Rating

Rating
Risk

Risk
‫العواقب‬

‫العواقب‬
‫األرحجية‬

‫األرحجية‬
ces

ces
‫ الظروف‬/‫الخطر‬ ‫من قد يتعرض‬ ‫الشخص‬
‫النشاط‬ ‫"اإلحتياطيات الالزمة لضبط الخطر وتقليصه الى الحدود المقبولة عمليا‬
‫التي قد تفاقم وتطور الخطر‬ ‫للخطر‬ ‫المسؤول‬
Signature : ‫ التوقيع‬: Signature: ‫ التوقيع‬:
Likelihood / ‫اــإلحتماــلية‬ Severity / ‫اــلشدة‬ Likelihood 4 3 2 1
1 Remote / ‫مستبعـد‬ Minor /‫طفيف‬ Severity
4 16 12 8 4
2 Unlikely / ‫غير مرجح‬ Major /‫اساسي‬ 3 12 9 6 3
3 Likely / ‫مرجح‬ Severe / ‫حـاد‬ 2 8 6 4 2
4 Frequent / ‫متكرر‬ Fatality / ‫اــلوفاة‬ 1 4 3 2 1

HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012 Page 7 of 6

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HSEF 4.3.1-01-01 Issue: 1 Rev: 2 Issue Date: 20 Mar 2012 Page 8 of 6