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    Risk Assessment Form

    Uploaded by

    Raghu Kumar
    This document provides a form for conducting a risk assessment for jobs at the Marafiq-Saur Operations & Maintenance Company (MaSa). The form includes sections to identify the job location and activity, potential hazards and their consequences, control measures, required materials, and a log for communicating the risk assessment details to employees. It must be completed by an assessment team, reviewed by safety and coordinating departments, and approved by management prior to starting the job.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Risk Assessment Form

    Uploaded by

    Raghu Kumar
    667 views5 pages
    This document provides a form for conducting a risk assessment for jobs at the Marafiq-Saur Operations & Maintenance Company (MaSa). The form includes sections to identify the job location and activity, potential hazards and their consequences, control measures, required materials, and a log for communicating the risk assessment details to employees. It must be completed by an assessment team, reviewed by safety and coordinating departments, and approved by management prior to starting the job.

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    This document provides a form for conducting a risk assessment for jobs at the Marafiq-Saur Operations & Maintenance Company (MaSa). The form includes sections to identify the job location and activity, potential hazards and their consequences, control measures, required materials, and a log for communicating the risk assessment details to employees. It must be completed by an assessment team, reviewed by safety and coordinating departments, and approved by management prior to starting the job.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    667 views5 pages

    Risk Assessment Form

    Uploaded by

    Raghu Kumar
    This document provides a form for conducting a risk assessment for jobs at the Marafiq-Saur Operations & Maintenance Company (MaSa). The form includes sections to identify the job location and activity, potential hazards and their consequences, control measures, required materials, and a log for communicating the risk assessment details to employees. It must be completed by an assessment team, reviewed by safety and coordinating departments, and approved by management prior to starting the job.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    You are on page 1of 5

    Document ID No :MaSa- QHSE-SP-08

    Page 1 of 5

    MARAFIQ SAUR OPERATIONS & MAINTENANCE COMPANY


    (MaSa)

    Rev. No.: 1
    Date of issue: 11-08-2012

    SAFETY PROCEDURE RISK ASSESSMENT

    Attachment 1

    Revision Date: 10-08-2015

    RISK ASSESSMENT FORM

    SECTION 1-MASA Department / Contractor: -

    Date:

    APR (Authorized Permit Receiver ) Name:


    Facility /
    Department:

    Job Location :

    Discipline:
    Assessment Team
    Member

    Specify Activity to be assessed :-

    Signature

    1
    2
    3
    Reviewed By -MaSa / Marafiq Coordinating
    Department Engineer:
    Name:
    Date:

    SR

    Signature:
    Time:

    JOB STEPS

    Reviewed By - MaSa QHSE Dept. Safety


    Section
    Name:
    Date:
    POTENTIAL
    HAZARD

    (What can cause harm?)

    Signature:
    Time:

    SEVERITY /
    CONSEQUENCES
    (What can go wrong to who?)

    Approved By (MaSa O & M Manager/Supt.):


    Name:
    Date:

    Signature
    Time:

    CONTROL MEASURE
    (What can be done to prevent it from going wrong?)

    MARAFIQ SAUR OPERATIONS & MAINTENANCE COMPANY


    (MaSa)
    SAFETY PROCEDURE RISK ASSESSMENT

    SR

    SR

    JOB STEPS

    JOB STEPS

    POTENTIAL
    HAZARD

    SEVERITY /
    CONSEQUENCES

    (What can cause harm?)

    (What can go wrong to who?)

    POTENTIAL
    HAZARD

    SEVERITY /
    CONSEQUENCES

    (What can cause harm?)

    (What can go wrong to who?)

    Document ID No :MaSa- QHSE-SP-08


    Page 2 of 5

    Rev. No.: 1
    Date of issue: 11-08-2012
    Revision Date: 10-08-2015

    CONTROL MEASURE
    (What can be done to prevent it from going wrong?)

    CONTROL MEASURE
    (What can be done to prevent it from going wrong?)

    MARAFIQ SAUR OPERATIONS & MAINTENANCE COMPANY


    (MaSa)
    SAFETY PROCEDURE RISK ASSESSMENT

    Document ID No :MaSa- QHSE-SP-08


    Page 3 of 5

    Rev. No.: 1
    Date of issue: 11-08-2012
    Revision Date: 10-08-2015

    SECTION 2-List of Materials


    (Tools, work equipment, safety and emergency items)
    Job should be started only after making provision of suitable and safe tools, work equipment, safety and emergency items on site as stated in
    risk assessment.
    Sr. Tools and other work equipment
    Qty
    Sr. Safety and Emergency items
    Qty

    MARAFIQ SAUR OPERATIONS & MAINTENANCE COMPANY


    (MaSa)

    10

    10

    Rev. No.: 1
    Date of issue: 11-08-2012

    SAFETY PROCEDURE RISK ASSESSMENT

    Document ID No :MaSa- QHSE-SP-08


    Page 4 of 5

    Revision Date: 10-08-2015

    11
    12

    SECTION 3-Information to Employees


    (Details of job, hazards, risks and safety precautions)
    Prior to commencement of job, Authorized Permit Receiver / Supervisor must give information on details of job, hazards, risks and safety
    precautions to all personnel involved in the job and obtain their signatures on the form to acknowledge the same.
    Sr.

    Name of the employee

    Profession

    ID No.

    Signature of the employee


    I am informed of job details, hazards, risks and

    MARAFIQ SAUR OPERATIONS & MAINTENANCE COMPANY


    (MaSa)
    SAFETY PROCEDURE RISK ASSESSMENT

    Document ID No :MaSa- QHSE-SP-08


    Page 5 of 5

    Rev. No.: 1
    Date of issue: 11-08-2012
    Revision Date: 10-08-2015

    safety precautions in order to perform above job


    safely.
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    1.0

    2.0

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