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RISK ASSESSMENT FORM

Task/ Activity: Severity


Slight health Minor health Major health PTD or single Multiple
People effect / injury effect / injury effect / injury fatality fatalities
Extensive
Environment Slight effect Minor effect Local effect Major effect
effect
Location: Extensive
Assets/ Reputation Slight damage Minor damage Local damage Major damage
damage
1 2 3 4 5

Date: Likely occurrence/


Happens several times in one location E
Intolerable Risk Probable occurrence/
Riskby:
Completed D

Likelihood
Happens several times in Company
Reduction Measures Credible occurrence/
Checked by: Occurred several times in Company C
Unlikely occurrence/
Occurred at least once in Company B
Line Manager:
Continuous Improvement Rare occurrence/
Heard of in E&P industry A

RISK ADDITIONAL CONTROL RESIDUAL RISK


EVALUATION
NO. HAZARD CONSEQUENCE EXISTING CONTROL ANALYSIS MEASURES (WITH CONTROLS)

S L R S L R
 Forklift certificates & forklift operator
certificate
 Forklift must be free from diesel and
 Injury oil leakage  SAFETY INDUCTION
Forklift  Fire  Spark arrestor & back alarm be
installed  COMPETENT
 Explosion SUPERVISOR
 Driving regulation be implemented 3 D 3D 3 C 3C
 Property  FIRE EXTINGUSHER  REGULAR
damage  Weight capacity be written SWL INSPECTION
 Road be clear from obstruction
 LEL test if the activity inside plant
 Proper PPE

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