HSE Risk Assessment and Control Form

Department /Project: Asset Integrity Risk Assessment by: Basharat Ali Date: 02/08/2017 Verification by: Syed Haider Raza Date: 02/08/2017
Location: Futehally Chemical Ltd Karachi Sign: Sign:
SECTION I: RISK ASSESSMENT Section II: Control Measures

Consequence (C) Likelihood (L) Residual Risk after Control Measures Responsibility
Assessed Risk Planned Actual Reason in case of
Sr. No. Activity Identified Hazard Impact Control Measures Assessed Risk= L Remarks
(L X C) Consequence ( C ) Likelihood (L) Name Target Date Completion Date Delay
xC
Descriptor Rating Descriptor Rating

Proper face mask, gloves are ensured to Avoided by

Ultrasonic Thickness Can react with human
1 Chemicals, Dust & Rust Major 4 Major 4 16 wear be every team member to avoid any 2 2 4 IPL Team Immediate using proper
Monitoring skin upon contact
such incident PPE's

Client will
provide
- Wearing harness -
Ultrasonic Thickness - Improper Scaffolding for Elevated Personal injury/Fracture Owner/Engineer proper
2 Major 4 Major 4 16 Ensure availability of appropriate working 2 1 2 Immediate
Monitoring places (abv 6 ft) /Fatality Operator scafolding
plateform.
where
required

Ultrasonic Thickness Owner/Engineer

3 - Skin contact with couplant Skin allergy Moderate 3 Unlikely 2 6 - Wearing appropriate PPE's 2 1 2 Immediate
Monitoring Operator

Measurement of Consequence Measurement of Likelihood Assessed Risk

Descriptor Rating Description Descriptor Rating Description Level Rating Description

Death, Permanent Disability, Catastrophic Environmental Will certainly occur in most of

Fatal 5 Very Likely 5 Extreme 18-25 Stop the activity, Immediate action Required; notify site supervisor
Incident circumstances

Extensive Injuries with lost time injury > 5 days, Severe Will probably occur in most
Major 4 Likely 4 High 12-18 Immediate action Required; notify site supervisor
Environmental Spillage circumstances

Requires medical treatment with lost time injury 1-5 days,

Moderate 3 Occasionally 3 Might occur at sometime Moderate 6-12 Remedial action required
Moderate Spillage/Emission

Could occur in some

Minor 2 Medical help needed e.g. Outpatient, Minor Spillage Unlikely 2 Low 1-6 Remedial action required to minimize injury, Supervisor attention needed
circumstances

Note: Working above 12 rated residual risk is not acceptable unless otherwise special precautionary measures have been
Incident that don't require serious medical treatment, May occur only in unexceptional taken.
Insignificant 1 Very Unlikely 1
Negligible Environmental Spillage circumstances

Incident that don't require serious medical treatment, May occur only in unexceptional
Insignificant 1 Very Unlikely 1
Negligible Environmental Spillage circumstances

Issue 03, January 2016 Page 1 of 1 Form: HSE/012