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List of processes List all your proccesses to be risk assessed, and name them P1, P2,P3, etc

List all the areas where the process considered takes place. List all activities (name
them A1, A2, etc) from the process and map them to show where they take place.
Matrix activities areas Create one matrix per process.

Risk assess all the activites from process 1, using the references used in the
matrix.
If needed, add lines (rows) but not below the yellow mark. Formulae from columns
H, O, P, Q & R need to be copied in added lines.
Process 1 Create one tab per process.

Copy all risk assessment from the "Process " sheets, and paste ("Paste Special" -
"Values") them on this sheet to have data for the complete site.
Data must be pasted in the first empty row from column B after the columns titles
line (yellow line with red titles).
Then complete the column A by adding the reference of the process that has just
Complete Site been pasted.

Definitions Definitions of the hazards (examples)

LISTS Lists used in the sheets. Should not be modified.


Risk Score Describes the scoring system.
Site : CTCI
List of processes :
P1A1 Manual loading unloading
P2A1 Equipment loading unloading
P3A1 DG Installation
P4A1 Pannel Installaton
P5A1 Conduit Wiring
P6A1 Transformer Installation
P7A1 Cable Tray
P8A1 Light Fixture
P9A1 Fabrication
P10A1 Cable Laying
P11A1 Testing and commissining
P12A1 Housekeeping
P13A1 Scaffold erection
P14A1 Vehicle movement
P15A1 Manual excavation
JSA Date: Reviewed by:

PREPARED BY Approved by:

Type Of Activity: unloading & shifting of material manualy

Category of activity:- cold work

Required/recommended PPEs: Safety shoes, Helmet , Goggles, reflected jackets,ruber coated cotton hand gloves.

Sequence of Basic Job Steps Potential Hazards Recommended Safe Job Procedure What Could Go Wrong Corrective Action

1. HSE induction is provided to workers/persons.


1.'Unskilled
2. All required PPE's are provided to the
untrained/medically unfit
Workers/Persons.
person 1.'medicaly unfit worker leads to 1.induction traing shall be provied
3. Specific signages are displayed at required location of
Mobilization of manpower 2.unaware about site bodily injury. 2.Do
site.
hazards. 2.unskilled worker are working at site. medical check up of every worker
4. Ensure gate pass.
3.alcoholic and drugs.
5. Medical check-up should be done of the workers who
4.Lack of competency.
doing work..
1. Driver have Valid RTO approved driving license.
2.. In company premises vehicle speed limit must be
15Kmph.
3. Signal man with the vehicle will be moving with it
continuously from the start to end point within the
premises.
1.Untrained driver may cause 4. Inspection of vehicle is carried out as per standard
incident that leads to bodily checklist.
1.In company premises vehicle speed
injury. 5. Driver and signal man are given gate pass after
1.Untrained Driver for site condition limit must be 15Kmph.
2.Untrained driver for site ensuring all requisites.
Mobilization and de-mobilization of may cause vehicle damage and 2.Inspection of vehicle as per checklist.
condition may cause vehicle 6. All necessary signages are provided to define the path
material vehicle and parking in defined property damage. 3.Driver have valid license
damage and property of movement considering obstacles of the vehicle.
areas 2. without signal man carried out this 4.Hand brake are applied & wheel
damage. 7. The ground where parking is done will be checked for
activities. chokes to be provided.
3. Roll over compaction and levelled surface.
5.Access free
4.Over speed 8. Proper path is shown to the driver before entering the
5.collision area.
9. Path is well compacted and not uneven.
10. All excavated pits are barricaded.
11. Proper signages are provided.
12. Signal man is moving with the vehicle.
13. Hand brakes are applied and wheel chokes are
provided by the driver.

1.Ensure work permit before start of work activity.


2.Ensure the stacked material in vehicle does not exceed
the vehicle capacity.
3.The vehicle will not be allowed inside the permises
1.Fall of material from vehicle
which is overloaded. 1.Bodily injury due to toppling of
Mobilization and de-mobilization of due to overloading of vehicle
4.The information is passed on to the suppliers not to vehicle during movement and when
material vehicle and parking in defined 2.Fall of person from height
overload the vehicle and the back door will be free from parked.
areas can lead serious bodily injury.
obstructions. 2.Path is not well compacted.
5.use of safety helmet, safety shoes,safety
goggles,reflective jacket,rubber coated cotton hand
gloves, full body harness.
6.Deployment of proper supervision during unloading of
material
1. Ensure work permit before start of work activity.
2. Person deployed are trained for the specific activity.
3. Unloading area to be temporarily isolated.
1.Fall of material from vehicle due to
4. Use of safety helmet,safety shoe,safety goggle and
overloading of vehicle.
reflected jackets at site.
1.Fall of material from vehicle 2.Material are not properly
5. Ladder provided to climb on the vehicle
due to overloading of vehicle handle/gripping before movement.
6. Tool Box Talk is given to persons/workers before start
2.Fall of person from height 3.Worker lift the exceeded load 1.Ensure not more than
Unloading of materials mannuly. of job.
can lead serious bodily injury. during unloading 20kg is lifted by 1person.
7. Lifeline and safety belt is provided if the vehicle
3.Slip trip fall 4.Improper handling of material leads
doesn't have the bordering sides.
to bodily injury ( Cuts and Wounds)
8. Person deployed are trained for the specific activity.
5.Fall of person from height can lead
9. Ensure not more than 20kgs is lifted by 1 person.
serious bodily injury
10. Ensure material are properly handal/Gripping before
movment.
11. Deployment of proper supervision during unloading
work.

1. Ensure work permit before start of work activity.


1. Proper access is provided to climb on the vehicle.
2. Lifeline and safety belt is provided if the vehicle
Shifting of material from vehicle to 1. Fall of person doesn't have the bordering sides. Fall of person from the vehicle can
ground 2. bodily injury 3. Tool Box Talk is given to persons/workers before start lead bodily injury
of job.
4. Task specific training to be done.
5. Deployment of proper supervision during work.
1. Ensure work permit before strat of work activity.
2. Person deployed are trained for the specific activity.
3. There is sufficient gap for movement between 2 stacks
or 2 individual items.
Finger/hand caught Finger/hand caught in between
Stacking of unloaded material 4. Use of safety helmet, reflected jackets, safety shoes
material while stacking
and goggels at site.
5. The area is levelled before stacking.
6. Use of cotton hand gloves during stacking of material.
7. Deployment of proper supervision during work.

1. Maintaining good housekeeping.


2. barricating working area.
3. Use of safety helmet, reflected jackets, safety shoes
and goggels at site.
Slip, trip and fall Hazard can lead to
House keeping 4. Remove all scrap material after work compliance.
minor injury
5. Ensure work permit before start of any work activity.
6. Daily TBT should be conducted before start of work.
7.work permit to be closed after compeltion of the work
activity .
Physical Control Organizational Control Procedure & Training
1 1 3 Yes
2 1.5 3 No
2.5 2 2
3 2.5 1
3

Exposure RATING Severity/Consequence RATING


10 100
6 50
3 25
2 15
1 5
0.5 1

Type of Hazard
*M = Mechanical Hazard:
*CH = Chemical Hazard:
*PH = Physical Hazard
*F = Fire Hazards
*B = Biological Hazard
*S= Special Hazard
*E = Ergonomic Hazards
TYPE OF HAZARD
Hazard Concept Examples
Catching, winding, pulling in Abrasion

Equipment in motion motor


vehicles, forklifts, equipment parts,
etc
Falling Materials or Fall hazards
*M = Mechanical Hazard: products
Friction Slipping hazards
Insufficiently guarded Tripping hazards
machine parts
Parts becoming projectiles

Irritant Chronic nerve or tissue damage


Mutagenic Corrosive
Reactive/Unstable Explosive
*CH = Chemical Hazard:
Reproductive Hazard Sensitizing
Toxic
Carcinogenic
Electrostatic charges Heat
Live electrical parts High pressure
Odor Noise
Parts electrically live when Radiation (ionizing and nonionizing
*PH = Physical Hazard defective sources such as lasers, radio
frequency, microwave, nuclear,
etc.)
Vibration
Cold
Ignition sources (heat, Fuel sources (flammable,
*F = Fire Hazards electrical, etc.) combustible materials)
Animal and insect bites Allergens
Bacteria Cell Cultures
*B = Biological Hazard Blood and plasma products
Parasites
Viruses
Weather Being dependent on other
employee knowledge and skill

*S= Special Hazard


Working in closed or Earthquake
*S= Special Hazard confined spaces or pits
Working with animals Escape and access routes
Working with external air working on unfamiliar worksites
supply
Arrangement of Excessive exertion
manipulation units
Catching, winding pulling in Heavy loads

*E = Ergonomic Hazards eyestrain Suitable seats


Repetitive motion Work surface
Working materials Working clothes or equipment
Working position
SAFETY PRIORITY RISK SCORE.
Is a systematic, standardized approach that places a numeric value to an exposure situation considering the following
factors:
Risk Score = Consequence x Exposure x Probability
In using the formula, the numerical ratings or weights assigned each factor are based upon the judgment and
experience of the investigator making the calculation.

The first element, CONSEQUENCE, is defined as the most severe likely consequences of the accident, From 100
points for a catastrophe down through various degrees of Severity to one (1) point for a minor cut, bruise, or first aid
treatments.

CONSEQUENCES

DEGREE OF SEVERITY OF CONSEQUENCES RATING


A. Catastrophe; numerous fatalities external to site boundaries 100
B. Several fatalities within site boundaries 50
C. Fatality; 25
D. Injury or Illness/Disease leading to permanent disability 15
E. Personal Injury or Illness/Disease leading to lost working time 5
F. Minor cuts, bruises, first aid treatments 1

The second element (factor), EXPOSURE, is defined as the frequency at which the employee is doing the task or
frequency at which he is exposed to the hazard/event. E.g.; access/egress to Office using stairs, Use of a tool to open
packing boxes.
EXPOSURE

THE HAZARD-EVENT OR EMPLOYEE IS EXPOSED, OCCURS; RATING


A. Continuously during the day or repeatedly during more than one hour 10
B. Several times per day 6
C. Once per day 3
D. Once per week or more (but < once per day) 2
E. Once per month or more (but < once per week) 1
F. Once per year or more (but < than once per month) 0.5

The third element (factor), is the PROBABILITY that, once the hazard-event occurs, the complete accident sequence of
events will follow with the timing and coincidence to result in the accident and consequences. This PROBABILITY is
determined by the CONTROLS that are in place, which will influence the likelihood for the incident to happen. E.g. an
operator working at height on a roof has less "chance" (i.e. probability) to have an accident if he is trained and works
according to well enforced safety instructions, and if there are guards on that roof, than if there is no control in place : the
controls determine the probability.

COMBINATION OF PHYSICAL & ORGANIZATIONAL CONTROLS;

PHYSICAL CONTROLS
Criteria Rating
No Control Measure 3
Risk signage (colour coding or pictograms) 2.5
Personal protective equipment (PPE - Emergency Stop) 2
Engineering solution (guards, lights beam curtain, lifting aid, ergonomic design, ) 1

ORGANIZATIONAL CONTROLS
Criteria Rating
No Control Measure 3
Procedure or Training or Audit 2.5
(Procedure & Training) or (Procedure & Audit) or (Training & Audit) 2
Procdure & Training & Audit 1.5
Procedure & Training & Audit & Licensing 1

Matrix of Physical & Organizational Control Scorings


Organizational

Related
3 2.5 2 1.5 1 RANGE Cummins Score
3 9 7.5 6 4.5 3 9 10
Physical

2.5 7.5 6.25 5 3.75 2.5 6 - 7.5 6


2 6 5 4 3 2 4-5 3
1 3 2.5 2 1.5 1 2.5 - 3.75 1
1.5 - 2 0.5
Cummins Methodology Scoring 0-1 0.1
Organizational
3 2.5 2 1.5 1
Physical

3 10 6 6 3 1
2.5 6 6 3 1 1
2 6 3 3 1 0.5
1 1 1 0.5 0.5 0.1
Method Statement
Contract details and Responsibility: (The Supplier executing the work is responsible for carrying out a p
Suppliers On-site Coordinator is responsible to ensure that the Supplier is competent and satisfied with the p
Suppliers On-site Coordinator is required to provide supervision, to the extent necessary, to make sure the Metho
followed and to take immediate corrective action if it is not).

Scope of work: (Provide description of the work)


Identified Hazard and
Job Step
Assessment

Item (What can cause a high degree of


(Break the job down into steps)
harm?)

P1A1 Mobilization of manpower Unskilled worker leads to bodily injury.

Mobilization and de-mobilization of


Untrained driver may cause incident that
P1A2 material vehicle and parking in
leads to Bodlily injury
defined areas

Mobilization and de-mobilization of Untrained Driver for site condition may


P1A2 material vehicle and parking in cause vehicle damage and property
defined areas damage (by toppling)

Mobilization and de-mobilization of


Bodily injury due to toppling of vehicle
P1A3 material vehicle and parking in
during movement and when parked.
defined areas
Fall of material from vehicle due to
P1A3 Loading and unloading - Manually
overloading of vehicle.

Fall of person from height can lead


P1A3 Loading and Unloading - Manually
serious bodily injury

Loading and unloading by Improper handling of material leads to


P1A4
manually bodily injury ( Cuts and Wounds)

Shifting of material from ground to Fall of person from the vehicle can lead
P1A5
vehicle or vehicle to ground bodily injury

Stacking of loaded and unloaded Finger/hand caught in between material


P1A5
material while stacking

Stacking of loaded and unloaded Stacks settlement can lead to collapsing


P1A5
material and have bodily injuy
Stacking of loading and unloading Falling of material from height due to
P1A6
material improper stacking can lead serious injury

Slip, trip and fall Hazard can lead to minor


P1A6 House keeping
injury

Method of work:
If required for a specific site, detail the method of control for any additional hazards. Attach additional pag
insufficient.

Accepted by:____________________
ment
ork is responsible for carrying out a particular action. The
er is competent and satisfied with the procedures listed. The
xtent necessary, to make sure the Method Statement is being

Controls

(What you are going to do to make this step as safe


as possible, include equipment to be used where
appropriate)

1. HSE induction is provided to workers/persons.


2. All required PPE's are provided to the
Workers/Persons.
3. Specific signages are displayed at required location of
site.
4. Ensure gate pass.

1. Driver have Valid RTO approved driving license.


2.. In company premises vehicle speed limit must be
15Kmph.
3. Signal man with the vehicle will be moving with it
continuously from the start to end point within the
premises.
4. Inspection of vehicle is carried out as per standard
checklist.
5. Driver and signal man are given gate pass after
ensuring all requisites.
6. All necessary signages are provided to define the path
of movement considering obstacles of the vehicle.
7. The ground where parking is done will be checked for
compaction and levelled surface.

1. Proper path is shown to the driver before entering the


area.
2. Path is well compacted and not uneven.
3. All excavated pits are barricaded.
4. Proper signages are provided.
5. Signal man is moving with the vehicle.
6. Hand brakes are applied and stoppers are provided by
the driver.
7. REF :- JAK/HSE/MS/14

1. Ensure work permit before start of work activity.


1. Ensure the stacked material in vehicle does not
exceed the vehicle capacity.
2. The vehicle will not be allowed inside the premises
which is overloaded.
3. The information is passed on to the suppliers not to
overload the vehicle and the back door will be free of
obstructions.
4. Use of safety helmet,safety shoe,safety goggle,etc.
5. Deployment of proper supervision during unloading of
material.
6. REF :- JAK/HSE/MS/14
1. Ensure work permit before start of work activity.
2. Person deployed are trained for the specific activity.
3. Unloading area to be temporarily isolated.
4. Use of safety helmet,safety shoe,safety goggle and
reflected jackets at site.
5. Ladder provided to climb on the vehicle
6. Tool Box Talk is given to persons/workers before start
of job.
7. Lifeline and safety belt is provided if the vehicle doesn't
have the bordering sides.
8. Deployment of proper supervision during unloading of
material.

1. Ensure work permit before start of work activity.


2. Person deployed are trained for the specific activity.
3. Use of safety helmet,safety shoe,safety goggle, and
reflected jacket at site.
4. Tool Box Talk is given to persons/workers before start
of job.
5. Ensure not more than 20kgs is lifted by 1 person.
6. Ensure material are properly handal/Gripping before
movment.
7. Deployment of proper supervision during work.

1. Ensure work permit before start of work activity.


1. Proper access is provided to climb on the vehicle.
2. Lifeline and safety belt is provided if the vehicle doesn't
have the bordering sides.
3. Tool Box Talk is given to persons/workers before start
of job.
4. Task specific training to be done.
5. Deployment of proper supervision during work.

1. Ensure work permit before strat of work activity.


2. Person deployed are trained for the specific activity.
3. There is sufficient gap for movement between 2 stacks
or 2 individual items.
4. Use of safety helmet, reflected jackets, safety shoes
and goggels at site.
5. The area is levelled before stacking.
6. Use of cotton hand gloves during stacking of material.
7. Deployment of proper supervision during work.

1. Material is stacked at levelled and compacted surface.


2. Material stacking height no more than 1 meter.
3. There is sufficient gap for movement between 2
successive stacks.
4. Proper barricade is provded for the area.
5. Skilled workers shall be put on the job.
6. Deployment of proper supervision during work.

1. The stacking place is well defined.


2. Keep stacking areas free from obstacles.
3. Only authorized person will enter the stacking area.
4. Stacked area shall be proper barricaded and no one
should enter.
5. Material stacking height no more than 1 meter.
1. Maintaining good housekeeping.
2. barricating working area.
3. Use of safety helmet, reflected jackets, safety shoes
and goggels at site.
4. Remove all scrap material after work compliance.
5. Ensure work permit before start of any work activity.
6. Daily TBT should be conducted before start of work.
7.work permit to be closed after compeltion of the work
activity .

1. Maintaining good housekeeping.


2. barricating working area.
3. Use appopriate PPE.
4. Remove all scrap material after work compliance.
5. Ensure work permit before start of any work activity.
6. Daily TBT should be conducted before start of work.
7.work permit to be closed after compeltion of the work
activity .

ditional hazards. Attach additional pages if space is

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