RISK / IMPACT ASSESSMENT

CONTROL SHEET
Contract No.
Project Title
RA Reference RA/Department/Contract No/000
RA Date
RA Revision No. 00

SEVERITY RATING: MATRIX

Please Note
If the severity rating lies between 1 to 16, then corrective actions
People/Equipment/Production needs to be taken by concerned persons with documentary evidence
provided in conjunction with WI HSE 09
Health Safety Loss & Environmental Impact
Probability
OH&S Environmental 1 2 3 4 5

1-3 Immediate Very High - VH Fatal / Permanent disability Major Incident 1 1 2 3 4 5

High - H Serious injury / illness Serious Incident 2 2 4 6 8 10

Severity
4-9 Before task commences
10-16 Before task commences Medium - M Moderate injury / Illness Moderate Incident 3 3 6 9 12 15
20-25 Acceptable Low - L Minor injury / Illness Minor Incident 4 4 8 12 16 20
>25 Very Low - VL Slight injury (No lost time). First Aid Case. Slight Incident 5 5 10 15 20 25
Working group Designation Certain or
Very Likely Likely May Happen Unlikely
Imminent

Fill in & enclosed herewith WI HSE 069

Approved by:
Verified by: Client
Project Manager: Name: ________________________ Signature: ______________ Date / /
________________________ Signature: ______________ Date / /
Consultant Approval:
Construction Manager/Site Agent:
Name: ________________________ Signature: ______________ Date / /
________________________ Signature: ______________ Date / /

Distribution: Original to Site HSE File Cc: HSE Department

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 RISK / IMPACT ASSESSMENT
CONTROL SHEET

Scope / Activity: Access Tower

Rating (see Rating (see Sign.

Priority Existing Controls Existing Controls Priority
No. Hazard /Aspect Risk / Impact enclosed legend (*) VH,H,M,L (OH&S) (Environmental)
enclosed legend (*) VH,H,M,L
Resp.
page for details) page for details) Person

Hazard is anything with potential to Risk is the harm resulting from

cause harm or loss. the hazard. OH&S E OH&S E OH&S E OH&S E

Check that the base is

Not having a good base for Injury to worker stable and level
01
access tower to stand on Damage to property Supervisor to check during
erection
Access tower to be strictly
Collapse of access tower if Injury to worker and according to drawings
02 supplied
not properly erected possible fatal
Site agent/Supervisor to
check ongoing basis
Strict supervision at all
Unstable structure may Injury to worker and times
03
collapse possible fatal
Supervisor to control
erection procedure
Provide safety harness;
Injury to worker and Induct workers on work
04 Fall
possible fatal elevated positions
Supervisor to enforce
Workers erecting the tower
Unstable landings might Injury to all parts of to be instructed
05
cause worker to fall body
Supervisor to check all
stages of erection
Weekly inspection and
Section of the tower Injury to workers record registers
06
collapsing Damage to property Supervisor to check all
stages of erection
Items below might increase Injury to all parts of the Daily visual inspections
severity of injuries during body around tower to make sure
07
fall it is kept clean
Supervisor ensure

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 RISK / IMPACT ASSESSMENT
CONTROL SHEET

Page 3 of 3 WI HSE 001/ OCT 2007