Scribd Logo
Upload

Welcome to Scribd!

  • 8 views

    Risk Assessment Form

    Uploaded by

    Luigi Andrew Mercado
    This document presents a risk assessment template for evaluating hazards, risks, controls, and assigning risk levels. It includes tables for documenting hazards and risks, controls, and a risk assessment matrix for determining overall risk. The responsible manager must sign off on the assessment.

    Copyright:

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

    Risk Assessment Form

    Uploaded by

    Luigi Andrew Mercado
    8 views4 pages
    This document presents a risk assessment template for evaluating hazards, risks, controls, and assigning risk levels. It includes tables for documenting hazards and risks, controls, and a risk assessment matrix for determining overall risk. The responsible manager must sign off on the assessment.

    Copyright

    © © All Rights Reserved

    Available Formats

    DOC, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document presents a risk assessment template for evaluating hazards, risks, controls, and assigning risk levels. It includes tables for documenting hazards and risks, controls, and a risk assessment matrix for determining overall risk. The responsible manager must sign off on the assessment.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    8 views4 pages

    Risk Assessment Form

    Uploaded by

    Luigi Andrew Mercado
    This document presents a risk assessment template for evaluating hazards, risks, controls, and assigning risk levels. It includes tables for documenting hazards and risks, controls, and a risk assessment matrix for determining overall risk. The responsible manager must sign off on the assessment.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    You are on page 1of 4

    Corresponding Permit to Work No.

    Risk Assessment

    Risk Assessment of: Ref:


    Assessor(s): Date of Assessment:

    Responsible Manager: Signature Date:

    Description of activity:

    Description of equipment:

    Overall Assessment of Risk (using ISLA LPG Risk Assessment Matrix): High Medium Low
    Action needed: (inc responsible party and close out target)

    Comment (if any):

    Form – Risk Assessment Version 0 Page 1 of 4


    Hazard Analysis Worksheet (For Assessment ref: )
    Hazards & Risks Those at Risk Controls in place Risk Those Responsible Recommendations
    What hazards and risks are What measures are See RAM below
    Who will be affected by the Who is responsible to
    associated with the task? These required to eliminate or for probable
    hazards? Employees and any ensure that these
    must be identified before the job is control the hazards to an consequence and
    others in the area. measures are put in place?
    carried out. acceptable level? likelihood

    Form – Risk Assessment Version 0 Page 2 of 4


    Non exhaustive list of hazard categories

    1. Electricity 10. High Pressure 19. Extremes of temperature 28. Other (specify)
    2. Noise 11. Explosión 20. Confined spaces
    3. Lasers 12. Fire 21. Working environment
    4. Radiation 13. Gas vapour release 22. Manual Handling
    23. Gravity (height or above
    5. Vacuum 14. Toxic chemicals
    excavations)
    6. Legionella 15. Flammable substances 24. Moving vehicles
    7. Wiels disease 16. Hazards to eyes 25. Cleaning devices
    8. Other Biological (specify) 17. Hand tools 26. Slips, Trips & Falls
    9. Psychological hazards 18. Dangerous machinery 27. Environmental impact

    When conducting a risk assessment:

     The assessment should be carried out in good time prior to the relevant decision being made
     When a specific assessment is needed then such an assessment, rather than a generic assessment should be made
     The risk from each activity should be considered
     A team of people or employees with practical knowledge of the process/activity being assessed should be used as appropriate
     Consultants should be used where necessary
     All the hazards associated with a particular activity should be considered
     Hazards and risk controls should be linked
     The results of the assessment should be properly used.

    Form – Risk Assessment Version 0 Page 3 of 4


    Select the realistic worst case outcome Likelihood Categories
    and the likelihood of it happening - A Improbable OR Never Heard of in Industry.
    B Possible OR Heard of in Industry.
    Enter an X in the box
    C Has happened more than once per year in the LPG industry
    D Has happened at the location or more than once per year in the Company
    E Has happened more than once per year at the Location

    POTENTIAL CONSEQUENCE (OUTCOME) LIKELIHOOD OF POTENTIAL


    CONSEQUENCE OCCURING
    Injury or Property Environmental Reputation A B C D E
    Health Effect Damage Damage Damage
    No Health effect No Damage No Effect No Impact
    0
    or injury
    Slight Health Slight <$10K Slight effect Slight - Impact Low
    1
    effect/injury No disruption

    Minor Health Minor $10K - Minor effect Minor/ Limited/


    2
    effect/injury $100K Local impact
    Brief disruption
    Major Health Local $100K- Localised effect Considerable
    3 Med.
    effect/injury $1M impact -
    Partial shutdown
    PTD or 1-3 Major $1M- Major effect Major impact High
    4
    Fatalities $10M
    Partial
    operational loss
    Multiple Extensive Massive effect Massive/
    5
    fatalities >$10M International
    Substantial/total impact -
    loss
    Permanent Total Disability

    Form – Risk Assessment Version 0 Page 4 of 4

    You might also like