Power & water utility company for jubail and Yanbu (Marafiq) Document ID No :

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OHSMS Forms Date of issue: 03-06-2018

Attachment 1 RISK ASSESSMENT FORM

SECTION 1-Marafiq Department / Contractor: - Tunisian saoudian projects Date: 03/06/2018
APR (Authorized Permit Receiver) Name: Ali Ben Yahia Discipline: Electrical

Facility / Assessment Team

Job Location : Specify Activity to be assessed :- Signature
Department: Member
Engineering CONNECT THE PLC CONTROL CABLE 1 MALEK ATROUS
department WITH AIR COMPRESSOR
2 Ali Ben Yahia
3 AMROU BEN RJEB
Reviewed By - Marafiq Coordinating Reviewed By – Marafiq OHS Section Approved By (Marafiq Operations Dept):
Department Engineer:
Name: Signature: Name: Signature
Name: Signature: Date: Time: Date: Time:
Date: Time:

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS Only document with stamps are considered official.
EXPRESSLY PROHIBITED EXCEPT UPON WRITTEN PERMISSION BY MASA.
 Power & water utility company for jubail and Yanbu (Marafiq) Document ID No :
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Rev. No.: 0
OHSMS Forms Date of issue: 03-06-2018

POTENTIAL SEVERITY /
SR JOB STEPS HAZARD CONTROL MEASURE
CONSEQUENCES (What can be done to prevent it from going wrong?)
(What can cause harm?) (What can gowrong to who?)
1  All personnel must complete specific site
Induction
 Personnel must wear mandatory PPE on site
 Congestion of
Access to work area working area  Slip, trip and fall  Ensure other contractors working in the area
are aware of work taking place.
 Surroundings  Falling objects
hazards  Be aware of surroundings especially
concerning other contractors performing
overhead work/lifts.
 DO NOT work under overhead work/lifts
 Ensure correct manual handling techniques,
warm up & stretch to avoid strains / sprains.
 Do not carry long or awkward materials on
your own.
 Manual  Review prospective route of access prior to
Transportation and unloading of
handling  Injuries carrying materials to work area with
2 equipment to work area
consideration given to any obstacles / trip or
slip hazards.
 Stick to designated pathways as much as
possible.
 Use gloves to protect hands.
Connection cable between PLC and  Slip, Trip,  Personal injury  Before connection cables; APR shall confirm
PROPRIETARY NOTICE IMPORTANT
THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS Only document with stamps are considered official.
EXPRESSLY PROHIBITED EXCEPT UPON WRITTEN PERMISSION BY MASA.
 Power & water utility company for jubail and Yanbu (Marafiq) Document ID No :
Page 3 of 5
Rev. No.: 0
OHSMS Forms Date of issue: 03-06-2018

Fall & fatality/pinch isolations and all panels must be isolated

Accidents point/slip/trip and from electrical supplier
 Electricity fall or property  LOTO system must insured:
 Live cables damage  Main circuit breaker for compressor panel
 Electric Shock located in MCC shall be shut down and
insulated
 Proper PPEs must be worn as per job
requirement
 Materials must be inspected and approved by
3 air compressor
MASA representative before to be used
 Warning signs must be installed
 Assigned competent supervisor to closely
monitor and supervise the activities during
connection of cables
 Housekeeping must be conserved 100% all
the working duty time and before to leave the
site
 Supervision 100%
 Manual  Sprains and  Use suitable hand gloves
handling of strains, back pain,  Remove all tools and materials
4 heavy and prolapsed  Clean–up the area
Housekeeping after completion materials or (slipped) discs  Remove safety signs
sharp edge  Hand cuts  Equipment/Material properly barricaded in
 Untidy site storage area.
 Untidy site

SECTION 2-List of Materials

PROPRIETARY NOTICE IMPORTANT
THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS Only document with stamps are considered official.
EXPRESSLY PROHIBITED EXCEPT UPON WRITTEN PERMISSION BY MASA.
 Power & water utility company for jubail and Yanbu (Marafiq) Document ID No :
Page 4 of 5
Rev. No.: 0
OHSMS Forms Date of issue: 03-06-2018

(Tools, work equipment, safety and emergency items)

Job should be started only after making provision of suitable and safe tools, work equipment, safety and emergency items on site as stated in
risk assessment.
Sr. Tools and other work equipment Qty Sr. Safety and Emergency items Qty

1 Hand tools 1 PPE (Safety glass, safety shoes, safety 1/per

shoes, reflective vest, leather gloves)
2 2 First aid box 1
3 3 Fire extinguisher 1
4 4 Warning signs
5 5
6 6
7 7

8 8

SECTION 3-Information to Employees

PROPRIETARY NOTICE IMPORTANT
THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS Only document with stamps are considered official.
EXPRESSLY PROHIBITED EXCEPT UPON WRITTEN PERMISSION BY MASA.
 Power & water utility company for jubail and Yanbu (Marafiq) Document ID No :
Page 5 of 5
Rev. No.: 0
OHSMS Forms Date of issue: 03-06-2018

(Details of job, hazards, risks and safety precautions)

Prior to commencement of job, Authorized Permit Receiver / Supervisor must give information on details of job, hazards, risks and safety
precautions to all personnel involved in the job and obtain their signatures on the form to acknowledge the same .

Sr. Name of the employee Profession ID No. Signature of the employee

I am informed of job details, hazards, risks and
safety precautions in order to perform above job
safely.
1
2
3
4
5
6
7
8
9
10

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS Only document with stamps are considered official.
EXPRESSLY PROHIBITED EXCEPT UPON WRITTEN PERMISSION BY MASA.