Document ID No :MaSa- QHSE-SP-08

Page 1 of 5

MARAFIQ SAUR OPERATIONS & MAINTENANCE COMPANY

(MaSa)

Rev. No.: 1
Date of issue: 11-08-2012

SAFETY PROCEDURE RISK ASSESSMENT

Attachment 1

Revision Date: 10-08-2015

RISK ASSESSMENT FORM

SECTION 1-MASA Department / Contractor: -

Date:

APR (Authorized Permit Receiver ) Name:

Facility /
Department:

Job Location :

Discipline:
Assessment Team
Member

Specify Activity to be assessed :-

Signature

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Reviewed By -MaSa / Marafiq Coordinating
Department Engineer:
Name:
Date:

SR

Signature:
Time:

JOB STEPS

Reviewed By - MaSa QHSE Dept. Safety

Section
Name:
Date:
POTENTIAL
HAZARD

(What can cause harm?)

Signature:
Time:

SEVERITY /
CONSEQUENCES
(What can go wrong to who?)

Approved By (MaSa O & M Manager/Supt.):

Name:
Date:

Signature
Time:

CONTROL MEASURE
(What can be done to prevent it from going wrong?)

MARAFIQ SAUR OPERATIONS & MAINTENANCE COMPANY

(MaSa)
SAFETY PROCEDURE RISK ASSESSMENT

SR

SR

JOB STEPS

JOB STEPS

POTENTIAL
HAZARD

SEVERITY /
CONSEQUENCES

(What can cause harm?)

(What can go wrong to who?)

POTENTIAL
HAZARD

SEVERITY /
CONSEQUENCES

(What can cause harm?)

(What can go wrong to who?)

Document ID No :MaSa- QHSE-SP-08

Page 2 of 5

Rev. No.: 1
Date of issue: 11-08-2012
Revision Date: 10-08-2015

CONTROL MEASURE
(What can be done to prevent it from going wrong?)

CONTROL MEASURE
(What can be done to prevent it from going wrong?)

MARAFIQ SAUR OPERATIONS & MAINTENANCE COMPANY

(MaSa)
SAFETY PROCEDURE RISK ASSESSMENT

Document ID No :MaSa- QHSE-SP-08

Page 3 of 5

Rev. No.: 1
Date of issue: 11-08-2012
Revision Date: 10-08-2015

SECTION 2-List of Materials

(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

MARAFIQ SAUR OPERATIONS & MAINTENANCE COMPANY

(MaSa)

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Rev. No.: 1
Date of issue: 11-08-2012

SAFETY PROCEDURE RISK ASSESSMENT

Document ID No :MaSa- QHSE-SP-08

Page 4 of 5

Revision Date: 10-08-2015

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SECTION 3-Information to Employees

(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

MARAFIQ SAUR OPERATIONS & MAINTENANCE COMPANY

(MaSa)
SAFETY PROCEDURE RISK ASSESSMENT

Document ID No :MaSa- QHSE-SP-08

Page 5 of 5

Rev. No.: 1
Date of issue: 11-08-2012
Revision Date: 10-08-2015

safety precautions in order to perform above job

safely.
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1.0

2.0