SR No:SBTN-HAC-230817-00034 HAZARD ASSESSMENT AND CONTROL FORM
Department/ Unit: PCQ 2 Equipment/Location: TEA DRAIN ASSEMBLY AT UTILIT Issued Date: 08/17/2023 Execution Date: 08/21/2023
Sec-1
Description of the work/Task (Including Method/Equipment/Substances/Limitations): TO INSTALL THE TEA DRAIN PIPE SPOOL ASSEMBLY BY WELDING , FABRICATION , PAINTING AND DPT INSPECTION AT 8 LOCATIONS
Hazard Identification
1. What can go wrong? 2. What can cause it to go wrong?
Slips / Trips / Fall / Strain Noise Radiation Sharp Edges/Manual Handling Excavation Expose to Electrical
Dust / Fumes / Mist Vibration Electrical Shock /Arc Flash/ Static electricity Contact with electric current Nitrogen handling Tools / Equipment involved/Congested area
Fall from height Pressure Movement / Hit by / Caught in between Working at height Start/Stop Machinery Awkward Positions / Static Postures
Section-2
Poor Visibility Heat / Hot Surface Damage to EHSS critical assets. Poor Lighting Lifting activity Contact with Hot Surface
Blind Spot / Shadows Chemical presence Falling Objects/ Flying Objects Mobile Equipment Radiation source Dealing with high pressure
O2 Deficiency / Enrichment Cryogenic Material Heat Stress / Cold stress Contact with Machinery Vehicle Entry Hazardous substance / Source of Ignition
Flammable Material Cut / Pinching Wrong Posture Radiant heat source Release of energy Bypass of EHSS critical devices
Fire / Explosion Other Specify: _________________ Other Specify: _________________ Environmental conditions Other Specify: _________________ Other Specify: _________________
Potential Hazard:
Control Measures
3. What can be done to prevent it? 4. If it does go wrong what can be done to minimize the negative consequences?
Avoid Hand lifting Use of Tested & Certified Tools Physical Guard Rails Report to Clinic Provide Fire Extinguisher / Fire hose Location of Safety Shower / Eyewash
Provide sufficient lights Provide certified lights / flashlights Use of Competent User Stand by ERT Tool Box Talk with Crew members Provide Work instructions
Blinds Installation Check equipment in close proximity Lock out/Tag out (energy isolation) Use of Air horn Fall Arrest/Harness Rotation of workers
Section-3
Provide GFCI / ELCB Provide Machine guards Maintain Housekeeping TLD-Thermoluminescent dosimeter to Determine safe distance from
Provide communication tools
radiographers radioactive source
Remove combustibles / flammable Provide continuous ventilation to
Fire Blanket / curtains / Wet Area
materials worksite Conduct Survey for monitoring
Install of retrieval device Provide warning signage
(radiation area)
Grounding / bonding to avoid static Sound proof barriers to avoid high level
Use of Flagman
electricity Noise Location of Manual call point – MCP Other Specify: _________________ Other Specify: _________________
Area Barricade / Fencing Other Specify: _________________ Other Specify: _________________
Mitigation Plan:
Tools or Equipment to be used: Ensure that all tools & equipment should be checked and inspected before use. YES
Section-4
Hand Tools Generator/Compressor Transmitters Calibration Vibration Monitor Gas Torch Voltage Detector Grit Blaster Crane
Hydraulic Tools Grinder Hydro-jetting machine Electric Tools Other Specify: WELDING MACHINE
Receiver Supervisor (direct/contractor): (Name): Mohammad safwan (Signature): safwanM@sabtank.sabic.com Owner Supervisor : (Name): Mohammed Alomany (Signature): omanymo@sabtank.sabic.com
Section-5
Q: Select One type of work permit required for doing this Task:
Hot Work Permit Electrical Work Permit HP Jetting Work Permit Radiation Work Permit Excavation Work Permit General Work Permit Lifting Work Permit Line Opening Work Permit
Notes:
*Owner Supervisor and Maintenance Supervisor shall discuss Hazard Assessment and Control Form Face to face.
** Tick mark for the related hazardIdentification & Control Measures points, then write applicable points above in section-02 & section-03 (Potential Hazard & Mitigation Plan).
*** Tick ( √ ) for applicable boxes and Tick [-] for not applicable boxes in the permit..
SR No:SBTN-HAC-230817-00034 HAZARD ASSESSMENT AND CONTROL FORM
Section-6 Risk Evaluation Guidelines Table
TOTAL RISK FACTOR SCORE TRANSLATES TO THE WORK CONTROL PERMIT PROCESS AS INDICATED BELOW
• Management Approval required
9-10 Major RISK Permit Issuer and Plant Manager
• Formal Job Safety Analysis
• Hazard assessment & control Form shall be Permit Issuer shall obtain the
attached with work permit. approval from unit manager and
6-8 Significant RISK
• Detailed instructions/job method need to decide on necessity for
• Close supervision and/or support formal JSA
• Hazard assessment & control Form shall be
4-5 MINOR RISK attached with work permit. Permit Issuer
• Detailed instructions/job method Sheet
• Hazard assessment & control Form shall be
0-3 LOW RISK Permit Issuer
attached with work permit.
Q: If Risk is still Not Properly Mitigated after the initial hazard assessment Form (As per Section-06 risk evaluation guidelines); Then Formal JSA is Required Further?
Owner/Unit ManagerName: _______________________ Signature: __________ ( in case of Significant risk)
Section-7 :Re-validation Approval Process Before Issuing Permit
Q: If the activity required to continue for more than One Week: (Re-validation)
Approval by: (Owner/Unit Manager): _______________________ Signature: __________ Approval by: (Maintenance Manager): _______________________ Signature: __________
Note: Max. Validity of the form is 30 days(Form Validity-Date): __________
Permit Issuer Permit Receiver Revalidation additional precautions and Permit Issuer Permit Receiver Revalidation additional precautions and
Date Signature Date Signature comments (if required); Date Signature Date Signature comments (if required);
