NMS 24254259
Neste Singapore Appendix 4
Version 1
LAST MINUTE RISK ASSESSMENT
This form must be referred to during the pre-task meeting at the work site.
The Task Lead must lead the discussion with the Work Group and complete this form.
General Permit to
Location Work No.
Exact Location / Scope of
Equipment No. Work
Date / Time Company
Ensure all boxes are ✔ (YES) before work starts.
If any of the boxes are ⨯ (NO), DO NOT start work. Inform your Superior.
STEP 1: ASSESS
LOTO is placed
☐ Others: _______________________________________________________
THE WORK
High Risk
Low Risk
STEP 2: IDENTIFY
Use of
flammable /
combustible
chemical
☐ Others: _______________________________________________________
_______________________________________________________
Revision 4 (September 2022)
NMS 24254259, Appendix 4, Version 1
THE HAZARDS AND CONSEQUENCES
Chemical
& Toxic
gas
release
Was any flammable /
combustible material
applied?
Take a look around your working environment and the nearby surroundings. Are
there any ADDITIONAL Hazards based on site conditions? ☐ YES ☐ NO
1: _________________________________________________________________________
STEP 3: IDENTIFY
2: _________________________________________________________________________
3: _________________________________________________________________________
4: _________________________________________________________________________
What are the Consequence of the identified Hazards?
Are there any ADDITIONAL Consequences based on the site conditions?
1: _________________________________________________________________________
2: _________________________________________________________________________
3: _________________________________________________________________________
4: _________________________________________________________________________
Revision 4 (September 2022)
NMS 24254259, Appendix 4, Version 1
STEP 4: CONTROLS & A. I have communicated all control measures for this activity to the work group.
By Field Supervisor / Task Lead (tick here):
COMMUNICATE
YES
B. Are there any ADDITIONAL Controls needed for the ADDITIONAL Hazards identified at the
work site?
1: _________________________________________________________________________
2: _________________________________________________________________________
3: _________________________________________________________________________
4: _________________________________________________________________________
COMMENCE
Does the job require manual handling?
(If Yes, complete this section.)
⃞ YES ⃞ NO
The objects to be manually carried are below 25 kg per person. ⃞ YES ⃞ NO
⃞ ⃞
STEP 5: WORK
Mechanical handling equipment is used. YES NO
(If Yes, select the appropriate equipment below)
⃞ Trolley ⃞ Hoist ⃞ Pallet Jack ⃞ Others: _________________________
EMERGENCY situation: Fire, Gas, Leakage or Medical Emergency
EMERGENCY
RESPONSE
1. Immediately stop all work activities
2. Notify direct Supervisor and Neste Host; or
Inform Neste Shift Supervisor / Field Technician; or
Inform Control Room via walkie-talkie Channel 2 or 3; or
Activate nearest Manual Call Point in case of a Fire, Chemical or Gas leak.
3. Move to the nearest safe pre-assembly area and report presence
Revision 4 (September 2022)
NMS 24254259, Appendix 4, Version 1
Declaration:
“We have discussed the activities to be carried out and the associated Hazards and Control
Measures. We understand the importance of maintaining Effective Control Measures to keep us
safe.
We have been orientated in the Risk Assessment(s) (RA) attached to this permit and I understood the
contents. I will report immediately if I observed any risk or lack of safety which have not been assessed
in the RA(s) or in this LMRA.”
Field Supervisor
/ Task Lead: __________________________________ Signature: __________________
Worker: ______________________________________ Signature: __________________
Worker: ______________________________________ Signature: __________________
Worker: ______________________________________ Signature: __________________
Worker: ______________________________________ Signature: __________________
Worker: ______________________________________ Signature: __________________
Worker: ______________________________________ Signature: __________________
Worker: ______________________________________ Signature: __________________
Worker: ______________________________________ Signature: __________________
Worker: ______________________________________ Signature: __________________
Worker: ______________________________________ Signature: __________________
To be completed by the Task Lead after the activity for the day has been completed.
Are there any HSSE Incidents or Near Miss observations to report? YES ⃞ NO ⃞
If Yes, immediately provide details of any incident or near miss to your Superior and Neste
Representative (host).
Name: ___________________________
Signature: ________________________
Date: ____________________________
NOTE: Contractors to attach this form to permit as supporting document during permit closure.
Revision 4 (September 2022)
