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Occupational Safety and Health Division 18 Havelock Road #03-02 Singapore 059764 Tel: 64385122 www.mom.gov.sg mom_oshd@mom.gov.

sg

Activity-based Risk Assessment Form


This form may take you 30 minutes to complete. You will need the following information to fill in the form: Process Flow Chart

RISK ASSESSMENT FORM ACTIVITY-BASED RISK ASSESSMENT INVENTORY OF WORK ACTIVITIES


Company: Tricaftan Environmental Technology Pte Ltd No. Process/Location Tricaftan Office 1.
working in Office 1) Open desk ,file drawer, door, bookcases and other objects at office 2) Moving the desk, bookcases or other furniture. 3) Work station ergonomics (Typing, filing, telephone calls, writing etc 4) Indoor air quality in office 5) Lighting inside the office 6) Using of electrical equipments in office 7) Using of toilet and pantry at office 8) Emergency preparedness for working at office

Work Activities

Instructions on how to use Activity-Based Risk Assessment Form can be found in Guidelines on Risk Assessment

RISK ASSESSMENT FORM

RISK ASSESSMENT FORM


Company

Tricaftan Environmental Technology Pte Ltd RA FOR WORKING IN OFFICE

RA Leader

Htin Lin Aung Safety Supervisor)

Approved By Name/ Designation

Process/ Activity/ Location Original Assessment Date Last Review Date Next Review Date

RA Member 1

Hla Htoon Phyu (Safety Supervisor)

Mr Khoo Lip Kee-PM (Tricaftan)

RA Member 2

Signature Date

06/06/2013 05/06/2014

RA Member 3 RA Member 4

06/06/2013
4. RESIDUAL RISK
4a. 4b. 4c.

1. HAZARD IDENTIFICATION
1a. 1b. 1c. 1d.

2. RISK EVALUATION
2a. 2b. 2c. 2d. 3a.

3. RISK CONTROL
3b.

Work A c t i v i t y
Open desk ,file drawer, door, bookcases and other objects at office
Possible Accident / Ill Health & Persons-atRisk Existing Risk Control (if any) Action Officer, Designation (Follow-up date)

No.

Hazard

Additional Risk Control

-Trip and fall over due to open drawer -falling objects from wall mounted shelf -Bump or hit by door, desks, filing

Bodily injury to office staffs

1)Pathway must clear before walking 2)Must use small A frame adder for overhead access 3)Not to use chairs for in place of step

1)Do not leave desk, drawer or door in open position 2)Remind to all office staffs

1)Safety personnel 2)office administrator

Instructions on how to use Activity-Based Risk Assessment Form can be found in Guidelines on Risk Assessment

RISK ASSESSMENT FORM


1. HAZARD IDENTIFICATION
1a. 1b. 1c. 1d.

2. RISK EVALUATION
2a. 2b. 2c. 2d. 3a.

3. RISK CONTROL
3b.

4. RESIDUAL RISK
4a. 4b. 4c.

Work A c t i v i t y
Possible Accident / Ill Health & Persons-atRisk Existing Risk Control (if any) Action Officer, Designation (Follow-up date)

No.

Hazard

Additional Risk Control

cabinet

ladders 3)Do not put heavy items on wall mounted shelve.

Moving the desk, bookcases or other furniture.

-Strains & Back injury

Bodily injury to office staff

1)Must get assistance with heavy load 2)Do not lift anything about shoulder height 3)Squat down rather than bending to lift from the floor 4)Never twist when

Must use buddy system when moving office materials

1)Safety personnel 2)office administrator

Instructions on how to use Inventory of Work Activities Form can be found in Guidelines on Risk Assessment http://mom.gov.sg/OSHD/Resources/Guides/Guidelines/index.htm

RISK ASSESSMENT FORM


1. HAZARD IDENTIFICATION
1a. 1b. 1c. 1d.

2. RISK EVALUATION
2a. 2b. 2c. 2d. 3a.

3. RISK CONTROL
3b.

4. RESIDUAL RISK
4a. 4b. 4c.

Work A c t i v i t y
Possible Accident / Ill Health & Persons-atRisk Existing Risk Control (if any) Action Officer, Designation (Follow-up date)

No.

Hazard

Additional Risk Control

lifting 3 Work station ergonomics (Typing, filing, telephone calls, writing etc Eyes, hands, arms, and back injury due to poor furniture design Bodily injury to workers
1)Must be adjust table and chair height to position thighs parallel to floor 2)Ensure chair is properly size to prevent back of the knee from pushing into the front of chair 3)The computer must be comfortable distance from the eyes

M 1)Briefing all staffs about office ergonomics 2)change position frequently, do not cradle the phone when keying, 1)Inspect & clean ventilation components regularly 2)Encourage to

1)Safety personnel 2)office administrator

Indoor air quality in office

-Poor maintenance of ventilation system -Chemical or

-discomfort for work in office -stressful psychological condition

1)Response immediately to any water intrusion & dry the area 2)Maintain good

1)Safety personnel 2)office administrator

Instructions on how to use Inventory of Work Activities Form can be found in Guidelines on Risk Assessment http://mom.gov.sg/OSHD/Resources/Guides/Guidelines/index.htm

RISK ASSESSMENT FORM


1. HAZARD IDENTIFICATION
1a. 1b. 1c. 1d.

2. RISK EVALUATION
2a. 2b. 2c. 2d. 3a.

3. RISK CONTROL
3b.

4. RESIDUAL RISK
4a. 4b. 4c.

Work A c t i v i t y
Possible Accident / Ill Health & Persons-atRisk Existing Risk Control (if any) Action Officer, Designation (Follow-up date)

No.

Hazard

Additional Risk Control

Microbiological contaminants in air

housekeeping 3)Must use cleaning solvents are manufacturers recommendations 4)Must change or clean filter regularly

staffs suffering symptoms to see medical treatment

Lighting inside the office

Vision problem can lead to headaches and other symptoms

Eyes or bodily injury to staffs

1)Minimise direct overhead lighting 2)Must avoid glare from window by using curtains

Must check the computer monitors that do not require high lighting levels

1)Safety personnel 2)office administrator

Instructions on how to use Inventory of Work Activities Form can be found in Guidelines on Risk Assessment http://mom.gov.sg/OSHD/Resources/Guides/Guidelines/index.htm

RISK ASSESSMENT FORM


1. HAZARD IDENTIFICATION
1a. 1b. 1c. 1d.

2. RISK EVALUATION
2a. 2b. 2c. 2d. 3a.

3. RISK CONTROL
3b.

4. RESIDUAL RISK
4a. 4b. 4c.

Work A c t i v i t y
Using of electrical equipments in office
Possible Accident / Ill Health & Persons-atRisk Existing Risk Control (if any) Action Officer, Designation (Follow-up date)

No.

Hazard

Additional Risk Control

-Electrical shock & burn injury to office staff -Trip & fall by electrical cable laying on floor

Serious injury to office staffs

1)Maintain grounding & ground fault circuit interrupters 2)Do not over load outlets 3)Do not twist cords or push tightly against outlets 4)Must check faulty electrical equipment by LEW

1)Not allowed to work on live electrical equipment for cleaning, adjusting or maintaining 2)Inspect regularly for defective equipment

1)Safety personnel 2)office administrator

Instructions on how to use Inventory of Work Activities Form can be found in Guidelines on Risk Assessment http://mom.gov.sg/OSHD/Resources/Guides/Guidelines/index.htm

RISK ASSESSMENT FORM


1. HAZARD IDENTIFICATION
1a. 1b. 1c. 1d.

2. RISK EVALUATION
2a. 2b. 2c. 2d. 3a.

3. RISK CONTROL
3b.

4. RESIDUAL RISK
4a. 4b. 4c.

Work A c t i v i t y
Possible Accident / Ill Health & Persons-atRisk Existing Risk Control (if any) Action Officer, Designation (Follow-up date)

No.

Hazard

Additional Risk Control

Using of toilet and pantry at office

-Slippery floor due to falling hazard -Crack or worn parts cause pinch injury -Falling objects from shelf

Bodily injury to staffs

1)Regularly clean and keep dry the floor 2)Proper ventilation system at toilet 3)Do not put heavy materials on pantry shelf 4) pantry shelf doors must be closed all the time

1)Good housekeeping to prevent falling 2)Must report and repair any defect items

1)Safety personnel 2)office administrator

Emergency preparednes s for working at office

-Fire hazard -Medical emergency

-Bodily injury due to trip and fall at emergency

1)Must be display written emergency plan 2)Must be display emergency contact list 3)Must be aware of fire

All staffs Must be participate in Emergency Drill exercise and

` 1)Safety personnel 2)office administrator

Instructions on how to use Inventory of Work Activities Form can be found in Guidelines on Risk Assessment http://mom.gov.sg/OSHD/Resources/Guides/Guidelines/index.htm

RISK ASSESSMENT FORM


1. HAZARD IDENTIFICATION
1a. 1b. 1c. 1d.

2. RISK EVALUATION
2a. 2b. 2c. 2d. 3a.

3. RISK CONTROL
3b.

4. RESIDUAL RISK
4a. 4b. 4c.

Work A c t i v i t y
Possible Accident / Ill Health & Persons-atRisk Existing Risk Control (if any) Action Officer, Designation (Follow-up date)

No.

Hazard

Additional Risk Control

exit/access way blockage -Panic or shock

alarm and all staffs to understand ERP system 4)Must clear the any blockage from access way 5)Must be use emergency exit and walk to assembly area in case of emergency

held periodically

Risk Matrix to Determine Risk Level

Instructions on how to use Inventory of Work Activities Form can be found in Guidelines on Risk Assessment http://mom.gov.sg/OSHD/Resources/Guides/Guidelines/index.htm

RISK ASSESSMENT FORM


Likelihood Severity Catastrophic (5) Major (4) Moderate (3) Minor (2) Insignificant (1) Rare (1) Medium (M) Medium (M) Low (L) Low (L) Low (L) Unlikely (2) Medium (M Medium (M Medium (M Medium (M Low (L) Possible (3) High (H) Medium (M) Medium (M) Medium (M) Low (L) Likely (4) High (H) High (H) Medium (M) Medium (M) Medium (M) Almost Certain (5) High (H) High (H) High (H) Medium (M) Medium (M)

* Note: S = Severity; L = Likelihood; R = Risk Level

Severity categories and description Level Severity Description 5 Catastrophic Fatality, fatal diseases or multiple major injuries 4 Major Serious injuries or life threatening occupational disease (includes amputation, major fractures, multiple injuries Occupational cancer, acute poisoning 3 Moderate Injury requiring medical treatment or ill-health leading to Disability (includes laceration, burns, sprain, minor fractures Dermatitis, deafness, work-related upper limb disorders). Instructions on how to use Inventory of Work Activities Form can be found in Guidelines on Risk Assessment http://mom.gov.sg/OSHD/Resources/Guides/Guidelines/index.htm

RISK ASSESSMENT FORM


2 1 Minor Insignificant Injury or ill-health requiring first-aid only (includes minor cuts and bruises, irritation , ill-health with temporary discomfort.) Not likely to cause injury or ill-health

Likelihood categories and description Level Likelihoo d 1 Rare 2 Unlikely 3 4 5 Possible Possible or know to occur. Likely Almost Certain Common occurrence Continual or repeating experience Description Not expected to occur but still possible. Not likely to occur under normal circumstances

Acceptability of risk and recommended actions. Risk level Low Risk Risk Acceptabilit y Acceptable Recommendation Action No additional risk Control measures may be needed Frequent review and monitoring of hazards are required to ensure that the risk level assigned is accurate and does not increase over time

Instructions on how to use Inventory of Work Activities Form can be found in Guidelines on Risk Assessment http://mom.gov.sg/OSHD/Resources/Guides/Guidelines/index.htm

RISK ASSESSMENT FORM


Medium Tolerable Risk A careful evaluation of the hazards should be carried out to ensure that the risk level is reduced to as low as reasonable practicable (ALARP) within a define time period. Interim risk control measures such as administrative controls or PPE may be implemented while longer term measure are being established. Management attention is required. High Risk level must be reduced to as least Medium Risk before work commences. There should not be any interim risk control measures. Risk control measure should not be overly dependent on PPE or appliances If practicable, the hazard should be eliminated before work commences Management review is required before work commences.

High Risk

Not acceptable

Instructions on how to use Inventory of Work Activities Form can be found in Guidelines on Risk Assessment http://mom.gov.sg/OSHD/Resources/Guides/Guidelines/index.htm

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