RISK ASSESSMENT CONTROL SHEET

Scope / Activity:

Rating (see Existing Controls Existing Controls Rating (see

No. Aspect / Hazard Impact /Risk enclosed legend Priority enclosed legend Priority Sign.
page for details)
(*) VH,H,M,L (OH&S) (Environmental) page for details)
(*) VH,H,M,L
Resp.
Person
OH&S E OH&S E OH&S E OH&S E

First Gulf Line Road Contracting LLC 2 WI HSE 001/Aug. 2015

 RISK ASSESSMENT CONTROL SHEET

Project title
Contract No.
RA Reference RA/Department/Contract No/000

RA Date
RA Revision No. 00

SEVERITY RATING: MATRIX

Please Note
If the severity rating lies between 1 to 9, then corrective actions
People/Equipment/Production
needs to be taken by concerned persons with documentary
evidence provided
Health Safety loss & Environmental Impact
Probability
OH&S Environmental 1 2 3 4 5
1-3 Immediate (within 1 week) Very High - VH Fatal / Permanent disability Major Incident 1 1 2 3 4 5
4-9 within 1 month High - H Serious injury / illness Serious Incident 2 2 4 6 8 10

Severity
10-16 > 4 weeks Medium - M Moderate injury / Illness Moderate Incident 3 3 6 9 12 15
20-25 Acceptable Low - L Minor injury / Illness Minor Incident 4 4 8 12 16 20
>25 Very Low - VL Slight injury (No lost time). First Aid Case. Slight Incident 5 5 10 15 20 25
Working group Designation Certain or
Very Likely Likely May Happen Unlikely
Imminent

Approved by:

Name: Signature & Date / /

Client Approval:

Name: Signature & Date / /

Distribution: Original to Site HSE File Cc: HSE Department

A Dutco Balfour Beatty LLC Page 01/02 WI HSE 001/Aug. 2006