Delta Company Ltd.

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Project Name:

  Select Al Maather Al Hazem 69KV Al Waha Hindawiah Murjan Mahjar Al Lieth Bawat Taima Khatam Hail Khuzam

  • Al Maather
  • Al Hazem
  • 69KV
  • Al Waha
  • Hindawiah
  • Murjan
  • Mahjar
  • Al Lieth
  • Bawat
  • Taima
  • Khatam
  • Hail
  • Khuzam

HEALTH SAFETY and ENVIRONMENT REPORT

• Project No.:

• Date

  Date

• Type of Risk Assesment:

  Select Area Process Procedure Person Risk Other

  • Area
  • Process
  • Procedure
  • Person
  • Risk
  • Other

• Type of Risk Assesment:

  Select Area Process Procedure Person Risk Other

  • Area
  • Process
  • Procedure
  • Person
  • Risk
  • Other

• Type of Risk Assesment:

  Select Area Process Procedure Person Risk Other

  • Area
  • Process
  • Procedure
  • Person
  • Risk
  • Other

• Hazard Identification:

  Select INSPECTION FMEA FMECA HAZOP ACC. INV.

  • INSPECTION
  • FMEA
  • FMECA
  • HAZOP
  • ACC. INV.

• What are the hazards (The hazards will mainly effect (incident ))

  Select Machinery People Materials Environment Area Fire/Explosion

  • Machinery
  • People
  • Materials
  • Environment
  • Area
  • Fire/Explosion

• Consequences (outcome)

  All could result in head injuries

• Hazard (Unsafe Act/Unsafe Condition)

  Select 1. Hazardous operations 2. Design and layout of plant 3. Inadvertently coming into contact with live equipment 4. Occupational Hazard and poor handling of tools and equipment

  • 1. Hazardous operations
  • 2. Design and layout of plant
  • 3. Inadvertently coming into contact with live equipment
  • 4. Occupational Hazard and poor handling of tools and equipment

• Deviation (from standard)

  Select 1. Natural hazard due to position of crane 2. Design layout of plant 3. Hazardous operation 4. Design Hazardous work performance

  • 1. Natural hazard due to position of crane
  • 2. Design layout of plant
  • 3. Hazardous operation
  • 4. Design Hazardous work performance

• Cause (Direct/Undirected/Natural)

  Select 1. Natural and plant layout 2. Design and plant layout 3. Design and type of operation 4. Hazardous operations

  • 1. Natural and plant layout
  • 2. Design and plant layout
  • 3. Design and type of operation
  • 4. Hazardous operations

ANALYZE THE RISK

• Probability

  Select Damage Fire Explosion Injury Severe Injury Catastrophe Disaster

  • Damage
  • Fire
  • Explosion
  • Injury
  • Severe Injury
  • Catastrophe
  • Disaster

• Severity

  Select Minor Injury Disabling Injury Lost Time Permanent Disability Multiple Disability Death Multiple Deaths

  • Minor Injury
  • Disabling Injury
  • Lost Time
  • Permanent Disability
  • Multiple Disability
  • Death
  • Multiple Deaths

• Frequency

  Select Anytime Hourly Weekly Monthly Semi Annual Yearly Less Often

  • Anytime
  • Hourly
  • Weekly
  • Monthly
  • Semi Annual
  • Yearly
  • Less Often

RANK THE RISK

• Probability Score

  Select Task 1 Task 2 Task 3 Task 4

  • Task 1
  • Task 2
  • Task 3
  • Task 4

• Severity Score

  Select Task 1 Task 2 Task 3 Task 4

  • Task 1
  • Task 2
  • Task 3
  • Task 4

• Frequency Score

  Select Task 1 Task 2 Task 3 Task 4

  • Task 1
  • Task 2
  • Task 3
  • Task 4

• Frequency Score

  Select Task 1 Task 2 Task 3 Task 4

  • Task 1
  • Task 2
  • Task 3
  • Task 4

• Frequency Score

  Select Task 1 Task 2 Task 3 Task 4

  • Task 1
  • Task 2
  • Task 3
  • Task 4

• Total Risk Ranking

  Select Task 1 Task 2 Task 3 Task 4

  • Task 1
  • Task 2
  • Task 3
  • Task 4

• What observation

  Unsafe Act

  Unsafe Condition

• What Deviation:

• Date of Observation

  Date

• Whose Responsible

  Select Project Engineer Project Manager Site Manager Foreman Safety Officer

  • Project Engineer
  • Project Manager
  • Site Manager
  • Foreman
  • Safety Officer

• Corrective Action/Recommendation

• Target Date

  Date

• Status

  Select Open Close

  • Open
  • Close

• What date of closing

  Date

• Whose Responsible

  Select Project Engineer Project Manager Site Manager Foreman Safety Officer

  • Project Engineer
  • Project Manager
  • Site Manager
  • Foreman
  • Safety Officer

• Corrective Action/Recommendation

• Target Date

  Date

• Status

  Select Open Close

  • Open
  • Close

• What date of closing

  Date

• Toral Risk Index

  Select Task 1 Task 2 Task 3 Task 4

  • Task 1
  • Task 2
  • Task 3
  • Task 4

Signature and Name

• Safety Officer

  Sign

• Name of Safety Officer

  Select Bahar Ali Muhammad Shindarth Khrisnan Abu Thomas Amal Muraly Michael Dave Herrero Bryce Cyril Besinga Darwin Llantada Ryan Cabarlo Allan Rey Rizalde Archie Pulmano Charlie Villanueva Charles Subong Jaafar Lagayan

  • Bahar Ali Muhammad
  • Shindarth Khrisnan
  • Abu Thomas
  • Amal Muraly
  • Michael Dave Herrero
  • Bryce Cyril Besinga
  • Darwin Llantada
  • Ryan Cabarlo
  • Allan Rey Rizalde
  • Archie Pulmano
  • Charlie Villanueva
  • Charles Subong
  • Jaafar Lagayan