RISK / IMPACT ASSESSMENT

CONTROL SHEET
Contract No.  
Project Title  
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 16, then corrective actions
People/Equipment/Production       needs to be taken by concerned persons with documentary evidence
provided in conjunction with WI HSE 09
Health Safety Loss & Environmental Impact
    Probability
    OH&S Environmental     1 2 3 4 5

1-3 Immediate Very High - VH Fatal / Permanent disability Major Incident 1 1 2 3 4 5

High - H Serious injury / illness Serious Incident 2 2 4 6 8 10

Severity
4-9 Before task commences
10-16 Before task commences 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
           
   
    Fill in & enclosed herewith WI HSE 069
   
   
Approved by:
Verified by:
Client
Project Manager:
Name: ________________________ Signature: ______________ Date / /
________________________ Signature: ______________ Date / /

Construction Manager/Site Agent: Consultant Approval:

________________________ Signature: ______________ Date / / Name: ________________________ Signature: ______________ Date / /

Distribution: Original to Site HSE File Cc: HSE Department

Page 1 of 3 WI HSE 001/ OCT 2007

 RISK / IMPACT ASSESSMENT
CONTROL SHEET

Scope / Activity: Bulk Earth Works

Rating (see Rating (see Sign.

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

Hazard is anything with potential to Risk is the harm resulting from

OH&S E OH&S E OH&S E OH&S E
cause harm or loss. the hazard.
   
Foreman to make sure that
bulks earthwork area is out
Large plant not able to stop of bounds for unauthorised
1. in time. Operator not seeing Injury – possibly fatal. persons.    
employees.
Foreman to control ad
monitor regularly.
All employees to be
inducted in this rule.
Not being visible to
2. Injury- possibly fatal.            
operators.
Foreman to enforce the
use of reflector vests.
Supervisor to induct all
employees and operators
regarding work procedures
Operators not being aware
and positions of plant and
of employees. Operator not
3. Injury- possibly fatal. people on site.            
able to stop the machine in
time.
Foreman to control all
movements of people and
plant on site.
All employees to be
inducted not to cross
Operator not able to stop haulage roads.
4. Injury- possibly fatal.            
the plant in time.
Supervisor to enforce this
rule.
5. Unsafe act or condition not Injury or damage to            
being rectified in time. property. Employees to be inducted
to report unsafe act or
conditions to supervisors.

Supervisor to act on
Page 2 of 3 WI HSE 001/ OCT 2007
 RISK / IMPACT ASSESSMENT
CONTROL SHEET
reporting.
Scope / Activity: Bulk Earth Works

Rating (see Rating (see Sign.

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

Hazard is anything with potential to Risk is the harm resulting from

OH&S E OH&S E OH&S E OH&S E
cause harm or loss. the hazard.
   
Employees to be inducted
not to cross or enter traffic
ways unless it is under
6. Hit by oncoming traffic. Injury- possibly fatal. controlled condition.  

Supervisor to enforce this

rule.

Page 3 of 3 WI HSE 001/ OCT 2007