Classified as MARAFIQ Internal Use

MARAFIQ –SAUR OPERATION & Document ID No: MaSa- QHSE-SF-067 B

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SAFETY PROCEDURE – RISK ASSESSMENT Date of Issue:30-04-2017

DYNAMIC RISK ASSESSMENT FORM

SECTION 1-MASA Department / Contractor: - Date:

Authorized Permit Receiver Name: Discipline:

Facility / Assessment Team

Job Location : Specify Activity to be assessed :- Signature
Department: Member
1
2
3
Reviewed By -MaSa / Marafiq Coordinating Reviewed By - MaSa QHSE Dept. Safety Approved By (MaSa O & M Manager/Supt.):
Department Engineer: Section
Name: Signature
Name: Signature: Name: Signature: Date: Time:
Date: Time: Date: Time:

POTENTIAL SEVERITY /
SR JOB STEPS HAZARD CONTROL MEASURE
CONSEQUENCES (What can be done to prevent it from going wrong?)
(What can cause harm?) (What can go wrong to who?)

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MASA. Only document with stamps are considered official.
Classified as MARAFIQ Internal Use

MARAFIQ –SAUR OPERATION & Document ID No: MaSa- QHSE-SF-067 B

MAINTENANCE COMPANY Page
Rev. No.: 1
SAFETY PROCEDURE – RISK ASSESSMENT Date of Issue:30-04-2017

SEVERITY /
CONTROL MEASURE
POTENTIAL HAZARD CONSEQUENCES
SR JOB STEPS (What can be done to prevent it from going
(What can cause harm?) (What can go wrong to
wrong?)
who?)
 Inadequate preparation /
failure to properly  Safe Work Permit shall be posted at
communicate to all involved work site while job is in progress.
personnel.
 Survey work area and address safe
 Failure to obtain approved
work method, hazards and
work permit.
precautions.
 JSA must be followed and to be
explained to all employees during
 Vehicle movement / failure.
Site Preparation: TBT prior to start of activities and it
Mobilize personnel, must be made available at the site.
materials, equipment,  All equipment and vehicles shall be
1 Moderate to Severe
vehicles and on-site  Slips, Trips and Falls. inspected and approved before use on
communications to the site.
task site.  Ensure job area must be free from
unnecessary materials and debris that
 Pinch Points.
may affect or obstruct work
execution.
 Fire Extinguishers must be present on
 Fatigue.
all vehicles.
 All Staff to wear High Visibility vests
 Personal Injury. so that they can be seen by vehicles or
other manned equipment.

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MASA. Only document with stamps are considered official.
Classified as MARAFIQ Internal Use

MARAFIQ –SAUR OPERATION & Document ID No: MaSa- QHSE-SF-067 B

MAINTENANCE COMPANY Page
Rev. No.: 1
SAFETY PROCEDURE – RISK ASSESSMENT Date of Issue:30-04-2017

SEVERITY /
CONTROL MEASURE
POTENTIAL HAZARD CONSEQUENCES
SR JOB STEPS (What can be done to prevent it from going
(What can cause harm?) (What can go wrong to
wrong?)
who?)
 Personnel shall be made aware
through TBT and Training on the
 Access to facilities
risks in the area to avoid slips, trips
and falls.
 Adequate plans to bring supply of
 Availability of water and food water and food to site to ensure
sufficient daily supply.

 Provision of first aid kit on site.

 ·Ensure that First Aid training is

 Slips, trips, falls, strain current, and encourage tetanus
Walking around the boosters.
worksite, Carrying  ·Ensure that environmental hazards
equipment, Loading & training is completed for field hazards
 Insect/animal born disease
2 Offloading samples, Minor to Severe including snake and other animal
equipment and other hazards
items from truck,  ·Use wheelbarrow or hand cart
vehicles etc., wherever possible.
 Employ proper ergonomics and lifting
techniques.

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MASA. Only document with stamps are considered official.
Classified as MARAFIQ Internal Use

MARAFIQ –SAUR OPERATION & Document ID No: MaSa- QHSE-SF-067 B

MAINTENANCE COMPANY Page
Rev. No.: 1
SAFETY PROCEDURE – RISK ASSESSMENT Date of Issue:30-04-2017

SEVERITY /
CONTROL MEASURE
POTENTIAL HAZARD CONSEQUENCES
SR JOB STEPS (What can be done to prevent it from going
(What can cause harm?) (What can go wrong to
wrong?)
who?)

 Perform quick vehicle inspection for

obvious items such as tire inflation,
 Vehicle collision/accident
windshield wipers, and sufficient fuel
to get to destination.
 Ensure routine vehicle checks are
 Unauthorized driving
done and are documented.
 Ensure the driver possess valid Saudi
Driving license and completed
defensive driving training.

3 Driving at worksite Severe  ·Do not use cell phones when driving.
 ·Follow posted speed limits.
 ·Reduce the speed in poor weather
condition such as foggy, sand storm
and rainy.
 ·Always use turn signals while
turning.
 ·Make sure all lamps are in working
order before each trip.
 ·Always wear seat belts.
 ·All vehicles must be equipped with a
first aid kit

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MASA. Only document with stamps are considered official.
Classified as MARAFIQ Internal Use

MARAFIQ –SAUR OPERATION & Document ID No: MaSa- QHSE-SF-067 B

MAINTENANCE COMPANY Page
Rev. No.: 1
SAFETY PROCEDURE – RISK ASSESSMENT Date of Issue:30-04-2017

SEVERITY /
CONTROL MEASURE
POTENTIAL HAZARD CONSEQUENCES
SR JOB STEPS (What can be done to prevent it from going
(What can cause harm?) (What can go wrong to
wrong?)
who?)

 ·All vehicles must be equipped with a

fire extinguisher.

 ·If weather has changed since leaving

the office or previous site, ensure that
 ·Poor weather conditions
proper precautions are taken before
beginning site work.

 ·Monitor lightning detectors and stop

 ·Wind borne contaminants work when alarm alerts closer than 20
miles.
 Obtain wind direction information
 Physical contact hazards
4 Working at site Moderate to Severe and identify “upwind” on site map.
 ·Dehydration  Be alert of fire conditions.
 ·Minimize flammables in and near
 Fire hazards
vehicle and work area.
 ·Ensure sufficient drinking water is
available at worksite for all
employees

 Always wear required PPE

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MASA. Only document with stamps are considered official.
Classified as MARAFIQ Internal Use

MARAFIQ –SAUR OPERATION & Document ID No: MaSa- QHSE-SF-067 B

MAINTENANCE COMPANY Page
Rev. No.: 1
SAFETY PROCEDURE – RISK ASSESSMENT Date of Issue:30-04-2017

SEVERITY /
CONTROL MEASURE
POTENTIAL HAZARD CONSEQUENCES
SR JOB STEPS (What can be done to prevent it from going
(What can cause harm?) (What can go wrong to
wrong?)
who?)
Drilling of Boreholes
 Assess the ground condition before
 Physical injuries.
setting up the drilling rig
 Ensure the ground surface is leveled
 Unlevelled ground surface.
for setting up the rig
 Unauthorized operations / rig  Authorized employees shall operate
moves the rigs
 Collision with equipment or  Proper tools and equipment shall be
Setting up the drilling
5 existing objects Moderate to Severe used at site.
rig
 Identify locations by survey  Ensure the rig is not set upped close
prior to setup electrical transmission lines

 Ensure the truck driver /driller is

guided by a banks man/assistant
driller while reversing

 ·Ensure good housekeeping is

 Slip, Trips, and Fall
maintained at worksite
Assembling,
 Being struck by or caught
disassembling and
6 between tubular and other Moderate to Severe  Take precaution when lifting pipes
transferring drilling
objects during movement.
rods.
 Physical injuries from poor  Stand clear of suspended and moving
handling tools. loads

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MASA. Only document with stamps are considered official.
Classified as MARAFIQ Internal Use

MARAFIQ –SAUR OPERATION & Document ID No: MaSa- QHSE-SF-067 B

MAINTENANCE COMPANY Page
Rev. No.: 1
SAFETY PROCEDURE – RISK ASSESSMENT Date of Issue:30-04-2017

SEVERITY /
CONTROL MEASURE
POTENTIAL HAZARD CONSEQUENCES
SR JOB STEPS (What can be done to prevent it from going
(What can cause harm?) (What can go wrong to
wrong?)
who?)
 Ensure proper lifting techniques are
adopted.
 Wear required PPE
 Ensure the fluid spills are cleared
 Slip , Trips, and Falls
immediately.
 physical injury caused by  Wear appropriate PPE including eye
contact with skins or eyes and face
Preparing drilling fluid  Protection
7 Moderate
(Bentonite)  MSDS Bentonite

 Mixing chemicals in steel mud pit to

avoid spillage and aid removal.
Strictly no mixing on ground surface.
 Strain and sprains during
operation
8 Drilling Operation  Lifting or controlling Moderate  Use proper lifting technique
movement of drill collars, bit
breaker, pipe and tongs

 Pinching fingers or other body

Preparing to break out  Implement effective , safe work
9 parts between slip handles and
Moderate
pipe procedures for using slips and tongs
rotary tables

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MASA. Only document with stamps are considered official.
Classified as MARAFIQ Internal Use

MARAFIQ –SAUR OPERATION & Document ID No: MaSa- QHSE-SF-067 B

MAINTENANCE COMPANY Page
Rev. No.: 1
SAFETY PROCEDURE – RISK ASSESSMENT Date of Issue:30-04-2017

SEVERITY /
CONTROL MEASURE
POTENTIAL HAZARD CONSEQUENCES
SR JOB STEPS (What can be done to prevent it from going
(What can cause harm?) (What can go wrong to
wrong?)
who?)
Excavation of Test Pits
 Dust arising while excavation
 Pre-excavation checklist
pits
 Continuous monitoring at job site,
 Fall into pits
safety briefing prior start of work.

 Use of shovel spade for excavation.

 Dermatitis No Mechanical means of excavation
encouraged.
Excavation of pits 1.5-
10 Moderate
m depth
 Underground utilities  Proper access to excavation (steps)
 Area should be barricaded, sign
boards posted and warning lights
installed, if left overnight

 Ensure NO underground utilities are

in place.

 Use the buddy system and carry a

cellular phone.
 Lone working leading to
11 Working in isolated areas Moderate  Always be alert.
phobia /injuries
 Never leave partner alone.

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MASA. Only document with stamps are considered official.
Classified as MARAFIQ Internal Use

MARAFIQ –SAUR OPERATION & Document ID No: MaSa- QHSE-SF-067 B

MAINTENANCE COMPANY Page
Rev. No.: 1
SAFETY PROCEDURE – RISK ASSESSMENT Date of Issue:30-04-2017

SEVERITY /
CONTROL MEASURE
POTENTIAL HAZARD CONSEQUENCES
SR JOB STEPS (What can be done to prevent it from going
(What can cause harm?) (What can go wrong to
wrong?)
who?)
Electrical Resistivity Test
 Ensure hand tools are in good
 Physical injury from condition. Damaged tools shall be
Hammering/removing removed from service
12 hammering the Moderate
the electrode
probes/electrodes.
 Brass hammer to be used only

 Trip falls  Lay off the cables in a proper manner.

 Ensure the cables are not shortened or

 Shortening of cables
connected incorrectly
Connecting the cables
13 and obtaining the Moderate
 Authorized person shall operate the
reading  Un calibrated equipment
equipment and record reading.

 Ensure the equipment is calibrated.

 Wear required PPE

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MASA. Only document with stamps are considered official.
Classified as MARAFIQ Internal Use

MARAFIQ –SAUR OPERATION & Document ID No: MaSa- QHSE-SF-067 B

MAINTENANCE COMPANY Page
Rev. No.: 1
SAFETY PROCEDURE – RISK ASSESSMENT Date of Issue:30-04-2017

SECTION 2-List of Materials

(Tools, work equipment, safety and emergency items)
Job should be started only after making provision of suitable and safe tools, work equipment, safety and emergency items on site as stated in
risk assessment.
Sr. Tools and other work equipment Qty. Sr. Safety and Emergency items Qty.

1 Drill Rig & Accessories 1 1 Helmet, Safety Shoe, Glass 1 set for
& Safety Jacket each person
2 Water Tank (Attached with Pickup) 1 2 Barricade tape, Trip tray & 1
other Misc. items
3 Resistivity Meter 1 3
4 4
5 5
6 6
7 7
8 8

9 9
10 10
11
12

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
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Classified as MARAFIQ Internal Use

MARAFIQ –SAUR OPERATION & Document ID No: MaSa- QHSE-SF-067 B

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Rev. No.: 1
SAFETY PROCEDURE – RISK ASSESSMENT Date of Issue:30-04-2017

SECTION 3-Information to Employees

(Details of job, hazards, risks and safety precautions)

Prior to commencement of job, Authorized Permit Receiver / Supervisor must give information on details of job, hazards, risks and safety
precautions to all personnel involved in the job and obtain their signatures on the form to acknowledge the same.

Sr. Name of the employee Profession ID No. Signature of the employee

I am informed of job details, hazards,
risks and safety precautions in order to
perform above job safely.
1 Zafar Iqbal Driller 2236156648
2 Muhammad Sarfaraz Driller 2255844439
3 Malang Jan Site Supervisor 2323807517
4 Muhammad Naseeruddin Helper 2224629564
5 Durga Bahadur Asst. Driller 2376987273
6
7
8
9
10

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MASA. Only document with stamps are considered official.
Classified as MARAFIQ Internal Use

MARAFIQ –SAUR OPERATION & Document ID No :MaSa- QHSE-SF-067 B

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SAFETY PROCEDURE – RISK ASSESSMENT Date of Issue:30-04-2017

FORM GUIDANCE
1.0 Requirements
The Dynamic risk assessment shall be:
i. completed on an approved format – Dynamic Risk Assessment Form (See Appendix 1) by
Authorized Permit Receiver of MaSa Maintenance section, Contractors and others, whoever
intends to carry out non-operational work.
ii. relevant to specific activity and once it is completed and need not be repeated for similar jobs
iii. reviewed and repeated if there are changes in activity or location or method of performing tasks or
work environment
iv. reviewed by:
a) MaSa or Marafiq Coordinating engineer – will ensure all the nonoperation work job steps
are enlisted step by step in sequential order including hazards, risks and control measures
and
b) MaSa Safety Engineer –QHSE Department – will ensure all the nonoperation work job
steps are enlisted in sequential order including hazards, risks and control measures
v. approved by MaSa BUM (Business Unit Manager) or Operations Superintendents – Authorized
Permit Controller and
vi. submitted to API Authorized Permit Issuer MaSa
vii. attached with following supporting documents where required:
a) Copies of “Contractor’s compliance statement” – for contract woks + APR card + IDs or gate
passes & MaSa / Marafiq Safety Induction training attendance sheets of personnel who will be
working on Marafiq plant, properties & premises managed by MaSa O&M..
b) Notification / Statement of project work or proposed action - – for contract woks, tie-ins, etc.
c) Plant outage Request + Excavation request forms with drawings for tie ins
d) Technical service request or approval for changes or modifications or additional electrical
connections to existing systems, etc.
e) Third party certificates of lifting equipment / pressure vessels that will be used – where required
f) Lifting plan for critical lifts
g) Inspection lists of work equipment that will be brought on site +
h) Driving licences / third party certificates / authorizations of operators, scaffold personnel, etc.
2 Responsibility of APR (Authorized Permit Receiver)
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Authorized Permit Receiver of MaSa Maintenance Section / the contractor who is intending to
perform the non-operational work with significant risk shall:
i. complete the risk assessment form Section 1 & 2
ii. attach the required supporting documents as specified in section 4 - vii
iii. get reviewed by MaSa / Marafiq coordinating department (for contractor) and MaSa QHSE
Department Safety Section
iv. get approved by MaSa Business Unit Manager or Superintendent
v. submit to API Authorized Permit Issuer
vi. Apply safety precautions on the site as specified in risk assessment form and the PTWC
(Permit to Work Certificate)
vii. inform the people who will be engaged in non-operational work, of the hazards, risks and
safety precautions to be taken prior to commencement of the job.
viii. Monitor precautions on site

3 Section 1 Details
Details includes following:
a) Name of MaSa Department / contractor – who intends to undertake work activity in MaSa
O&M areas
b) Date – on which it is prepared
c) Facility / Department – Area in which the intended work activity will be performed
d) Job Location – Exact workplace where the intended work activity will be performed
e) Specify Work Activity to be assessed - Actual work
f) Assessment team member – Team comprising of competent personnel from management ,
supervisor and employee intending to undertake work activity
g) Signature – signatures of team members
h) Job steps involved in the work activity –should be listed
i) Potential hazard –should be identified against each job step and recorded
j) Severity / consequences –which are likely to occur should be specified
k) Control measures –to eliminate or reduce the risks associated with identified hazards should
be specified clearly

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MASA. Only document with stamps are considered official.
Classified as MARAFIQ Internal Use

MARAFIQ –SAUR OPERATION & Document ID No: MaSa- QHSE-SF-067 B

MAINTENANCE COMPANY Page
Rev. No.: 1
SAFETY PROCEDURE – RISK ASSESSMENT Date of Issue:30-04-2017

4 Risk Assessment Review and Approval

4.1 MaSa Maintenance Section or the contractor who intends to undertake activity on completion
of Section 1 and 2 of the risk assessment shall:
i. get it reviewed by MaSa / Marafiq coordinating department (for contractor) and MaSa
QHSE Department Safety Section on first page in Section 1 and
ii. further approved by MaSa O&M Business Unit Manager / Superintendent

4.2 MaSa / Marafiq Coordinating department, who is either directly undertaking the activity, or
coordinating with the contractor assigned to undertake the activity, shall review the risk
assessment, give comments accordingly and ensure the following:
i. job steps involved in the work activity – are identified and correctly listed
ii. potential hazard –against each job step is identified and recorded
iii. severity / consequences – likely to occur on exposure are specified
iv. control measures –to eliminate or reduce the risks associated with identified hazards are
specified clearly
v. List of material – All tools , work equipment, safety and emergency items are listed

4.3 MaSa QHSE Department Safety Section shall:-

i. Review the risk assessment against each job step with respect to identified hazards,
severity /consequences, risk control measures and list of material and
ii. suggest any additional risk control measures

4.4 MaSa O&M Manager or Superintendent shall review and approve the risk assessment and
acknowledge the same.

5.0 Section 2 - List of Materials (Tools & Work Equipment)

List of materials should be listed in two columns detailing following:
I) Tools and other work equipment used in conducting the intended activity. Examples include
lifting equipment, pneumatic equipment (air compressor and accessories for abrasive blasting,
painting), scaffolding, welding and gas cutting sets, hand and portable power tools, etc.

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MASA. Only document with stamps are considered official.
Classified as MARAFIQ Internal Use

MARAFIQ –SAUR OPERATION & Document ID No: MaSa- QHSE-SF-067 B

MAINTENANCE COMPANY Page
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SAFETY PROCEDURE – RISK ASSESSMENT Date of Issue:30-04-2017

II) Safety and emergency items used for protection of employees against hazards or mitigating
effects from tolerable residual risks. Examples include:
 Personal protective equipment – helmets, safety shoes, goggles, face shields, full
body harness, respirators, special clothing, etc.
 Emergency items – Emergency rescue arrangement - tripod and winch assembly, fire
fighting equipment, etc.

6.0 Section 3 - Information to Employees

On review and approval of risk assessment, Authorized Permit Receiver / Supervisor of MaSa
department or the contractor intending to perform the activity in MaSa O&M areas, shall:
i. Give information on details of job, hazards, risks and safety precautions to all personnel
involved in the job, and
ii. Acknowledge the same with Name of the employee, Profession, ID No, Signature prior to
obtaining Permit to Work Certificate.

7.0 Submission of Risk Assessment

Prior to obtaining Permit to Work Certificate, MaSa Department or the contractor shall:
i. Ensure that all the control measures identified in the risk assessment and safe method of work
are in place before work commences.
ii. Arrange, inspect and ensure that all tools, work equipment, safety and emergency items are in
a safe working condition before bringing them to the workplace
iii. Ensure personnel who will be performing work are trained and competent to do the job safely
using listed tools, work equipment, safety and emergency items
iv. Submit all copies of risk assessment to operations department / Area owner

8.0 Compliance with the Risk Assessment

Authorized Permit Controller / Authorized Permit Issuer should ensure that: -

PROPRIETARY NOTICE IMPORTANT

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EXCEPT UPON WRITTEN PERMISSION BY MASA. Only document with stamps are considered official.
Classified as MARAFIQ Internal Use

MARAFIQ –SAUR OPERATION & Document ID No: MaSa- QHSE-SF-067 B

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SAFETY PROCEDURE – RISK ASSESSMENT Date of Issue:30-04-2017

i. Risk assessment are obtained for all works that are inherent with significant risks and
repeated whenever there are likely changes in intended work activity / location / work
environment, etc.

ii. The MaSa Department or the contractor,( whoever submits the reviewed and approved risk
assessment) has all specified risk control measures in place prior to issue of Permit to Work
Certificate

iii. Risk control measures specified in risk assessment are in place and utilized while performing
the intended activity.

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MASA. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED
EXCEPT UPON WRITTEN PERMISSION BY MASA. Only document with stamps are considered official.