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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: - EXPERTISE CONTRACTING CO. Date: 12/27/2020
Authorized Permit Receiver Name: Iqbal Bazaz Discipline: CIVIL WORKS

Facility / Assessment Team

Job Location: Specify Activity to be assessed: Signature
Department: Member
SWC Facilities Canal-1,2&3 Flow Site Survey of Flowmeter
meter Chambers Chambers/Laterals of Canal-1,2 & 3 1 Abdul Kabeer
(Laterals)
2 Iqbal Bazaz
3
4
Reviewed By -MaSa / Marafiq Coordinating Reviewed By - MaSa QHSE Dept. Safety Approved By (MaSa O & M
Department Engineer: Section Manager/Supt.):

Name: Signature: Name: Signature: Name: Signature:

Date: Time: Date: Time: Date: Time:

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

POTENTIAL HAZARD SEVERITY /

SR JOB STEPS CONTROL MEASURE
(What can cause harm?) CONSEQUENCES (What can be done to prevent it from going wrong?)
(What can go wrong to who?)
1. Mobilization and • Accident/Incident Minor and major injury to • The site should be clean and with proper
preparation of due to improper a person and property access for work.
work activities. working practice. damage. • Proper illumination should be provided.
• Proper ventilation systems should be
installed.
• Maintain proper housekeeping.
• Only authorized and competent person
should perform the job.
• Communicate the hazard and their control
measures associated with the activity through
a toolbox talk prior to start of site survey
works.
• All workers should work as per the approved
MOS and according to the Marafiq standards.
• Supervisor to ensure PTWC has been
received prior to start of any activity from the
APR.
• Ensure Strict compliance to Covid 19 Safety
Precautions ie,
1-All person’s temperature to be checked
prior to entering site.
2- Wearing face mask at all times.
3- Maintain safe distance of 1.5 meters from
other person.

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

POTENTIAL HAZARD SEVERITY /

SR JOB STEPS CONTROL MEASURE
(What can cause harm?) CONSEQUENCES (What can be done to prevent it from going wrong?)
(What can go wrong to who?)
4-Use hand sanitizer frequently and wash
hands before touching eyes, nose and face.
2. Entry inside flow • Water • Bone fracture • Ensure all area is free of water and dry prior to
meter chamber accumulation • Physical Injury start of work.
through Access • Working at height • Minor or Major Injury • Provide proper access.
Ladders (Improper access, • Fatality • Use full body harness with 100% tie off to a
poor guard rail • Damage to the property strong anchor point when working at height.
system, in • Slight injury in the • Do not stand on guard rail.
complete plat form) eyes/blindness. • Take proper rest and drink sufficient water,
• Dehydration due to avoid soft drinks and smoking.
high temperature. • Do not allow the work if temperature is high.
• Tripping and • Wear appropriate PPE at all times.eg, Dust
Slipping Hazard masks, Hard Had, Safety gloves, Safety
• Pinch point glasses, safety shoes etc.
• Hydrocarbon dust • Monitor all activity by HSE officer & Supervisor.
• Flying object • Ensure Strict compliance to Covid 19 Safety
Precautions ie,
1-All persons temperature to be checked prior
to entering site.
2- Wearing face mask at all times.
3- Maintain safe distance of 1.5 meters from
other person.
4-Use hand sanitizer frequently and wash
hands before touching eyes, nose and face.
3. Visual • Falling hazard • Physical injury • Follow approved MOS while performing the
inspection & • Tripping hazard • Property damage job.

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

POTENTIAL HAZARD SEVERITY /

SR JOB STEPS CONTROL MEASURE
(What can cause harm?) CONSEQUENCES (What can be done to prevent it from going wrong?)
(What can go wrong to who?)
Linear • Ergonomics hazard • Bone Fracture. • Provide a step ladder for the worker to stand
Measurements • Improper posture, on during taking measurements.
with tape twisting, awkward • Maintain proper housekeeping. All area
position should be clean from unwanted and scattered
material.
• Workers should maintain wearing suitable
PPE at all times.eg, Dust masks, Hard Had,
Safety gloves, Safety glasses, safety shoes
etc.
• Monitor all activity by HSE officer &
Supervisor.
• Ensure Strict compliance to Covid 19 Safety
Precautions ie,
1-All person’s temperature to be checked prior
to entering site.
2- Wearing face mask at all times.
3- Maintain safe distance of 1.5 meters from
other person.
4-Use hand sanitizer frequently and wash
hands before touching eyes, nose and face.

4. Data Collection • Tripping hazard • Minor and Major • APR should ensure that the workers fully
• Ergonomics hazard Injury to a person. understand the area & follow approved MOS.
• Improper posture, • Damage to the • Maintain proper housekeeping. All area
twisting, awkward property. should be clean from unwanted and scattered
position. . material.

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

POTENTIAL HAZARD SEVERITY /

SR JOB STEPS CONTROL MEASURE
(What can cause harm?) CONSEQUENCES (What can be done to prevent it from going wrong?)
(What can go wrong to who?)
• Provide proper platform with proper access.
• Workers should maintain wearing suitable
PPE at all times.eg, Dust masks, Hard Had,
Safety gloves, Safety glasses, safety shoes
etc.
• Execute the Job as per approved MOS.
• Monitor all activity by HSE officer &
Supervisor.
• Ensure Strict compliance to Covid 19 Safety
Precautions ie,
1-All person’s temperature to be checked prior
to entering site.
2- Wearing face mask at all times.
3- Maintain safe distance of 1.5 meters from
other person.
4-Use hand sanitizer frequently and wash
hands before touching eyes, nose and face.
6. House keeping • Tripping Hazard • Minor injury • Maintain proper housekeeping.
• Falling Hazard • Property Damage • APR should make sure that area is cleaned,
• Scattered material and material is removed from laterals before
leaving the site.
• Wear proper PPE.
• Monitor all activity by HSE officer &
Supervisor.
• Ensure Strict compliance to Covid 19 Safety
Precautions ie,

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

POTENTIAL HAZARD SEVERITY /

SR JOB STEPS CONTROL MEASURE
(What can cause harm?) CONSEQUENCES (What can be done to prevent it from going wrong?)
(What can go wrong to who?)
1-All person’s temperature to be checked prior
to entering site.
2- Wearing face mask at all times.
3- Maintain safe distance of 1.5 meters from
other person.
4-Use hand sanitizer frequently and wash
hands before touching eyes, nose and face.

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 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.

Signature of the employee

I am informed of job details,
Sr. Name of the employee Profession ID No. hazards, risks and safety
precautions in order to perform
above job safely.
1 Danish Hamid Project Manager
2 Muzaffar Trag Planning Engineer
3 Izhar Ali Site Supervisor
4 Abdul Kabeer Safety Officer
5 Iqbal Bazaz Civil APR
6 Mohsin Khan Lead Piping Engineer
Project Manager-
7 Ahmed Mujeebuddin
Design Team
Lead Instrumentation
8 Eqbal Ahmad
Engineer
9 Abdul Aziz Draftsman
10 Mohammad Ali Piping Designer
11 Chandan Thakur QA/QC Engineer
12 Shujath Khan Pipe Fabricator
13 Shahbaz Noor Pipe Fitter
14
15

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

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.
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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

2 Responsibility of APR (Authorized Permit Receiver)

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
Rev. No.: 1
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,
firefighting 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

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

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.