RISK ASSESSMENT FORM

Vessel: Task Category: Work Activity: Issue Date:

ALL / ENVIRONMENTAL Ballast Exchange August 17
Risk Assessment Conditions Important Instructions Analysis of expressions used to calculate Risk Risk LIKELIHOOD (L)
Work Authorization Work Activity is High Risk:  YES  NO (S) Severity (L) Likelihood Risk Rating Rating 1 2 3 4 5
Work has been authorized  Y N Relevant SMS Sections: 1 Negligible 1 Improbable SxL= RF 1 1 2 3 4 5

SEVERITY (S)
No Fatigue 2 Minor 2 Remote RF Risk 2 2 4 6 8 10
Staff is adequately rested Y N See relevant SMS Sections 3 Significant 3 Possible L Low 3 3 6 9 12 15
Use of proper PPE 4 Critical 4 Likely M Medium 4 4 8 12 16 20
Staff is using proper PPE Y N Relevant SMS Form(s) to be used : 5 Catastrophic 5 Certain H High 5 5 10 15 20 25
Experienced staff How to assess Risk :  Select Severity expression that applies to hazard WITH NO Controls
Relevant Form to be used
Staff has task experience Y N  Select appropriate likelihood with NO Controls  Apply controls and RECALCULATE risk
HAZARD DESCRIPTION Risk Rating Risk Rating
Risk CONTROL MEASURES TO BE TAKEN Risk
No (Assume NO CONTROLS (SxL = RR) (SxL = RR)
L/M/H (To Reduce the Risk and calculate the residual/FINAL Risk Rating) L/M/H
to initially assess risks) S L RR S L RR
Ballast water exchanged Officer in charge, Safety meeting and all departments to be briefed accordingly, exchange method
1 4 3 12 Medium 4 2 8 Medium
method not defined to be determined as reflected in BWMP.
Stability issues not taken into All intact and damage stability requirements to be met as per BWMP, Officer in charge, ballast water
2 4 3 12 Medium 4 1 4 Low
account exchange records.
Vessel's condition not within Sheering forces and bending moments within the limits throughout exchange, ballast exchange
3 4 3 12 Medium 4 1 4 Low
acceptable limits records, loadicator records, Officer in charge.
Slamming and shoshing effect to be considered, propeller immersion and draft forward to be
adverse weather conditions /
4 4 3 12 Medium maintained at all times as described in Vessel's BWMP, exchange should be postponed till weather 4 2 8 Medium
rough seas
improvement.
Which ever the exchange method, flow through, dilution, sequential, ensure proper ventilation of all
Over / under pressure of the
5 4 3 12 Medium tanks from the correct openings, air vent head screens maintenance, checks, Officer in charge, 4 1 4 Low
tanks
BWMP records.
6 Local / national regulations 3 3 9 Medium National requirements to be obtained from BWMP.Relevant information provided prior arrival. 3 1 3 Low
7 Inadequate communication 3 3 9 Medium Safety meeting, planning of work, establish communication (VHF/UHF) Bridge watches. 3 1 3 Low
Excessive Bridge visibility WBMP, Ensure bridge blind sector is less than 500 mtrs or 2 ship's length.
8 3 3 9 Medium 3 1 3 Low
blind sector
9 Ice on deck 4 3 12 Medium In case ice on main deck do not follow Flow Through method. 4 1 4 Low
10

Item Further Actions to control residual risk Action Due Date Completion Date Risk Assessment Review & Approval
Date: Prepared/Reviewed By:

Date: Approved By:

Guidance : To be consulted for every such operation Page 1 of 1