Format: IMS-C-MRD-01-F

Department

xyz

Sl.
No.

Activity

Fictitious

Description of activity in brief, if

necessary. Every activity being
done, or proposed activity or
activity of others effecting the
organisation needs to be
covered.

Condition

quality risk

N/A/E

Existing control on
parameter that
operator applies

abc

Impact

Productivity could be affected

1

Quality opp
Frequency

Once a month
3

Quality risk

Additional measures that

can be taken for quality in
this activity

bcd

Quality opportunity
Impacting

Productivity

Level

Good improvement
4

Safety risk
Quality
opportunity

Safety hazard in
activity with existing
controls

May work at height

Safety risk
Impact

FA could occur

Frequency

Once in a month

Safety opportunity
Safety Risk

Additional safety
measure that can be
taken for safety

CSE

Safety opportunity
Impacting

Safety hazard relevant to minor injury

Action

Effectively communication for

safety hazards
1

Occupation Health risk

Safety
opportunity

Health hazard
presently with
existing controls

bbb

Impact

Medium severity health hazards

Health risk
Frequency

Exposure Less than 2 hrs/day

2

Health Risk

Occupation Health opportunity

Additional measure
that can be taken for
health hazard
aaa

Impacting

low severity health hazard

unity
Action

Reduction in OH hazards

Health opportunity

Environment Risk
Environment aspect
presently with existing
controls
nea

Impact

Pollution involving toxic material

Frequency

Once in few months

Environment
Risk

Additional measures
that can be taken for
environment

Nil

Environment opportunity
Impacting

Pollution involving toxic material

portunity
Action

Effectively communication on Environment

aspects
1

Environment
opportunity

Rating
Overall

30

Significant if
overall rating 25

Significant

Reference control procedure/s

and work instructions