Assessors Name: Assessors signature: Location of Date of Review date:

Method
task/operation being Task Carried assessment: Ongoing
Statement Action by
Sajimon KK assessed: out by? 15 January 09
by When?
Site
Ref No: Rev – 02 – RA – 2009 - Depa Cross reference to N.B. Residual risk:
SSOW/method Other on site The risk left
statement: (Highlight SSOW/Method statement control measures after all control
one below) Ref No: may be required measures have
Page No: due to weather been put in
YES NO M/S 001 conditions/other place – see
Risk Persons at risk reasons at time risk matrix at
severity of footer:
E C P Oth
(before task/operation:
Activity/ Significant ers
controls Control measures Work must not
Operation hazard
are in required: start until the
place) risks have
been assessed:

Fall of High Yes Yes Yes Prior to the Project Site Engineer
 Scaffolding should
31 persons commencement Manager
of the activity be erected only by Supervisor
Construction
competent person.
Mobile Manager Foreman
Platform
Site Manager Charge hand
 All caster wheels
Fall of High Yes Yes Yes should be locked. Project Workers
Materials Engineer
Helpers
 Before moving the HSE Manager
scaffold, all
operatives must
step down.
Collapse of High Yes Yes Yes
Scaffolding
 Use internal access
of scaffolding.

RISK RATING MATRIX 1 E = employees

C = contractors/subcontractors
Likelihood: 5 very likely 4 likely 3 fairly likely 2 unlikely 1 very unlikely P = Public
Severity: 5 catastrophic 4 major 3 moderate 2 minor 1 insignificant QMS – Rev – 02 – RA – 2009
Sajimon KK – January 09
Assessors Name: Assessors signature: Location of Date of Review date:
Method
task/operation being Task Carried assessment: Ongoing
Statement Action by
Sajimon KK assessed: out by? 15 January 09
by When?
Site
Ref No: Rev – 02 – RA – 2009 - Depa Cross reference to N.B. Residual risk:
SSOW/method Other on site The risk left
statement: (Highlight SSOW/Method statement control measures after all control
one below) Ref No: may be required measures have
Page No: due to weather been put in
YES NO M/S 001 conditions/other place – see
Risk Persons at risk reasons at time risk matrix at
severity of footer:
E C P Oth
(before task/operation:
Activity/ Significant ers
controls Control measures Work must not
Operation hazard
are in required: start until the
place) risks have
been assessed:

 Top rails and mid

Injury / High Yes Yes Yes
rails should be in
crush of
fingers place.
during
erection /
dismantling  Regular inspection
of the scaffold.

 No horseplay while
working on the
scaffolds
 Use proper PPE

RISK RATING MATRIX 2 E = employees

C = contractors/subcontractors
Likelihood: 5 very likely 4 likely 3 fairly likely 2 unlikely 1 very unlikely P = Public
Severity: 5 catastrophic 4 major 3 moderate 2 minor 1 insignificant QMS – Rev – 02 – RA – 2009
Sajimon KK – January 09
Assessors Name: Assessors signature: Location of Date of Review date:
Method
task/operation being Task Carried assessment: Ongoing
Statement Action by
Sajimon KK assessed: out by? 15 January 09
by When?
Site
Ref No: Rev – 02 – RA – 2009 - Depa Cross reference to N.B. Residual risk:
SSOW/method Other on site The risk left
statement: (Highlight SSOW/Method statement control measures after all control
one below) Ref No: may be required measures have
Page No: due to weather been put in
YES NO M/S 001 conditions/other place – see
Risk Persons at risk reasons at time risk matrix at
severity of footer:
E C P Oth
(before task/operation:
Activity/ Significant ers
controls Control measures Work must not
Operation hazard
are in required: start until the
place) risks have
been assessed:

RISK RATING MATRIX 3 E = employees

C = contractors/subcontractors
Likelihood: 5 very likely 4 likely 3 fairly likely 2 unlikely 1 very unlikely P = Public
Severity: 5 catastrophic 4 major 3 moderate 2 minor 1 insignificant QMS – Rev – 02 – RA – 2009
Sajimon KK – January 09