Risk Assessment Form – Job Site Review Section

Base / Area / Dept / Project: ____ Reviewed by: ___

Activity / Operation / Job: _____Pigging________ Job No/Project No: _______

Guidance Notes
General risk assessments must be reviewed and, if appropriate, revised at the job planning stage. Reviewed (and if appropriate – revised) assessments must be made available to all affected personnel and shall always
be included in job documentation held on-site for reference by job supervision and personnel.

Assessments must be further reviewed at the job site by the job supervisor before work commences. Job supervisor should take into account:

- actual job site conditions

- local or unforeseen changes since the job was planned
- hazards / risks mentioned in the assessment which do not now apply
- hazards / risks identified locally which have not been foreseen in the assessment
- local job scope changes arising during the job and which require a review of the risk assessment (and where appropriate the client permit to work - see Procedure Change Control)

Job supervisor must enter all significant changes onto this Risk Assessment - Job Site Review Section - Page 2 and then any control measures that could be used to minimise them.
He must sign the form to confirm his review - Page 1. He must ensure that all BJ crewmembers, relevant client / third party personnel also read the assessment and review forms and sign the review form before work
commences - Page 1.

Job Site Review Confirmation

I confirm that I have read the General Risk Assessment provided for this Work Scope and have surveyed the work site, where the additional risks have been identified they are
listed above and control measures suggested.

Job Site Review Performed by: …………………………………………………… Signature: …………………………………… Date: …………………

Signatures
I confirm that I have read and understood both the General Risk Assessment and this Job Site Assessment Review for this Work Scope.
(To be signed by all personnel involved in this work scope ie all BJ and Client/Third Party as appropriate. Use reverse if not enough
space below for signatures)
Name (Printed) Signature Name (Printed) Signature Name (Printed) Signature

………………………………………………………… ………………………………………………………… …………………………………………………………

………………………………………………………… ………………………………………………………… …………………………………………………………
………………………………………………………… ………………………………………………………… …………………………………………………………

Page 1 of 14
 Job Site Risk Assessment Validation Form
Base / Area / Dept / Project: _________________________ Reviewed by: ______________________
Activity / Operation / Job: _____Pigging Job No/Project No: _____

Note: If Procedure Change Control provisions apply during the job this form shall be used for the required assessment review.
Hazards / Risks on General Risk Assessments which are not applicable for this Work Scope:
(Identify by no. and description)

Hazards / Risks which have not been identified in General Risk Assessments which are applicable for this Work Scope:
(Brief Description of Hazards / Risks identified)

Control Measures to be utilised to minimise these additional Hazards / Risks:

(Full Description of Control Measures to be implemented)

Page 2 of 14
 Risk Assessment Tables
(Guidance for assessing risk)

Risk Rating & Rating Number Table

Harm / Damage to High Likelihood Medium Likelihood Low Likelihood

Regular occurrence once Occasional occurrence Unlikely to occur, has

People Equipment / Property Environment per day/shift once per job / month occurred in operation /
(Damage costs – direct & (Damage to the Environment
type of work
indirect) is / involves)

Costs exceeding $ 50.000 Catastrophic, severe

Major Injury / Fracture / 5 Intolerable risk 4 Substantial risk 3 Moderate risk
High Severity damage to company image,
Disablement / Fatality
substantial costs to remedy

Costs between $ 50.000 and External to local area,

Lost Time Injury 4 Substantial risk 3 Moderate risk 2 Tolerable risk
Moderate Severity $5.000 damage to company image
and profits

First Aid Injury, Medical

Costs not exceeding $ 5.000 Local and has minimal 3 Moderate risk 2 Tolerable risk 1 Low risk
Low Severity Aid Treatment Injury,
external impact
Minor Cuts & Bruises

Notes:
For each Hazard :- 1) Risk Rating Table - Estimate Likelihood of Occurrence 2) Risk Rating Table - Estimate Severity of potential injury, property damage or environmental damage 3) Risk Rating Table -
Combine estimates to allocate Initial Risk Rating 4) Risk Tolerability Table - Assess Risk Tolerability or Acceptance 5) Risk Assessment Form - Introduce Control Measures to reduce risk 6) Risk Rating Table -
Reassess revised estimates of Likelihood and Severity after controls implemented and allocate new risk rating 7) Reassess Risk Tolerability and if acceptable, enter Residual Risk Rating and associated
Likelihood and Severity levels in Risk Assessment Form. If not acceptable, repeat stages 5 - 7.

Page 3 of 14
 Risk Assessment Tables
(Guidance for assessing risk)

Risk Tolerability / Acceptance Table

Risk Rating & Rating Number Remedial Action and Timescale

5 Intolerable risk Work shall not be started or continued until the risk has been reduced. If it is not possible to reduce the risk even with unlimited resources, work shall remain prohibited

Work shall not be started until the risk has been reduced. Considerable resources may be required to do this. Where the risk involves work in progress, urgent action
4 Substantial risk shall be taken.

Work may proceed but efforts should be made to reduce the risk below this level. The resources/costs required for prevention should be carefully measured and limited.
Risk reduction measures and remedial action shall be implemented as soon as practicable and within one month as a maximum.
3 Moderate risk Where the moderate risk (level 3) involves high severity consequences, further assessment may be necessary to establish the likelihood more precisely and determine
the need for improved control measures

2 Tolerable risk No additional controls are required. Consideration may be given to more cost effective remedial actions or improvements that involve no additional resource / cost
burden. Monitoring is required to ensure that controls are maintained and in place.

1 Low risk Risk Acceptable. No action is required. Document findings

Notes:
For each Hazard :- 1) Risk Rating Table - Estimate Likelihood of Occurrence 2) Risk Rating Table - Estimate Severity of potential injury, property damage or environmental damage 3) Risk Rating Table -
Combine estimates to allocate Initial Risk Rating 4) Risk Tolerability Table - Assess Risk Tolerability or Acceptance 5) Risk Assessment Form - Introduce Control Measures to reduce risk 6) Risk Rating Table -
Reassess revised estimates of Likelihood and Severity after controls implemented and allocate new risk rating 7) Reassess Risk Tolerability and if acceptable, enter Residual Risk Rating and associated
Likelihood and Severity levels in Risk Assessment Form. If not acceptable, repeat stages 5 - 7.

Page 4 of 14
 Risk Assessment Form
Base / Area / Dept / Project: MPNU DOMGAS 12’’ BRT Precommissioning_ Reviewed by: ___Gary Duncan_____
Activity / Operation / Job: _____Pigging____________ Job No/Project No: 394_____

Asst Ref No: 394/RA/001 Date Assessed: 15/11/11

Task/Job Hazard Initial Risk Controls Residual Risk

Steps Hazard Description and Effect for each Task. Personnel / Hazard Likelihood Risk List and describe fully all Controls Hazard Likelihoo Risk
Note: Additional hazards may arise from Equipment / Severity of Occur Rating Required. Cross refer to any other Severity d of Rating
interaction with other work. Environment -ence No. relevant assessment (PPE, COSHH, Occur No.
at Risk Manual Handling, LOLER etc) -ence

Procedure Incorrect isolations identified. BJPPS High Mod 4 Sub Internal procedure review. High Low 3 Mod
Preparation personnel. Client procedure review.
Over-pressurisation. BJPPS
Impact. equipment.
Installation
personnel &
equipment.
Procedure Incorrect injection point. BJPPS High Mod 4 Sub Internal procedure review. High Low 3 Mod
Preparation personnel. Client procedure review.
Over-pressurisation. BJPPS
Impact. equipment.
Installation
personnel &
equipment.
Procedure Incorrect depressurisation point. BJPPS High Mod 4 Sub Internal procedure review. High Low 3 Mod
Preparation personnel. Client procedure review.
Over-pressurisation. BJPPS
Impact. equipment.
Unable to depressurise system under test. Installation
personnel &
equipment.

Approved by (Name): ________________________ Approved by (Title): ________________________

Approved by (Signature): ________________________ Date: _____________ Page 5 of 14

Risk Assessment Form Asst Ref No: A3000/RA/001

Task/Job Hazard Initial Risk Controls Residual Risk

Steps Hazard Description and Effect for each Task. Personnel / Hazard Likelihood Risk List and describe fully all Controls Hazard Likelihoo Risk
Note: Additional hazards may arise from Equipment / Severity of Occur Rating Required. Cross refer to any other Severity d of Rating
interaction with other work. Environment -ence No. relevant assessment (PPE, COSHH, Occur No.
at Risk Manual Handling, LOLER etc) -ence

Procedure Incorrect instrument point. BJPPS High Mod 4 Sub Internal procedure review. High Low 3 Mod
Preparation personnel. Client procedure review.
Over-pressurisation. BJPPS
Impact. equipment.
System not depressurised. Installation
personnel &
equipment.

Arrival at Unfamiliar with installation layout and BJPPS Mod High 4 Sub Installation induction. Mod Low 2Tol
Worksite procedures. Personnel.

Disorientation.
Difficulties in locating escape routes.
Difficulties in locating muster stations &
lifeboats.

Equipment Crane operations. BJPPS High Mod 4 Sub Operations co-ordinated by Deck High Low 3 Mod
Spotting personnel. Foreman.
BJPPS Crane suitably rated.
equipment. All slings certified.
Installation
personnel &
equipment.

Page 6 of 10
Risk Assessment Form Asst Ref No: A3000/RA/001

Task / Hazard Initial Risk Controls Residual Risk

Hazard Description and Effect for each Task. Personnel / Hazard Likelihood Risk List and describe fully all Controls Hazard Likelihoo Risk
Job Note: Additional hazards may arise from Equipment / Severity of Occur Rating Required. Cross refer to any other Severity d of Rating
Steps interaction with other work. Environment -ence No. relevant assessment (PPE, COSHH, Occur No.
at Risk Manual Handling, LOLER etc) -ence

Equipment Conflicting activities. BJPPS Mod High 4 Sub Operations co-ordinated by Deck Mod Low 2 Tol
Spotting personnel. Foreman.
BJPPS
equipment.
Installation
personnel &
equipment.
Equipment Blocked escape routes. BJPPS Mod Mod 3 Mod Operations co-ordinated by Deck Mod Low 2 Tol
Spotting Conflicting equipment locations. personnel. Foreman.
BJPPS Deck plan.
equipment. BJPPS assistance.
Installation
personnel &
equipment.
Equipment Trip hazards. BJPPS & Mod High 4 Sub Toolbox talk. Mod Low 2 Tol
Rig-Up Installation Trip hazards to be kept to a minimum.
personnel.
Equipment Manual handling during preparatory works. BJPPS Mod High 4 Sub HSE Procedures Manual: Mod Low 2 Tol
Rig-Up personnel. Section 7 (Personal Protection).
Physical injury (backs, fingers etc). Manual Handling Course.
Manual Handling Assessment.
Competent personnel.
PPE.

Page 7 of 14
Risk Assessment Form Asst Ref No: A3000/RA/001

Task / Hazard Initial Risk Controls Residual Risk

Hazard Description and Effect for each Task. Personnel / Hazard Likelihood Risk List and describe fully all Controls Hazard Likelihoo Risk
Job Note: Additional hazards may arise from Equipment / Severity of Occur Rating Required. Cross refer to any other Severity d of Rating
Steps interaction with other work. Environment -ence No. relevant assessment (PPE, COSHH, Occur No.
at Risk Manual Handling, LOLER etc) -ence

Equipment Incorrect use of tools. BJPPS Mod Mod 3 Mod Instruction in the correct use of tools. Mod Low 2 Tol
Rig-Up personnel. Competent personnel.
Physical injury (backs, fingers etc). PPE.
Pig Loading Pressurised system. BJPPS Mod Mod 4 Sub Approved procedure. Mod Low 2 Tol
personnel. Valve status checks completed.
Impact. System depressurised (confirmed by
instrumentation).
Pig Loading Manual handling. BJPPS Mod High 4 Sub HSE Procedures Manual: Mod Low 2 Tol
personnel. Section 7 (Personal Protection).
Physical injury (backs, fingers etc). Competent personnel.
Manual Handling Course.
PPE.
Pig Loading Incorrect use of tools. BJPPS Mod Mod 3 Mod Instruction in the correct use of tools. Mod Low 2 Tol
personnel. Competent personnel.
Physical injury (backs, fingers etc). PPE.
Hose Manual handling. BJPPS Mod Mod 3 Mod Competent personnel. Mod Low 2 Tol
Deployment. personnel and PPE.
Physical injury (backs, fingers etc). plant, Hose pre-tested on-site.
Impact. other Hose deployed on a tugger or winch wire.
personnel &
surrounding
plant.

Page 8 of 14
Risk Assessment Form Asst Ref No: A3000/RA/001

Task / Hazard Initial Risk Controls Residual Risk

Hazard Description and Effect for each Task. Personnel / Hazard Likelihood Risk List and describe fully all Controls Hazard Likelihoo Risk
Job Note: Additional hazards may arise from Equipment / Severity of Occur Rating Required. Cross refer to any other Severity d of Rating
Steps interaction with other work. Environment -ence No. relevant assessment (PPE, COSHH, Occur No.
at Risk Manual Handling, LOLER etc) -ence

Pigging. Over-pressurisation. BJPPS Mod Mod 3 Mod Approved procedure. Mod Low 2 Tol
personnel and Valve status checks completed.
Impact. plant, Communications.
& Barriers.
surrounding Pump deadheads at a lower pressure
plant. than pipeline rated pressure (centrifugal
pump).
Rated PRV fitted (positive displacement
pump).
Pigging. Pig failure. Surrounding Mod Mod 3 Mod Pig checked prior to loading. Mod Low 2 Tol
plant.
Impact.
Pigging. Pump failure during pumping. BJPPS High Mod 4 Sub Preventative maintenance. High Low 3 Mod
personnel and Equipment checks & tests on-site.
Impact/Fire. plant, Competent operators.
& Back-up unit on-site.
surrounding Fire extinguisher on-site.
plant. Barriers.
Pigging. Hose rupture during pumping. BJPPS Mod Mod 3 Mod All hoses pre-tested & certified. Mod Low 2 Tol
personnel and Hoses tested on-site against closed
Impact. plant, system valves.
& Hoses secured.
surrounding Barriers.
plant.

Page 9 of 14
Risk Assessment Form Asst Ref No: A3000/RA/001

Task / Hazard Initial Risk Controls Residual Risk

Hazard Description and Effect for each Task. Personnel / Hazard Likelihood Risk List and describe fully all Controls Hazard Likelihoo Risk
Job Note: Additional hazards may arise from Equipment / Severity of Occur Rating Required. Cross refer to any other Severity d of Rating
Steps interaction with other work. Environment -ence No. relevant assessment (PPE, COSHH, Occur No.
at Risk Manual Handling, LOLER etc) -ence

Pigging. Fitting/valve failure during pumping. BJPPS Mod Mod 3 Mod All fittings rated. Mod Low 2 Tol
personnel and Fittings tested on-site.
Impact. plant, Barriers.
&
surrounding
plant.
Pigging. Instrument failure during monitoring. BJPPS High Mod 4 Sub All instrumentation calibrated & rated. High Low 3 Mod
personnel and Instrumentation tested on-site.
Impact. plant, Instruments monitored continuously.
& Back-up units on-site.
surrounding
plant.
Pigging. Receiving pigs. BJPPS High Low 3 Mod Approved procedure. High Low 3 Mod
personnel Instrumentation indicates pig arrival.
Impact & Receiver rated.
surrounding Barriers.
plant. Communications.
Pig Removal. Pressurised system. BJPPS High Low 3 Mod Approved procedure. High Low 3 Mod
personnel. Valve status checks completed.
Impact. System depressurised (confirmed by
instrumentation).
Barriers.
Pig Removal. Manual handling. BJPPS Mod High 4 Sub HSE Procedures Manual: Mod Low 2 Tol
personnel. Section 7 (Personal Protection).
Physical injury (backs, fingers etc). Manual Handling Course.
Manual Handling Assessment.
Competent personnel.
PPE.

Page 10 of 14
 Risk Assessment Form Asst Ref No: A3000/RA/001

Task / Hazard Initial Risk Controls Residual Risk

Hazard Description and Effect for each Task. Personnel / Hazard Likelihood Risk List and describe fully all Controls Hazard Likelihoo Risk
Job Note: Additional hazards may arise from Equipment / Severity of Occur Rating Required. Cross refer to any other Severity d of Rating
Steps interaction with other work. Environment -ence No. relevant assessment (PPE, COSHH, Occur No.
at Risk Manual Handling, LOLER etc) -ence

Pig Removal. Incorrect use of tools. BJPPS Mod Mod 3 Mod Instruction in the correct use of tools. Mod Low 2 Tol
personnel. Competent personnel.
Physical injury (backs, fingers etc). PPE.
Hose recovery. Manual handling. BJPPS Mod Mod 3 Mod Competent personnel. Mod Low 2 Tol
personnel and PPE.
Physical injury (backs, fingers etc). plant, Hose pre-tested.
Impact. other Hose recovered on a tugger or winch
personnel & wire.
surrounding
plant.
Equipment Manual handling during de-rig. BJPPS Mod High 4 Sub HSE Procedures Manual: Mod Low 2 Tol
De-Rig personnel. Section 7 (Personal Protection).
Physical injury (backs, fingers etc). Manual Handling Course.
Manual Handling Assessment.
Competent personnel.
PPE.
Equipment Incorrect use of tools. BJPPS Mod Mod 3 Mod Instruction in the correct use of tools. Mod Low 2 Tol
De-Rig personnel. Competent personnel.
Physical injury (backs, fingers etc). PPE.
Equipment Crane operations. BJPPS High Mod 4 Sub Operations co-ordinated by Deck High Low 3 Mod
De-Mob personnel. Foreman.
BJPPS Crane suitably rated.
equipment. All slings certified.
Installation
personnel &
equipment.

Page 11 of 14
 Risk Assessment Form Asst Ref No: A3000/RA/001

Task / Hazard Initial Risk Controls Residual Risk

Hazard Description and Effect for each Task. Personnel / Hazard Likelihood Risk List and describe fully all Controls Hazard Likelihoo Risk
Job Note: Additional hazards may arise from Equipment / Severity of Occur Rating Required. Cross refer to any other Severity d of Rating
Steps interaction with other work. Environment -ence No. relevant assessment (PPE, COSHH, Occur No.
at Risk Manual Handling, LOLER etc) -ence

Equipment Conflicting activities. BJPPS Mod High 4 Sub Operations co-ordinated by Deck Mod Low 2 Tol
De-Mob personnel. Foreman.
BJPPS
equipment.
Installation
personnel &
equipment.

Note: The following table is to be used for the Site Specific Risk Assessment which MUST be completed prior to operations commencing.

Page 12 of 14
Risk Assessment Form Asst Ref No: A3000/RA/001

Task / Hazard Initial Risk Controls Residual Risk

Hazard Description and Effect for each Task. Personnel / Hazard Likelihood Risk List and describe fully all Controls Hazard Likelihoo Risk
Job Note: Additional hazards may arise from Equipment / Severity of Occur Rating Required. Cross refer to any other Severity d of Rating
Steps interaction with other work. Environment -ence No. relevant assessment (PPE, COSHH, Occur No.
at Risk Manual Handling, LOLER etc) -ence

Page 13 of 14
Risk Assessment Form Asst Ref No: A3000/RA/001

Task / Hazard Initial Risk Controls Residual Risk

Job Hazard Description and Effect for each Task. Personnel / Hazard Likelihood Risk List and describe fully all Controls Hazard Likelihoo Risk
Note: Additional hazards may arise from Equipment / Severity of Occur Rating Required. Cross refer to any other Severity d of Rating
Steps interaction with other work. Environment -ence No. relevant assessment (PPE, COSHH, Occur No.
at Risk Manual Handling, LOLER etc) -ence

Page 14 of 14