Saipem 12000 Prepared by Approved by Rev.
Location of Job /Task Date JSA No
Department (Name) (Name & Signature) No
Operation/Job Description Project:
Risk Assessment
STEP / EXISTING AND POSSIBLE L = Low
TASK OPERATION HAZARDS / OR CONSEQUENCES OF CONTROL / PRECAUTIONS RESPONSIBLE M = Medium
No. EXPOSURE H = High
Cons Prob Risk
PROPER PPE TO BE USED, PERSONNEL TO BE
INSTRUCTED/TRAINED ON PROPER WAY TO HOOK UP
SLIPS, FALLS, PERSONNEL INJURY,
1 HOOK UP BASKET BASKET INSPECT AREA FOR TRIP HAZARDS STSL/CROP/ABSE L L L
BASKET SLUNG IMPROPERLY
COMPETENT PERSON TO INSPECT RIGGING; FILL UP
CHECKLIST
PERSONNEL NOT WEARING PROPER LIFEJACKETS TO BE DISTRIBUTED AND CHECKED IF
PERSONNEL EMBARKING
2 PPE/ WEAR INCORRECTLY; SLIPS & WORN PROPERLY PRE- BASKET TRANSFER BRIEFING; STSL/CROP/ABSE L L L
BASKET
TRIPS CHECK EMBARKATION AREA
AREA IS NOT READY ON BOARD OF S/V
TO RECEIVE BASKET, DECK CREW ON CLEAR COMMUNICATION BETWEEN CROP, DECK
BASKET TRANSFER FROM S12
3 BOARD OF S/V NOT READY TO ASSIST OFFICER, BRIDGE, S/V LUGGAGE COMPARTMENT, STSL/CROP/ABSE L L L
K TO BUNKER SHIP
LANDING CHECK PERSONNEL FOR LOOSE ITEMS
DROPPED OBJECTS
RECOVERING BASKET FROM
PERSONNEL IN BASKET NOT READY,
4 BUNKER VESSEL BACK TO S/V CREW TO GIVE “GOOD TO GO” SIGNAL NO ONE ELSE STSL/CROP/ABSE M L L
SAFETY BELTS UNSECURED
S12K
PERSONNEL INJURY, TUG LINES
LANDING BASKET ON BOARD
5 MISSING. NOT INVOLVED PERSONNEL BARRIER OFF THE AREA STSL/CROP/ABSE M L L
S12K
AROUND
DAMAGE TO MATERIALS AND STORED IN THE PROPER MANNER AND VISUAL
6 UNHOOK & STOW BASKET STSL/CROP/ABSE M L L
EQUIPMENT INSPECTION PRIOR TO STORAGE
Consequen Accidental consequences Accidental consequences for property and Probability Descripti
Definition Risk Value Action / Time scale Risk Level Probability
ce Level for bodily injuries environment Level on
Loss of or severe damage to rig requiring
immediate abandonment. Immediate: - Before
Fatality or Multiple Serious A common event that is likely to occur
High Loss of or severe damage to structures. Damage High Frequent High work is started or Consequence
Injuries one or more times per year.
leading to loss of containment over 25Te of allowed to continue
Hydrocarbons.
Damage to critical rig plant/equipment preventing
normal operations. An event is likely to occur one or more Controls to be in place
Lost Time Accidents or
Medium Damage to structures causing delay to normal Medium Probable times during operations or equipment Medium as soon as is High M H H
Single Serious Injury
operations. design life. practicable
Loss of containment under 25T of Hydrocarbons.
Operations continue with reduced efficiency.
Consider the cost
Minor injuries excluding Damage to plant/equipment with no delay to An event is not likely during operations
Low Low Unlikely Low benefits of improved Medium L M H
lost time accidents operations. or equipment design life.
controls
1Te discharge of Hydrocarbons to environment..
Low L L M
All personnel involved in this job must sign the JSA to confirm attendance to the pre-job meeting and to acknowledge their duties and
responsibilities:
Name Position Signature
PPE Requirements (Tick box):
Helmet X Boots X Rubber/Special Face Shield Other
gloves
Eye Harness and Breathing Ear Protectors
Protection Lanyard Apparatus
(Clear)
Coverall X Harness and X Mask w/Gas Yellow
Fall Arrestor Filter Wellington
Rubber Boots
High X Work Vest / Mask w/Dust Welder’s mask
Impact Inflatable Life Filter
Gloves Jacket
High Protective / Apron Knee Pads
Dexterity Disposable
gloves Suit
