Issue Date: 02nd Jan 2024

Revision No. : 00
Form #: 127

RISK ASSESSMENT FORM Code: RA-209 Version 00

Work Activity: Compressed Gas Issue Date: 02-Jan-
Vessel: Task Category: ALL / SAFETY
Cylinders 2024
Risk Assessment Conditions Important Instructions Analysis of expressions used to calculate Risk LIKELIHOOD (L)
Work Authorization Work Activity is High Risk: Risk
Likelihoo
Work has been authorized (Shipboard) Yes No (S) Severity (L) Risk Rating Rating 1 2 3 4 5
d
Y N
Indicate Relevant SMS SxL
Work has been authorized (Office, if needed) 1 Negligible 1 Improbable RF 1 1 2 3 4 5
Sections : =
Y N
FOM 14.12.4
1
2 Minor 2 Remote RF Risk 2 2 4 6 8

SEVERITY (S)
No Fatigue 0
Staff is adequately rested Y N Unplanned Occurrence: Y 1 1
N 3 Significant 3 Possible L Low 3 3 6 9
2 5
(Identify scenarios that
Use of proper PPE unforeseen events present new Mediu 1 1 2
Staff is using proper PPE Y N
4 Critical 4 Likely M 4 4 8
hazards) m 2 6 0
Experienced staff 1 1 2 2
Staff has task experience Y N
5 Catastrophic 5 Certain H High 5 5
0 5 0 5
Relevant Permit to Work filled : Y
N How to assess Risk :  Select Severity expression that applies to hazard WITH NO Controls  Select
(Indicate the name of Company Forms) appropriate likelihood with NO Controls  Apply controls and RECALCULATE risk

HAZARD Initial Risk Residual Risk

DESCRIPTION Rating Risk CONTROL MEASURES TO BE TAKEN Rating Risk
N HAZARD EFFECTS
(Assume NO (SxL = RR) L/ (To Reduce the Risk and calculate the Residual (SxL = RR) L/
o (What may happen)
CONTROLS to initially M/H Risk Rating) M/H
S L RR S L RR
assess risks)
Incorrect procedure
Training procedures, crew evaluation reports, crew
Incompetent personnel implementation,
1. 3 3 9 M certification authentication checks, interview process 3 2 6 M
to perform personnel injury,
prior employment
equipment damage
Failure to keep cylinder
valves, controls & Equipment failure, Instructions / familiarization / checks before use /
2. 3 3 9 M 3 1 3 L
associated fittings free damage Officer in charge of the operation
from oil/grease/paint
Replacing specially
designed hoses for
Fire, equipment Instructions / familiarization / Officer in charge of the
3. welding and cutting with 3 3 9 M 3 1 3 L
damage, injury operation
other non approved
hoses
Attempting to stop leaks
Equipment damage, Instructions / familiarization / Officer in charge of the
4. with non approved 3 3 9 M 3 1 3 L
injury operation
materials
Use of excessive force
on cylinder valve
Equipment damage, Instructions / familiarization / Officer in charge of the
5. spindles or hexagonal 3 3 9 M 3 2 6 M
injury operation
nuts of regulator
connections
6. Failure to use specially Equipment damage, 3 3 9 M Instructions / familiarization / Officer in charge of the 3 1 3 L
designed tools to unclog injury operation
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 Issue Date: 02nd Jan 2024
Revision No. : 00
Form #: 127

HAZARD Initial Risk Residual Risk

DESCRIPTION Rating Risk CONTROL MEASURES TO BE TAKEN Rating Risk
N HAZARD EFFECTS
(Assume NO (SxL = RR) L/ (To Reduce the Risk and calculate the Residual (SxL = RR) L/
o (What may happen)
CONTROLS to initially M/H Risk Rating) M/H
S L RR S L RR
assess risks)
blowpipe tip
Equipment
Transfer of gas between Follow PMS program, qualified personnel for
7. damage,explosion,fir 5 3 15 H 5 1 5 M
cylinders maintenance, spares on board
e, injury
Improper storage of gas Equipment damage, Ensure proper storage, not sunlight, not heat, outside
8. 4 4 16 H 4 1 4 L
cylinders injury engine room. Secure bottles by lashing
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.

Action Due Completion Risk Assessment Review & Approval

Item Additional actions to reduce Residual Risk
Date Date
1. Prepared by: Reviewed by:
2.
Shipboard
3. Approval Date: Date:
4.

5. Approved By (Name & Rank):

6.
Office Approval Date:
Have any alternate methods with lesser risks identified to
Yes No
accomplish this task

Consequence
Health & Safety Damage to Vessel / Property Environmental Impact Other Impact
Category
Not affecting sea worthiness repairable by Accidental Discharge within
1 Simple First Aid or NLTI Operational delay
ship staff containment tray
Injury Requiring Medical treatment Not affecting sea worthiness, repairs requiring
2 Spill on deck < 1 cu.m Minor off- hire
ashore (MTC) external assistance
Affecting sea worthiness, repaired with or
Serious Injury or Multiple Minor Injuries Major off-hire, blacklisting of vessel
3 without shore assistance. Leading to COC to Spill on deck > 1 cu.m
requiring Hospitalization (sig off) (LTI) by one oil major
be cleared by next DD
4 Permanent Disability, limited Impact on Requiring layup repairs, 3rd party claims Spill / discharge in water < Extensive off-hire, Loss of charter,
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 Issue Date: 02nd Jan 2024
Revision No. : 00
Form #: 127

blacklisting of vessel by more than

Public 100 Ltr
one oil major
Total Loss, immediate layup / dry docking for Spill / discharge in water > Major Industry Reaction. Fleet-wide
5 Fatality, Serious Impact on Public
major repairs. Major claims from 3rd party 100 Ltr blacklist by one or more oil major

LIKELIHOOD
Work should not start unless approval obtained from Management
HIGH: 1 2 3 4 5
ashore
Efforts should be made to reduce the risk, with heightened monitoring of the additional
MODERATE: 1 L L L L M
controls implemented

LOW: No additional controls required, monitoring required to ensure controls maintained 2 L L M M M

3 L M M M H

4 L M M H H

5 M M H H H

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