Task Risk and Impact Assessment Form
REF-HSEMNGTS/ATT04/BGT-2024/Rev01
Base Drainage (Water Run-Off/Retention) Upgrades
Contract No:
TASK RISK AND IMPACT ASSESSMENT FORM
Revision History
S.No. Description Revision number Revision date Prepared by
Task Risk and Impact
1 00 22 April 2024 Anoop Anil Kumar
Assessment Form
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TASK RISK AND IMPACT ASSESSMENT FORM
TASK RISK AND IMPACT ASSESSMENT FORM
Work activity
Location
Ref. No
Assessor (name)
Date
Review Date
Notes: Who is at risk? – Employees (E); Others (O); Public (P)
Risk Factor (RF) = Likelihood (L) x Severity (S) in the absence of risk controls
Residual Risk Factor (RRF) = Likelihood (L) x Severity (S) when risk controls are in place
LOW = 1-3 MEDIUM = 4-12 HIGH = 15-25
Severity Severity
Likelihood
1. Very Unlikely 1. Very minor injury or environmental incident. No Likelihood 1 2 3 4 5
lost time absence.
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2. Unlikely Injury resulting in up to 3 days off work / .2 1 1 2 3 4 5
Environmental incident with no long term damage
3. Likely 3. Injury with more than 3 days off work / 2 2 4 6 8 10
Environmental incident requiring mitigation
4. Very Likely 4. Long-term absence / Significant environmental incident 3 3 6 9 12 15
5. Certain 5. Death / Major environmental incident 4 4 8 12 16 20
5 10 15 20 25 20
Who is at risk? Residual Risk
Risk Factor Preventive measures and
Factor
Activity Hazard Category Nature of Risk risk controls
R
E O P L S L S RRF
F
Fall on same level Bodily or head injury
Fall from height Physical injury or death
Fall on stairs Physical injury or death
Struck by moving object Physical injury or death
Struck by falling object Physical injury or death
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Striking fixed/stationary Physical injury or death
object
Trapped between objects Physical injury or death
Trapped by collapsed Physical injury or death
object/structure
Collision Physical injury or death
Contact with sharp object Physical/eye injury
Contact with flying particle Physical/eye injury
Contact with Physical injury
rotating/moving machinery
Physical/eye injury,
Contact with extremely
scalding, burns, skin/tissue
hot/cold items
damage
Contact with live electrical Death or burn injury
conductor
Exposure to noise Permanent hearing loss
Exposure to airborne dust Respiratory problems
Exposure to harmful Physical bodily or eye
substances – carcinogenic, injury, respiratory disease
highly toxic, toxic, corrosive, or condition, anaphylactic
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TASK RISK AND IMPACT ASSESSMENT FORM
shock, skin disease,
irritant, etc. (solids, liquids,
cancer, poisoning,
particulates, dust, mist,
asphyxiation, chronic
fume, vapor, gas, etc.)
conditions
Exposure to ionizing Radiation burns, radiation
radiation (alpha, beta, sickness, cancer
gamma)
Exposure to non-ionizing Burns, tissue damage, eye
radiation (UV, infrared, damage, skin disease
microwave, lasers, etc.)
Exposure to extreme Heat stress, dehydration,
temperatures hypothermia
Musculoskeletal injuries &
Exposure to vibration
chronic conditions
Death, major physical
Fire / explosion
injury, burns, asphyxiation
Death, major physical
Uncontrolled release of
injury, blast injuries,
energy (e.g. pressure)
hearing impairment
Oxygen enrichment or As for explosion above or
depletion asphyxiation
Drowning Death
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Asphyxiation Death
Physical injury, acute or
Manual handling of loads chronic musculoskeletal
injuries/conditions
Ergonomic hazards &
use of Display Screen
Equipment (DSE)
Physical injury, acute or
Repetitive movement/action chronic musculoskeletal
injuries/conditions
Stress Stress-related illness
Miscellaneous injury or ill
Lone Working
health
Spill Soil / Water pollution
Emission Air pollution
Risk
Action and Timescale
Level
Low No additional controls are required. Consideration should be given to improvements that pose minimal financial or time burden upon the
company. The risk control measures should be monitored on an ongoing basis to ensure their effectiveness.
(1 to 3)
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Medium Efforts should be made to reduce the risk to a more tolerable level, but the associated costs need to be in line with the benefits. The identified
risk reduction methods should be implemented within clear timescales. If the risk has either high likelihood or high severity, then further
(4 to 12) investigation should be undertaken on how to specifically reduce these impacts before the work activity is carried out.
High Work should not be started until all appropriate risk control measures have been fully implemented.
Once measures are in place, the activity should then be reviewed further by a competent person to ensure the risks have been reduced to a
(15 to 25) tolerable level.
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