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Occupational Safety and Health Division

18 Havelock Road #03-02

Singapore 059764

Tel: 64385122

www.mom.gov.sg

[email protected]

Activity-based Risk Assessment Form

This form may take you 30 minutes to complete.You will need the following information to fill in the form:

Process Flow Chart


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RISK ASSESSMENT FORMACTIVITY-BASED RISK ASSESSMENT

INVENTORYOF WORK ACTIVITIES

Company: Tricaftan Environmental Technology Pte Ltd

No. Process/Location Work ActivitiesTricaftan Office

1. working in Office1) Open desk ,file drawer, door, bookcases and other objects at

office

2) Moving the desk, bookcases or other furniture.

3) Work station ergonomics (Typing, filing, telephone calls, writing

etc

4) Indoor air quality in office

5) Lighting inside the office

6) Using of electrical equipments in office

7) Using of toilet and pantry at office

8) Emergency preparedness for working at office

Instructions on how to use Activity-Based Risk Assessment Form can be found in Guidelines on Risk Assessment


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RISK ASSESSMENT FORM

1. HAZARD IDENTIFICATION 2. RISK EVALUATION 3. RISK CONTROL4. RESIDUAL

RISK

1a. 1b. 1c. 1d. 2a. 2b. 2c. 2d. 3a. 3b. 4a. 4b. 4c.

No.

WorkA

ctivity

Hazard

PossibleAccident / Ill

Health &Persons-at-

Risk

Existing RiskControl

(if any)

S L RAdditional

Risk Control

Action Officer,Designation

(Follow-up date)

S L R

1 Open desk,file drawer,door,bookcasesand other

objects atoffice

-Trip and fall

over due to open

drawer

-falling objectsfrom wall

mounted shelf

-Bump or hit by

door, desks, filing

Bodily injury to

office staffs

1)Pathway must

clear before

walking

2)Must use small Aframe adder for

overhead access

3)Not to use chairs

for in place of step

3 4 M 1)Do not leave

desk, drawer or

door in open

position2)Remind to all

office staffs

1)Safety personnel2)office administrator

3 4 L

Instructions on how to use Activity-Based Risk Assessment Form can be found in Guidelines on Risk Assessment

RISKASSESSMENT FORM

CompanyTricaftan Environmental

Technology Pte LtdRA Leader

Htin Lin AungSafety Supervisor)

Approved By

Process/ Activity/Location

RA FOR WORKING INOFFICE RA Member 1

Hla Htoon Phyu(Safety

Supervisor)

Name/Designation

Mr Khoo Lip Kee-PM(Tricaftan)

Original AssessmentDate

RA Member 2Signature

Last Review Date 06/06/2013 RA Member 3 Date 06/06/2013Next Review Date 05/06/2014 RA Member 4


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RISK

1a. 1b. 1c. 1d. 2a. 2b. 2c. 2d. 3a. 3b. 4a. 4b. 4c.

No.

WorkAc

tivity

Hazard

Possible

Accident / IllHealth &Persons-at-

Risk


(if any)

S L R AdditionalRisk Control


(Follow-up date)

S L R

lifting

3 Work station

ergonomics

(Typing,

filing,

telephone

calls, writing

etc

Eyes, hands,

arms, and back

injury due to poor

furniture design

Bodily injury to

workers

1)Must be adjust table

and chair height to

position thighs parallel

to floor

2)Ensure chair is

properly size to prevent

back of the knee from

pushing into the front of

chair

3)The computer must be

comfortable distance

from the eyes

3 4 M

1)Briefing all

staffs about

office

ergonomics

2)change

position

frequently, do

not cradle the

phone when

keying,


3 3 L

4 Indoor air

quality in

office

-Poor

maintenance of

ventilation

system

-Chemical or

-discomfort for

work in office

-stressful

psychological

condition

1)Response

immediately to any

water intrusion &

dry the area

2)Maintain good

2 4 M 1)Inspect &

clean ventilation

components

regularly

2)Encourage to

1)Safety personnel

2)office administrator

2 3 L

Instructions on how to use Inventory of Work Activities Form can be found in Guidelines on Risk Assessmenthttp://mom.gov.sg/OSHD/Resources/Guides/Guidelines/index.htm
http://mom.gov.sg/OSHD/Resources/Guides/Guidelines/index.htmhttp://mom.gov.sg/OSHD/Resources/Guides/Guidelines/index.htm


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RISK

1a. 1b. 1c. 1d. 2a. 2b. 2c. 2d. 3a. 3b. 4a. 4b. 4c.

No.

WorkAc

tivity

Hazard

Possible


Risk


(if any)



(Follow-up date)

S L R

Microbiological

contaminants in

air

housekeeping

3)Must use

cleaning solvents

are manufacturers

recommendations4)Must change or

clean filter regularly

staffs suffering

symptoms to

see medical

treatment

5 Lighting

inside the

office

Vision problem

can lead to

headaches and

other symptoms

Eyes or bodily

injury to staffs

1)Minimise

direct overhead

lighting

2)Must avoid

glare from

window by using

curtains

2 4 M Must check the

computer

monitors that do

not require high

lighting levels


2 3 L



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RISK

1a. 1b. 1c. 1d. 2a. 2b. 2c. 2d. 3a. 3b. 4a. 4b. 4c.

No.

WorkAc

tivity

Hazard

Possible


Risk


(if any)



(Follow-up date)

S L R

6 Using of

electrical

equipments

in office

-Electrical shock

& burn injury to

office staff

-Trip & fall by

electrical cablelaying on floor

Serious injury to

office staffs

1)Maintain

grounding & ground

fault circuit

interrupters

2)Do not over loadoutlets

3)Do not twist

cords or push

tightly against

outlets

4)Must check faulty

electrical

equipment by LEW

2 4 L 1)Not allowed to

work on live

electrical

equipment for

cleaning,adjusting or

maintaining

2)Inspect

regularly for

defective

equipment


2 3 L



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RISK

1a. 1b. 1c. 1d. 2a. 2b. 2c. 2d. 3a. 3b. 4a. 4b. 4c.

No.

WorkAc

tivity

Hazard

Possible


Risk


(if any)



(Follow-up date)

S L R

7 Using of

toilet and

pantry at

office

-Slippery floor due

to falling hazard

-Crack or worn

parts cause pinch

injury

-Falling objects

from shelf

Bodily injury to

staffs

1)Regularly clean and

keep dry the floor

2)Proper ventilation

system at toilet

3)Do not put heavy

materials on pantry shelf

4) pantry shelf doors

must be closed all the

time

2 4 M 1)Good

housekeeping to

prevent falling

2)Must report and

repair any defect

items


`

2 3 L

8 Emergency

preparednes

s for working

at office

-Fire hazard

-Medical

emergency

-Bodily injury

due to trip and

fall at

emergency

1)Must be display

written emergency plan

2)Must be display

emergency contact list

3)Must be aware of fire

2 4 M All staffs Must

be participate in

Emergency Drill

exercise and


2 3 L



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RISK

1a. 1b. 1c. 1d. 2a. 2b. 2c. 2d. 3a. 3b. 4a. 4b. 4c.

No.

WorkAc

tivity

Hazard

Possible


Risk


(if any)



(Follow-up date)

S L R

exit/access way

blockage

-Panic or shock

alarm and all staffs to

understand ERP system

4)Must clear the any

blockage from access

way

5)Must be useemergency exit and walk

to assembly area in

case of emergency

held periodically

Risk Matrix to Determine Risk Level



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* Note: S = Severity; L = Likelihood; R = Risk Level

Severity categories and description

Level Severity Description5 Catastrophic Fatality, fatal diseases or multiple major injuries

4 Major Serious injuries or life threatening occupational disease (includes

amputation, major fractures, multiple injuriesOccupational cancer, acute poisoning

3 Moderate Injury requiring medical treatment or ill-health leading toDisability (includes laceration, burns, sprain, minor fracturesDermatitis, deafness, work-related upper limb disorders).


Likelihood

Severity

Rare

(1)

Unlikely

(2)Possible

(3)

Likely

(4)

Almost

Certain

(5)

Catastrophic

(5)

Medium

(M)

Medium

(MHigh (H) High (H) High (H)

Major

(4)

Medium

(M)

Medium

(M

Medium

(M)High (H) High (H)

Moderate

(3)

Low (L) Medium

(M

Medium

(M)

Medium

(M)High (H)

Minor

(2)

Low (L) Medium

(M

Medium

(M)

Medium

(M)

Medium

(M)

Insignificant (1)Low (L) Low (L)

Low (L)Medium

(M)

Medium

(M)


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RISK ASSESSMENT FORM2 Minor Injury or ill-health requiring first-aid only (includes minor cuts

and bruises, irritation , ill-health with temporary discomfort.)

1 Insignificant Not likely to cause injury or ill-health

Likelihood categories and description

Level Likelihood

Description

1 Rare Not expected to occur but still possible.

2 UnlikelyNot likely to occur under normal circumstances

3 PossiblePossible or know to occur.

4 LikelyCommon occurrence

5 AlmostCertain

Continual or repeating experience

Acceptability of risk and recommended actions.

Risklevel

RiskAcceptabilit

y

Recommendation Action

LowRisk

Acceptable No additional risk Control measures may be needed

Frequent review and monitoring of hazards are

required to ensure that the risk level assigned isaccurate and does not increase over time



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RISK ASSESSMENT FORMMediumRisk

Tolerable A careful evaluation of the hazards should be carried

out to ensure that the risk level is reduced to as lowas reasonable practicable (ALARP) within a definetime period.

Interim risk control measures such as administrative

controls or PPE may be implemented while longer

term measure are being established. Management attention is required.

HighRisk

Notacceptable

High Risk level must be reduced to as least Medium

Risk before work commences.

There should not be any interim risk control

measures. Risk control measure should not be overlydependent on PPE or appliances

If practicable, the hazard should be eliminated before

work commences

Management review is required before work

commences.


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