NEPC Consortium Power Ltd. SSHEM Form 1.1 Revision 0.1 02.01.

2013 Page 1 of 2

NEPC HAZARD ANALYSIS FORM

JOB/TASK ORGANIZATION NEPC Required PPE: Required Tools: WORK LOCATION

PERMIT NUMBER

DATE

Sl. 1.

Major steps of the Job/Task

Energy sources potential/ associated hazards

Risk Rating P S R

Solutions/Control Measures

Risk Rating with Control

2.

3.

4.

5.

NEPC Consortium Power Ltd. SSHEM Form 1.1 Revision 0.1 02.01.2013 Page 2 of 2

The risk associated with this job has been evaluated with the work team and reduced to an acceptable level. Signature (Department Supervisor) Job Planning Team Members List any additional on separate sheet
(I as Work

Team Leader and We as team member participated in the Hazard Analysis carried out for this work and
confirmed the hazard controls are sufficient for the proposed work)

Date: Name 1. Position Work Team Leader Signature

2.

3.

Severity
Multiple fatalities, irrecoverable property, equipment damage and productivity loss.

Value

Probability
Almost inevitable that the incident could occur.

Value

Risk Rating

Catastrophic

13 16 = Extreme Risk

High

Imminent danger, LTA, severe illness/injury, major property damage. Medical (Doctor) treatment case, disability, cause illness/injury and property damage but not expected to be major.

Has a good chance of occurring and is not unusual.

10 12 = High Risk

Medium

Will occur in time but not immediately.

5 9 = Medium Risk

Low

Negligible injury/illness, minor first aid.

Expect to occur very rarely.

1 - 4 = Low Risk