METHOD STATEMENT
Date of the work scheduled:
Outside berm
Facility/Area/Location WQ-02 CL 06
SAP Work Order №:
-Soil washout filling for the outside security berm berm, location eastern side.
General Work Title: -Adjusting damaged barbed wire fence on the outside security berm, location North and southern sides
Equipment №:
Type of Permit: CWP / HWP / N/A
Type of Certificate: CSEC / EC / GCC / RC / N/A
Type of Isolation: EIC / MIC / PSIC / N/A√
PH confirms that the task will be carried out as per defined steps in this MS
Permit Holder: Name Mohammed Fakhri
_______________________ Signature ________________________
PRA accepts and endorses steps of work defined in this MS
Person Responsible for the Area: Name _______________________ Signature ________________________
Approved – Site Owner: Name _______________________ Signature ________________________
№ Main steps of the work process Equipment Required
1 TBT before and activity kick off in site.
2 Equipments to enter site from the chosen proper routes
3 Soil to be provided to site from a proper borrow pit
4 Front loader to start leveling process with caution - (inside and outside the cluster) Front Loader
5 JCB to start backfilling the slopes after backfilling completion- (inside and outside the cluster) JCB
6 Re-install the barbed wire post Unskilled Worker
7 Re-adjust the barbed wire fence Unskilled Worker
8 Housekeeping and PTW closure. Unskilled Worker
9
Assigned Risk Assessment Team
Approving Authority:
RA Team Leader:
RA Team members:
RISK ASSESSMENT № PTW № (if required) WORK TITLE Pages
REVISION: DATE: - Soil washout filling for the outside security perimeter berm, location eastern side. № of
…………………….……………..
№ - Adjusting damaged barbed wire fence on the outside security perimeter, location North and southern sides 1 1
Impact Initial Residual
Risk (People) Risk (People)
People
Equipment
Environment
Reputation
Severity
Likelihood
Risk
Severity
Likelihood
Risk
Activity Hazards Associated Risks Control Measures
COVID-19 Pre-shift Temperature check for all involved workers
All activities Respiratory/medical masks to be worn constantly during the
transportation from the places of accommodation to workplaces.
Regular disinfection of shared workplaces / Containers /Vehicles.
Maintain proper personal hygiene level, wash your hand with soap
or use sanitiser.
Avoid touching your eyes, nose, and mouth with unwashed hands.
Personnel illness Do not share personal items like: PPE, mobile phones, drinking
Delay or bottles, crockery, etc.
x x x 3 4 12 2 3 6
shutdown of Shared work tools or equipment shall be regularly disinfected.
operations Avoid close contact: like shaking hands, hugging or kissing as a
greeting.
Avoid unauthorized meetings / gathering of people.
Full PPE to be worn all time including masks.
Physical distance to be respected when possible.
Preventive measure to be discussed at daily TBT.
Work task to be planned and assigned with regards of above
COVID-19 preventive measures.
Workers unaware of the hazards
Unseen hazards Injuries Carry out a specific Tool Box Meeting before work starts (each day)
Work preparation Collisions Explain the details of the JRA
Underground facilities at work site x x x 3 4 12 Install barricade and hazard warning signs 2 2 4
Hazards Dehydration/fati
Provide regular rest breaks, Cold water, Shelter
gue Ensure the workers are using correct tools and PPE
Weather/ Heat
Access / Egress / Obstructing access/ escape routes
Plot plan detailing work site with all access/egress routes clearly
Movement of people identified.
Personal injury Adequate safety signage to guide personnel to safe area.
x x 4 4 16 Walkways kept clear of loose materials, tools, connections (hoses, 3 2 6
Collisions
wires, etc.).
Induction process for all personnel prior to entering site.
PPE
Assigned Risk Assessment Team
Approving Authority:
RA Team Leader:
RA Team members:
RISK ASSESSMENT № PTW № (if required) WORK TITLE Pages
REVISION: DATE: - Soil washout filling for the outside security perimeter berm, location eastern side. № of
…………………….……………..
№ - Adjusting damaged barbed wire fence on the outside security berm, location North and southern sides 2 1
Impact Initial Residual
Risk (People) Risk (People)
People
Equipment
Environment
Reputation
Severity
Likelihood
Risk
Severity
Likelihood
Risk
Activity Hazards Associated Risks Control Measures
Movement of vehicles Uneven ground, wet and slips
Certified operator.
conditions
such as dump trucks, Route is planned and inspected prior to commencing activity.
Collision with other vehicles, people,
Injuries Load secures.
trailer, front loader equipment, facility
Strict enforcement of speed limit.
Noise Damage to
x x x 5 4 20 Where possible, barrier off area preventing access by people or other 3 1 3
Fire / explosion / Injury / Fatality facility or
vehicles and install warning signs
equipment Banksman in place for areas of limited access.
Provision of reverse alarm
Flag man and Supervisor should be in the work area all times
Leveling of Unaware of working method Install barricades and hazard warning signs around work place
natural/existing ground, Trained and experience operator to operate the Equipment.
Collison Ensure reverse alarm and warning light are working
backfilling Personal Injury Unauthorised people must be out of working area
Electricity Shock x x x 4 4 16 2 2 4
Property Damage Ensure all Equipment are inspected and Colour coded.
Flag man and Supervisor should be in the work area all times
Check with site owner for record of underground facilities
PPE
Assigned Risk Assessment Team
Approving Authority:
RA Team Leader:
RA Team members:
RISK ASSESSMENT № PTW № (if required) WORK TITLE Pages
REVISION: DATE: - Soil washout filling for the outside security perimeter berm, location eastern side. № of
…………………….……………..
№ - Adjusting damaged barbed wire fence on the outside security berm, location North and southern sides 3 1
Impact Initial Residual
Risk (People) Risk (People)
People
Equipment
Environment
Reputation
Severity
Likelihood
Risk
Severity
Likelihood
Risk
Activity Hazards Associated Risks Control Measures
Manual handling AVOID MANUAL HANDLING IF IT CAN BE CARRIED OUT
MECHANICALLY
Weight of load to be checked before lifting – trial lift
Try lifting one corner, if it is too heavy use second person or other
means (Mechanical) to lift item.
Consider dual lifting (general rule of thumb if above 25 kg)
Carrying a load MAX allowed weight to be lifted by single person is 25 kg
too heavy Loads that can easily be carried a short distance can often be a
Carrying long problem when carrying long distances – take this into consideration
distance when assessing the weight of the load –( Even a load of less than 25
x x 4 6 24 kg can pose a problem if it has to be carried a long distance or up 4 2 8
Dropped load
and down stairs)
Personal injury Regular breaks should be taken
Damage to Load to be carried close to body at waist height
equipment Check the route first before lifting.
Correct lifting techniques to be used at all times e.g. lifting using legs
with load held close to your body, take a firm grip, maintain straight
back, turn body not twisting upper body and avoid overreaching
Make sure you can see over the load
Try to push the load rather than pull
Use leg muscles as much as possible
Completion of works Lack of work area protection
and housekeeping on improper material stack, trash or
Make safe working area.
site food waste Health and Remove all combustible materials from the site after finish the job
x x x personal injury 2 4 8 Stack materials properly 1 2 2
Pollution Maintain good housekeeping
Supervisor should check the work place after completion of work.
Assigned Risk Assessment Team
Approving Authority:
RA Team Leader:
RA Team members: Mohammed Fakhri
RISK ASSESSMENT № PTW № (if required) WORK TITLE Pages
REVISION: DATE: - Soil washout filling for the outside security perimeter berm, location eastern side. № of
…………………….……………..
№ - Adjusting damaged barbed wire fence on the outside security berm, location North and southern sides 4 1
Impact Initial Residual
Risk (People) Risk (People)
People
Equipment
Environment
Reputation
Severity
Likelihood
Risk
Severity
Likelihood
Risk
Activity Hazards Associated Risks Control Measures
Approving Authority * Job Title: Signature: Date: * For Yellow color of RAM
RA Team Leader ** Job Title: Road Infrastructure Supervisor Signature: Date: ** For Green color of RAM
RA Team member Job Title: Signature: Date:
RA Team member Job Title: Signature: Date:
RA Team member Job Title: Signature: Date:
Attachment to RA Form
Risk Assessment Matrix (RAM)
CONSEQUENCES INCREASING LIKELIHOOD
1 2 3 4 5
SEVERITY
Environment
Reputation
Property
Has happened in
People
Has happened at the
PJSC LUKOIL or Has happened more
Never recorded Recorded in the WQ-2 or more than
more than once than once per year
in the Industry Industry once per year in
per year in the at the WQ-2
PJSC LUKOIL
Industry
Massive Damage Major
Multiple
5 > 10.000.000 Massive effect International 1х5 2х5 3х5 4х5 5х5
fatalities
USD impact
Single fatality or Major Damage
Major National
4 permanent 1.000.000 – Major effect 1х4 2х4 3х4 4х4 5х4
impact
disability 10.000.000 USD
Major injury or Moderate Damage
Considerable
3 health effect 100.000 – Local effect 1х3 2х3 3х3 4х3 5х3
impact
(LWDC) 1.000.000 USD
Minor injury or Minor Damage
2 health effect 10.000 – 100.000 Minor effect Limited impact 1х2 2х2 3х2 4х2 5х2
(MTC/RWDC) USD
Slight injury or
Slight Damage
1 health effect Slight effect Slight impact 1х1 2х1 3х1 4х1 5х1
< 10.000 USD
(FAC)
TOOL BOX TALK FORM for PTW № _ _ _ _
All persons working under this PTW shall sign the form off before commencing of work to confirm
that they have understood the task and have been explained of the associated hazards. Work party must
understand the control measures which have been put in place and the actions they must follow.
Permit Holder Declaration:
PH declare that the Toolbox Talk has been held and all work team members were in attendance.
________________________ :Name __________________ :Signature _____________ :Date ___________ :Time
LIST OF PERSONNEL AT WORKING PLACE
Date Time Name Company Position Signature
