Sunday, April 20, 2014

IDENTIFIED RISK PROPOSAL FORM

IDENTIFIED RISK PROPOSAL FORM                              Consecutive No ________


VESSEL
COMPANY
   
Vessel/ Dept.

Date:

Short description of risk identified.

Person(s) and associated ranks dealing with the identified risk reporting.




Frequency (likelihood) may be expressed in terms of:
once per trip            once per ship year           once per fleet year

Consequence may be made more specific by the use of:
first aid injury        serious injury        death       damage to property / environment

RISK = FREQUENCY x CONSEQUENCE


CONSEQUENCE SEVERITY
4

Catastrophic

MEDIUM
HIGH MEDIUM
HIGH MEDIUM
HIGH
3
Severe
MEDIUM LOW
MEDIUM
HIGH MEDIUM
HIGH MEDIUM
2
Significant
LOW
MEDIUM LOW
MEDIUM
HIGH MEDIUM
1
Minor
LOW
LOW
MEDIUM LOW
MEDIUM

Extremely remote
Remote
Reasonable probable
Frequent
1
2
3
4

                                OCCURRENCE FREQUENCY


Risk level acceptable

Risk level tolerable

Risk level is not tolerable

Person responsible/ rank: ___________________ / _______________

Date form issued: ___________________  Date distribution to Company: _________________

Date form received in Company: ________________

DPA signature: ______________________

The present form must be acknowledged and distributed for proper analyze to qualified personnel; depending on final results the Company will proceed with further amendment of the existing SMS.