Hirarc Form
Hirarc Form
Hirarc Form
1.
2.
3.
4.
5.
6.
HIRARC FORM
HIRARC FORM
Company:
Process / Location:
Approved by:
(Name, designation)
Date:
Conducted by:
(Name,
designation)
Date:
(from to)
Review Date:
Next Review
Date:
Review 1:
Review 2:
1. Hazard Identification
No.
Work
activity
Hazard
Walking
along the
pavement
Uncovere
d
constructi
on site
Walking/
Jogging
Hole
There is
no
divider
between
the
sidewalk
and the
road.
Reid-bar
3
4
5
6
Uneven
dock
Nail is
exposed
Trip
Fall
Fall
Steppin
g on nail
2. Risk Analysis
3. Risk Control
Which can
cause /
effect
Bodily
Injured
Existing Risk
Control (if
any)
Pedestrian to
walk
opposite of
the direction
of the
vehicles.
Likeliho
od
Severi
ty
Risk
12
Bruises
and cuts
Put up fence
around the
site
Bruises
and cuts
Bruises
and cuts
Put up fence
Cover-up the
hole
Bruises or
Drown
Injuries
Repair the
dock
Hammer the
nail
Recommended
Control
Measures
Engineering
PIC
Due
Date
Status
7/04/201
6
Isolation
7/04/201
6
In
Progre
ss
Isolation
Elimination
7/04/201
6
7/04/201
6
15
Engineering
Engineering
7/04//20
16
7/04/201
6
In
progre
ss
Done
APPENDIX
Figure 1: Sidewalk
Figure 4: Hole