Hazard Identification Risk Assessment and Determine Control - duplicate

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Department / Proses:

• Date assess/review:

  Date

• HIRADC Assessor:

HIRADC Assessment

• Activity

Activity

• Activity:

• Add media

  Media
Hazard

• Hazard Classification

  Physical

  Chemical

  Biological

  Psychosocial

• Hazard Description

• Effect

• Existing Control

• Probability

• Severity

• Risk Rating

• Significant Hazard

  HIGH

  MEDIUM

  LOW
Control Measure

• Control Measure

• Due date:

  Date

• Departmental Program?

  Off

  On

• Person in charge:

  Sign

• Status of the Program

  Open

  Closed

  KIV

Department Head/Representative Approval

• Approved by:

  Sign