Hazard Identification Risk Assessment and Determine Control (New)

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Department / Proses:

• Date assess/review:

  Date

• Reason to review

  Periodic review

  Process Change

  Incident

  Other MOC

• HIRADC Assessor:

HIRADC Assessment

• Activity

Activity

• Activity:

• Add media

  Media
Hazard

• Hazard Classification

  Select Physical Chemical Biological Psychosocial Electrical Mechanical Base on Movement Base on Energy

  • Physical
  • Chemical
  • Biological
  • Psychosocial
  • Electrical
  • Mechanical
  • Base on Movement
  • Base on Energy

• Hazard Description

• Effect

• Existing Control

• Probability

  1

  2

  3

  4

  5

• Severity

  1

  2

  3

  4

  5

• Risk Rating

  1-5

  6-14

  15-25

• 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

Residual Risk

• Probability

  1

  2

  3

  4

  5

• Severity

  1

  2

  3

  4

  5

• Risk Rating

  1-5

  6-14

  16-25

• Significant Risk

  HIGH

  MEDIUM

  LOW

Department Head/Representative Approval

• Approved by:

  Sign

• Remark: