HPFOOD-HIRAC

• Departments / Title

• Risk assessment facilitated by:

• Worksite Manager:

• Team Leadero

• Line Manager

• Supervisors:

• WHS Officer:

• Details / Job Description:

• Job Number

• Location / Worksite
  Address

• Conducted on

  Date

• Planning Risk Analysis

Preparation

• Detailed description of work (Add further notes and follow-up action if required)

• Select Risk Rating for Work

  High Risk Construction Work

  High Risk Work

  Medium Risk Work

• Name and Signature of Person Responsible

  Sign

• Description of activity being conducted

• Hazard Identification, Risk Assessment and Control

HIRAC

• Step, Hazard and Risk Rating

  Low Risk

  Med Risk

  High risk

  At Risk

• Worksite Control and Risk Rating

  Eliminate

  Substitute

  Eng/Isolate

  Administration

  PPE

• Additional hierarchy of controls used?

  Select Eliminate Substitute Eng/Isolate Administration PPE

  • Eliminate
  • Substitute
  • Eng/Isolate
  • Administration
  • PPE

• Name and Signature of Person Responsible (Sign when control completed)

  Sign

2. Facilitator Details

• Facilitator details

Facilitator

• Comments / Recommendations

• Name and Signature

  Sign

3. Worker Details

• Worker details

Worker

• Comments / Recommendations

• Name and Signature

  Sign