Title Page

  • Activity

  • Date

  • Location in General
  • Location in Detail

  • Assessor

  • Personnel

Hazard Identification and Risk Assessment (HIRA)

  • Activity shall not commence until suitable and adequate risk assessment has been carried out.

  • HIRA carried out?

  • HIRA Document Number:

  • HIRA control measures implemented?

  • Activity shall not commence until all identified control measures are in place and effective.

Assessment

  • If response is NO to any statement and the concern cannot be safely rectified by activity lead, report to supervisor for guidance (details to be confirmed in remarks below).

  • Confirm ALL personnel understand the hazards, risks and controls associated with activity/task.

  • Confirm ALL necessary Permit(s) to Work (PTW) are complete and displayed in accordance with operator policy and procedure.

  • Confirm ALL personnel have read and understand Permit to Work (PTW) requirements.

  • Confirm ALL personnel hold in-date induction training relevant to the area(s) of operation.

  • Confirm ALL personnel hold in-date documentation required to gain access to the area(s) of operation.

  • Confirm ALL personnel understand area arrangements for emergency evacuation, preparedness and response.

  • Confirm arrangements for safe access/egress to, from and throughout area(s) of operation.

  • Confirm tools and equipment are suitable for use and in-date mandatory servicing and inspection.

  • Confirm ALL personnel hold suitable and adequate training, competence and experience for the task(s) assigned.

  • Confirm risk from simultaneous operations (SIMOPS) is controlled.

  • Confirm that all significant risk within area(s) of operation has been identified as part of task risk assessment.

  • Provide details of the nature of the task to be carried out and: • Answers of No to any statement as part of assessment. • General Health, Safety and Environmental feedback. • Additional hazards, level of risk and control measures implemented.

  • DRA is to be carried out by an individual at the following times:
    • Before starting a new task or tasks that involve a PTW and/or a revision to extant PTW.
    • At the start of a shift for ongoing tasks.
    • Where control measures for a task change.
    • If assessments become invalid due to changes in circumstances.

    Negative responses must be identified and resolved prior to commencement of operations for which this DRA is associated.

  • Completed DRA form returned to supervisor and HSEQ Lead?

  • All completed DRA forms to be returned to supervisor and HSEQ Lead.

Imagery

  • Add images as necessary.

  • Add drawing as necessary.

Signature

  • Add signature

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