Title Page
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Activity
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Date
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Location in General
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Location in Detail
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Assessor
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Personnel
Hazard Identification and Risk Assessment (HIRA)
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Activity shall not commence until suitable and adequate risk assessment has been carried out.
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HIRA carried out?
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HIRA Document Number:
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HIRA control measures implemented?
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Activity shall not commence until all identified control measures are in place and effective.
Assessment
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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).
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Confirm ALL personnel understand the hazards, risks and controls associated with activity/task.
- Yes
- N/A
- No
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Confirm ALL necessary Permit(s) to Work (PTW) are complete and displayed in accordance with operator policy and procedure.
- Yes
- N/A
- No
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Confirm ALL personnel have read and understand Permit to Work (PTW) requirements.
- Yes
- N/A
- No
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Confirm ALL personnel hold in-date induction training relevant to the area(s) of operation.
- Yes
- N/A
- No
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Confirm ALL personnel hold in-date documentation required to gain access to the area(s) of operation.
- Yes
- N/A
- No
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Confirm ALL personnel understand area arrangements for emergency evacuation, preparedness and response.
- Yes
- N/A
- No
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Confirm arrangements for safe access/egress to, from and throughout area(s) of operation.
- Yes
- N/A
- No
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Confirm tools and equipment are suitable for use and in-date mandatory servicing and inspection.
- Yes
- N/A
- No
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Confirm ALL personnel hold suitable and adequate training, competence and experience for the task(s) assigned.
- Yes
- N/A
- No
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Confirm risk from simultaneous operations (SIMOPS) is controlled.
- Yes
- N/A
- No
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Confirm that all significant risk within area(s) of operation has been identified as part of task risk assessment.
- Yes
- N/A
- No
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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.
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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?
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All completed DRA forms to be returned to supervisor and HSEQ Lead.
Imagery
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Add images as necessary.
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Add drawing as necessary.
Signature
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Add signature