This document is a Hazard Identification and Risk Assessment (HIRA) form used to document a HIRA that was conducted. It includes sections to record the date, location, activity, and name and number of the document being assessed. The main body is a 5x5 risk matrix table to assess job steps, associated hazards and risks, existing controls, likelihood, consequence, and overall risk rating. Risk ratings of 13 or higher require a safe work procedure to be developed. The supervisor details are recorded at the bottom. Additional resources on hazards, risk assessment and the risk matrix are referenced.
This document is a Hazard Identification and Risk Assessment (HIRA) form used to document a HIRA that was conducted. It includes sections to record the date, location, activity, and name and number of the document being assessed. The main body is a 5x5 risk matrix table to assess job steps, associated hazards and risks, existing controls, likelihood, consequence, and overall risk rating. Risk ratings of 13 or higher require a safe work procedure to be developed. The supervisor details are recorded at the bottom. Additional resources on hazards, risk assessment and the risk matrix are referenced.
This document is a Hazard Identification and Risk Assessment (HIRA) form used to document a HIRA that was conducted. It includes sections to record the date, location, activity, and name and number of the document being assessed. The main body is a 5x5 risk matrix table to assess job steps, associated hazards and risks, existing controls, likelihood, consequence, and overall risk rating. Risk ratings of 13 or higher require a safe work procedure to be developed. The supervisor details are recorded at the bottom. Additional resources on hazards, risk assessment and the risk matrix are referenced.
This document is a Hazard Identification and Risk Assessment (HIRA) form used to document a HIRA that was conducted. It includes sections to record the date, location, activity, and name and number of the document being assessed. The main body is a 5x5 risk matrix table to assess job steps, associated hazards and risks, existing controls, likelihood, consequence, and overall risk rating. Risk ratings of 13 or higher require a safe work procedure to be developed. The supervisor details are recorded at the bottom. Additional resources on hazards, risk assessment and the risk matrix are referenced.
Download as DOCX, PDF, TXT or read online from Scribd
Download as docx, pdf, or txt
You are on page 1/ 3
HIRA form
Department/section: ............................................................................... Time the HIRA was conducted (e.g., 22:00) ...... H ........
Page 2 of 3 Consequenc e 1 2 3 4 5 Minor Low Medium High Major Likelihood Elimination – the hazard is eliminated to avoid the associated risk 5 Medium Significant Significant High High Almost Certain 11 16 20 23 25 Substitution – the activity, process 4 Medium Medium Significant High High and/or material is substituted for one Likely that is less hazardous 7 12 17 21 24
3 Low Medium Significant Significant High Engineering and process control –
Possible 4 8 13 18 22 redesign the equipment, work process or automated processes to prevent 2 Low Low Medium Significant Significant interaction between the hazard and Unlikely 2 5 9 14 19 personnel and/or the environment
1 Low Low Medium Medium Significant Separation – separate the hazard by
Rare 1 3 6 10 15 enclosing or physically guarding it. This allows for physical barriers (human put in place and maintain) and non-human Figure 1: 5 x 5 Matrix interaction (interlocks, etc.)
Administration – including management
strategies, procedures (e.g. isolation, Note: temporary barricading, spill response), ‘Documents of Interest” can be located at the following location: SWPs, training, inductions, signage etc. Palweb > SHEQ MS > 2.1 Hazard Identification and Risk Assessment (HIRA) < Documents of Interest Personal Protective Equipment (PPE) – in compliance with the Palabora Personal Examples of useful documents: Protective Equipment Standard
A “List of Generic hazards / energy sources”
The “5x5 Risk Matrix” Figure 2: Hierarchy of control
