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Hirarc: Sample Hazard Identification Template

The document provides a template for a Hazard Identification and Risk Assessment (HIRARC) form that includes sections to identify hazards, analyze risks, and control risks. The form is to be used by a company to document potential hazards, existing risk controls, likelihood and severity of risks, and recommended additional control measures for various work activities and processes. A disclaimer at the bottom notes that the template is meant as a general guideline and the company is responsible for ensuring all laws and regulations are followed.

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Mohamad Zakwan Zach Zakaria
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228 views1 page

Hirarc: Sample Hazard Identification Template

The document provides a template for a Hazard Identification and Risk Assessment (HIRARC) form that includes sections to identify hazards, analyze risks, and control risks. The form is to be used by a company to document potential hazards, existing risk controls, likelihood and severity of risks, and recommended additional control measures for various work activities and processes. A disclaimer at the bottom notes that the template is meant as a general guideline and the company is responsible for ensuring all laws and regulations are followed.

Uploaded by

Mohamad Zakwan Zach Zakaria
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Sample Hazard Identification Template tft-earth.

org

HIRARC
HIRARC FORM

Company Name Conducted


by: (Name,
designation)
Process/Location Date:
(from…to ..)
Approved by: Last Review 1.
(Name, Date
2.
designation)
Date DD MM YYYY

No 1.) Hazard Identification 2.)Risk Analysis 3.) Risk Control


Work Activity Hazard Potential Existing Likeliho Sever Risk Recommend Person In
Effect Risk od ity Control Measure Charge
Control (Due Date)
(if any)
1 Example: Spra Example: Example: Exampl Example:
ying Hazardous Accident e: Safe Appropriate
chemicals al work facemasks/respir
are used contact practice ators, goggles,
with and face double-sided
chemical mask aprons, nitrile
s (eyes, gloves
inhalatio
n, etc.)
2

DISCLAIMER: The information in this document is prepared for a brief and general guideline on occupational health and safety and has been compiled using
various sources publicly available. Efforts have been made to ensure that relevant information has been included; however TFT does not claim that the
information in this guideline is exhaustive. Further, this document does not purport to contain all the information that the end user or reader including but not
limited to employers, buyers, importers, manufacturers, suppliers or distributors (collectively “End User”) may desire to understand regarding the processes,
practices or laws in Malaysia in respect of occupational health and safety or employment. The intent of this document is to provide basic guidelines which may be
of some help to the end user. With the help of this document, the end user should ensure that the relevant laws, rules, regulations and guidelines are applicable,
suitable, updated and relevant to their company or business as a whole.

TFT, its subsidiaries, related corporation, affiliates, associates, business partners (collectively, “TFT Group”) and TFT’s directors, shareholders, officers, employees,
agents, representatives and advisers (“Representatives”) do not:- (i) make any representation, undertaking or warranty, express or implied, nor any of them, to
the extent permitted by law, have any responsibility or liabilities whatsoever in respect of the truth, accuracy or completeness of, or omission from, this document
or any related documents or information, whether written or oral, supplied at any time or in respect of any statement, disclosure, or opinion expressed or omitted;
(ii) owe any duty of care or otherwise owed by TFT Group or its Representatives to the End User in respect of or in connection with this document; (iii) have any
obligation to update this document or to correct any inaccuracies, incompleteness or omissions therein; and (iv) accept any responsibility or liability to any reader
or third party for any damages, loss, cost or expense, or any loss of profits, business or anticipated savings or for any consequential loss whatsoever, whether
directly or indirectly, due to or in connection with any negligence, error, misstatement, misrepresentation or omission by TFT Group or its Representatives.

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