Hirarc FORM Sample Clinic

HAZARD IDENTFICATION, RISK ASSESSMENT AND RISK CONTROL (HIRARC) FORM
Doc No.
Prepared by Revision No :
JOB TITLE Verified by Date :
Activities / Equipment/
Facilites
R/NR* Hazard Consequences Current Risk Control Likelihood Severity
Risk
Level
Type of Control
Recommended
Control Measures
PIC (Due
Date /
Status)
R
Infectious
Diseases
Hepatitis B,
Hepatitis C and
Human
Immunodeficienc
y Virus (HIV) can
be spread by
infected blood
and body fluids
when they come
into direct
contact with
broken, scraped,
chapped or
inflamed skin or
when skin is
punctured by a
sharp object
such as a
needle.
13 a) wash hands
frequently (proper
handwashing is the
best way to prevent
communicable
diseases)
13 b) Follow
Routine Practices
at all times for all
patients
13 c) Check with
your Occupational
Health Nurse
regarding
immunizations
3 3 9 (M) Adminstrative
13 a) Provide a
written Routine
Practices document
that is easily
accessible
13 b) Ensure
availability of gloves
and other protective
equipment and
cleansing agents
13 c) Establish a
sharps program
13 d) Establish an
immunization
program for all
workers
Mr. F
(30/12/2011)
*R-Routine, NR - Non Routine
LIKELIHOOD SEVERITY
Most Likely (5) The most likely result of the hazard / event being realised Catastropic (5) Numerous fatalities
Possible (4) Has a good change of occuring and is not unusual (1-5 years) Fatal (4) Approximately one single fatality
Conceivable (3) Might be occur at sometime in future (5-10 years) Serious (3) Non-fatal injury, permanent disability or > 4 days MC
Remote (2) Has not been known to occur after many years (10 yrs) Minor (2) Disabling but not permanent injury or 1-4 days MC
Inconceivable (1) Is practically impossible and has never occurred Negligible (1) Minor abrasions, bruises, cut, first aid type injury
RISK = LIKELIHOOD X SEVERITY 15 - 25 : HIGH RISK 5-12 MEDIUM 1 - 4 : LOW RISK
RISK CONTROL
13
handling patients,
contaminated objects,
body secretions,
tissue or fluids
Working in Clinic
No
HAZARD IDENTIFICATION RISK ASSESSMENT
Doc No.
Facilites
Risk
Level
Type of
Control
Recommended
Control Measures
PIC (Due Date /
Status)
R
9.1 a) Exposure
to known &
unknown
bacteria, fungal &
viruses
9.1 a) Sick
9.1 b) Fatality
9.1 a) Competency
& Proper PPE to be
worn
2 2 4 (L) NIL NIL
10
Clearing medical
waste
R
10 a) Contact
with sharp object
10.1 a) Sick
10.1 b) Fatality
10.1 a)Competency
& Proper PPE to be
worn
2 2 4 (L) NIL NIL
11
Using X-ray machine
R
11 a) Exposure to
radioactive and
radiation
11.1 a) Cancer
11.1 b) Fatality
11a) Competency &
Proper PPE to be
worn
11b) Safe work
distance, allowable
exposure limit &
2 2 4 (L) NIL NIL
12
Release
Contamination /
Hospital treated waste
R
12 a) Scheduled
waste
12 a) Pollution to
atmosphere,
sanitary sewer,
ground water,
fresh water, soil
12a) Competency &
Proper PPE to be
worn
2 2 4 (L) NIL NIL
LIKELIHOOD SEVERITY
RISK CONTROL
No
Working in Clinic
9
Receive & treat
patient
Doc No.
Facilites
Risk
Level
Type of Control
Recommended
Control Measures
PIC (Due Date
/ Status)
R
14 a) Heavy lifting
and frequent
bending or
twisting when
moving objects or
patients
Back injuries 14 a) Use available
lifts
14 b) Get help to lift
if mechanical device
is not appropriate or
not available
14 c) Use proper
lifting technique
3 3 9 (M) Administrative
14 a) Provide
accessible
mechanical lifts
(ceiling lifts preferred)
14 b) Ensure all staff
are trained to use
mechanical lifts
14 c) Train staff on
proper lifting
techniques
Mr. G
(30/12/2011)
LIKELIHOOD SEVERITY
RISK CONTROL
14
Handling patients &
moving objects
Working in Clinic
No
Doc No.
Facilites
R/NR* Hazard Consequences Current Risk Control
Likeliho
od
Severit
y
Risk
Level
Type of Control
Recommended
Control Measures
PIC (Due
Date / Status)
15
Shiftwork
R
15 a) Changing
shifts and working
at night disrupts
your bodys
natural rhythms.
15 a) It can
contribute to
digestion
problems, heart
disease, and
sleep problems.
15 b) It also
makes
participation in
social activities
and family life
difficult.
15 a) Ask your
doctors advice
before becoming a
shift worker if you
have diabetes,
asthma, epilepsy or
mental health
problems
15 b) Improve your
sleep by practising a
regular bedtime
ritual and avoid
caffeine, smoking
and sleeping pills.
15 a) Avoid a
permanent night shift
15 b) Limit the
number of nights
worked
in a row
15 c) Avoid an early
start for morning
shifts
15 d) Give as many
weekends off as
possible with at least
two days off in a row
15 e) Keep schedules
regular and give
workers plenty of
notice of the
schedules
Mr. H
(30/12/2011)
LIKELIHOOD SEVERITY
RISK CONTROL
Working in Clinic
No
Doc No.
Facilites
Likeliho
od
Severit
y
Risk
Level
Type of Control
Recommended
Control Measures
PIC (Due
Date / Status)
R
16 a) Repetitive
Strain Injury (RSI)
16 a) Injury
usually affects
the wrist, hand,
shoulder, elbow,
back, knee or
ankle.
16 b) It can
cause pain,
weakness,
numbness or
difficulty in
grasping objects.
16 a) Organize your
work day so
repetitive tasks are
done for short
periods throughout
the day
16 b) Take regular
breaks
16 a) Provide
ergonomically correct
tools and equipment
16 b) Allow staff
control over how they
organize their work
day
16 c) Promote rest
breaks
Mr. I
(30/12/2011)
LIKELIHOOD SEVERITY
16
Repetitive, forceful or
awkward body
movements when
handling patient or
equipment
RISK CONTROL
Working in Clinic
No
Doc No.
Facilites
Likeliho
od
Severit
y
Risk
Level
Type of Control
Recommended
Control Measures
PIC (Due
Date / Status)
R
17 a) Health care
workers are at
risk from violence
17 a) Workplace
violence can
result in loss of
sleep, fear or
depression, post
traumatic stress
disorder, and
sometimes even
death.
17 a) Follow policies
and intervention
guidelines
17 b) Report
incidents to your
health and safety
representative
and/or committee.
17 a) Acknowledge
that violence is an
issue
17 b) Work with the
Health & Safety
Committee to identify
risks and develop
solutions
17 c) Post visible
signs reminding all
that this is a
respectful workplace
17 d) Train staff on
diffusing situations
and intervention
procedures
Mr. J
(30/12/2011)
LIKELIHOOD SEVERITY
17
Dealing with angry
and stressed patients
and their families.
RISK CONTROL
Working in Clinic
No
Doc No.
Facilites
Likeliho
od
Severit
y
Risk
Level
Type of Control
Recommended
Control Measures
PIC (Due
Date / Status)
R
18 a) Long term
and repeated
exposure to
radiation
18 b) Light beams
from lasers
18 a)can cause
genetic dam age
and reproductive
health problems.
18 b) Can harm
the eyes and
skin.
18 a) Follow
procedures and use
PPE

18 b) Take all safety
concerns to your
health and safety
representative
and/or committee
18 a) Provide
personal protective
equipment (PPE)
such as shield aprons
and safety glasses
18 b) Establish
procedures for use of
diagnostic equipment
and PPE
18 c) Minimize
exposure time to
radiation
18 d) Ensure warning
signs are posted
where appropriate
Mr. K
(30/12/2011)
LIKELIHOOD SEVERITY
18
18 a) Radiation is
used in diagnostic
procedures such
as x-ray, fluoroscopy
and angiography.
18 b) Used in tre atm
ents using radioactive
material.
18 c) Used in
microwaves, magnetic
fields and lasers.
RISK CONTROL
Working in Clinic
No
Doc No.
Facilites
Likeliho
od
Severit
y
Risk
Level
Type of Control
Recommended
Control Measures
PIC (Due
Date / Status)
R
19 a) A chemical
can enter your
body in three
main ways
i) It can be
breathed in
ii) It can go
through your skin
iii) It can be
swallowed
19 a) Cause
serious illness
and in some
cases, death.
19 b) Often the
effects are not
noticeable right
away.
19 a) Take concerns
to workplace health
& safety
representative
and/or committee
19 b) Read labels of
all chemicals used
and if m ore
information is
required, go to the
MSDS
19 a) Work closely
with the workplace
health & safety
committee to identify
chemicals used and
find out what health
effects they may have
19 b) Maintain all
MSDS (material
safety data sheets)
19 c) Eliminate toxic
chemicals or
substitute with less
toxic alternatives
when possible.
Mr. L
(30/12/2011)
LIKELIHOOD SEVERITY
19
Exposure to
chemicals in the form
of dusts, vapours,
gases or liquids.
RISK CONTROL
Working in Clinic
No
Doc No.
Facilites
Likeliho
od
Severit
y
Risk
Level
Type of Control
Recommended
Control Measures
PIC (Due
Date / Status)
R
20 a) Long term
exposure to high
levels of noise
(more than 80
decibels)
20 a) Cause
permanent
hearing loss.
20 b) Noise can
distract workers
and make it
difficult to
communicate
and concentrate.
20 a) Report any
equipment
malfunction as soon
as possible
20 b) Wear hearing
protection
20 c) Have hearing
checked regularly
20 a) Isolate noisy
machines in a room
where workers
seldom need to be
20 b) Use noise
dampeners
20 c) Maintain
equipment in good
working order
provide hearing
protection
Mr. M
(30/12/2011)
LIKELIHOOD SEVERITY
20
High levels of noise
from kitchens,
laundries and boiler
rooms.
RISK CONTROL
Working in Clinic
No
Doc No.
Facilites
Likeliho
od
Severit
y
Risk
Level
Type of Control
Recommended
Control Measures
PIC (Due
Date / Status)
R
21) Needlestick /
Sharps Injuries -
a) Unsafe needle
devices.
b) Improper
handling and
disposal of
needles and other
sharps.
21a) cause
disease in
humans. These
pathogens
include Human
Immunodeficienc
y Virus (HIV),
Hepatitis B Virus
(HBV), Hepatitis
C Virus (HCV),
and others.
21 a) Isolate or
remove the
bloodborne
pathogens hazard
from the workplace
21 b) Employee
injury is later
diagnosed with an
infectious
bloodborne disease
21 c) Use safer
needle devices and
needleless devices
to decrease
needlestick or other
sharps exposures.
21 a) Continously
send worker training
in appropriate
engineering controls
and work practices, to
eliminate or minimize
worker exposure.
Mr. N
(30/12/2011)
LIKELIHOOD SEVERITY
21
handling sharp
devices or equipment
such as scalpels,
sutures, hypodermic
needles, blood
collection devices, or
phlebotomy devices
RISK CONTROL
Working in Clinic
No
Doc No.
Facilites
Likeliho
od
Severit
y
Risk
Level
Type of Control
Recommended
Control Measures
PIC (Due
Date / Status)
R
22 a) Slip and
Falls
22 a) Slip and
trip
22 b) Body
injury
22 a) Use the non
slippery shoe or
sandals.
22 b) Avoid failing of
greasy liquids on
floor
a) Avoid slippery
flooring
b) Fix the side bars or
handles on stair case
c) Clean floor
regularly to avoid the
contents of greasy
liquids
Mr. O
(30/12/2011)
LIKELIHOOD SEVERITY
22
Walking on the
slippery floor
RISK CONTROL
Working in Clinic
No
Doc No.
Facilites
Likeliho
od
Severit
y
Risk
Level
Type of Control
Recommended
Control Measures
PIC (Due
Date / Status)
R
23 a) Exposure to
hazardous
processes or
infectious
materials or
chemicals
23 a) cause
disease in
humans through
pathogens
include Human
Immunodeficienc
y Virus (HIV),
Hepatitis B Virus
(HBV), Hepatitis
C Virus (HCV),
and others.
23 a) Wear gloves,
when handling
chemicals and/or
body fluids.
23 b) Wear safety
shoes/boots/covers
if hazardous
substance is likely
to splash.
23 c) Wear an
apron/gown/coverall
s- if hazardous
substance is likely
to splash.
23 d) Use a
respirator: when
hazardous
substance is
airborne such as
tuberculosis.
23 a) Provide
personal protective
equipment (PPE)
adequately and
appropriately
23 b) Establish PPE
policy for use of PPE
23 c) Ensure warning
signs required PPE to
be worn are posted
where appropriate
Mr. P
(30/12/2011)
LIKELIHOOD SEVERITY
23
inappropriate or lack
of PPE.
RISK CONTROL
Working in Clinic
No
Doc No.
Facilites
Risk
Level
Type of Control
Recommended
Control Measures
PIC (Due
Date / Status)
R
23 a) Exposure of
employees to
glutaraldehyde.
Exposure of
employees to
glutaraldehyde.
Short term
(acute) effects:
Long-term
(chronic) effects:
23 a) Make sure
that rooms in which
glutaraldehyde is to
be used are well
ventilated
23 b) Store
glutaraldehyde in
closed containers in
well ventilated
areas.
23 c) Use specially
designed, mobile,
compact,
disinfectant soaking
stations to facilitate
sterilization of heat
sensitive equipment
such as
endoscopes, or GI
scopes.
23 d) Use PPE
23 a) Ensure that the
hazards of all
chemicals are
evaluated and that
this information is
transmitted to the
employees by means
of a hazards
communication
program which
includes, labeling,
material safety data
sheets, and employee
training.
Mr. Q
(30/12/2011)
LIKELIHOOD SEVERITY
RISK CONTROL
23
Use Glutaraldehyde to
disinfect and clean
heat-sensitive
medical, surgical and
dental equipment.
Working in Clinic
No

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HAZARD IDENTFICATION, RISK ASSESSMENT AND RISK CONTROL (HIRARC) FORM

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