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HIRARC FORM

HAZARD IDENTIFICATION , RISK ASSESSMENT AND


Rev. 0
DETERMINING CONTROL FORM
(HIRARC FORM)
Page 1 of 1
Department: PROJECT SAFETY Function / Main Activity: WORK AT HEIGHT Date:

HAZARD IDENTIFICATION RISK ASSESSMENT CONTROL MEASURES

Probability

Severity

Total
Potential Of Potential Controls
NO Activity Description Hazard Action By
Hazard Risk Required

GRAVITY FALL FROM HEIGHT FATALITY 3 5 15 i. PEMASANGAN GUARD


RAIL PENYEDIAN,
BODY HARNESS i. Work
MAJOR Supervisor
GRAVITY FALLING OBJECT 5 15 SAFETY NET DAN
INJURY 3
WORKING AT HEIGHT FALLING OBJECT ii. Safety
1 Supervisor
PEMASANGAN KABEL PROTECTION PPE
PADA PENAMPANG
NYA
1) PENGATURAN KERJA
TRIP, SLIP AND FALL HOUSEKEEPING
DUE TO POOR MAJOR iii. Work
MECHANICAL HOUSEKEEPING( C INJURY 3 5 15 2) PENAMBAHAN GUARD
Supervisor
ABLE INSTALATION) RAIL ATAU BARICADE
TAPE iv. Safety
Supervisor
HIRARC FORM
HAZARD IDENTIFICATION , RISK ASSESSMENT AND
Rev. 0
DETERMINING CONTROL FORM
(HIRARC FORM)
Page 1 of 1
Department: PROJECT SAFETY Function / Main Activity: WORK AT HEIGHT Date: