HAZARD IDENTIFICATION & RISK ASSESSMENT (HIRA)

OHS-PR-09-03-F02 (A) HIRA-Hazard ID and Risk Assessment Form and Register

Operating Area: Project Name:
Contractors: Project Type: Contract No.:
Risk Assessment (Baseline and full RA)
TASK/ACTIVITY/PROCESS NAME: Site Survey of Land DEPARTMENT/AREA:
RA Number: DATE:
SEVERITY / CONSEQUENCE (Impact/Hazard Effect) (Where an event has more than one ' Loss Type ', choose the ' Consequence' with the highest rating)

Loss Type Additional "Loss Types" may exist for

an event: Identify & rate accordingly (1) Insignificant (2) Minor (3) Moderate (4) Major (5) Catastrophic

Loss Time Injury / Reversible Impact on Single Fatality or Loss of Quality of Life / Irreversible impact on
(S/H) Harm to People (Safety/Health) First Aid Case/Exposure to Minor Health Risk Medical Treatment Case/Exposure to Major Health Risk
Health Health
Multiple Fatalities / Impact on health Ultimately Fatal

Material Environment harm (RST) Serious

(EI) Environmental Impact Minimal environment harm incident with workplace Material Environment harm (RST)
environmental harm incident (RMT)
Major environmental incident (RLT) Major environmental harm – Incident Irreversible

(BI/MD) Business Interruption / Material / Fire No disruption to operation / 1000 SR to Less than 10k SR Brief Disruption to Operation / 10k SR to Less Than 100k SR Partial Shutdown/100k SR to Less than 1M SR Partial Loss of Operation/1M SR to Less than10M SR Substantial or Total Loss of Operation / 10M SR and more
Damage & Other Consequential Losses
LIKELIHOOD Examples (Consider Near-Hits as well as actual events) RISK RATING / PROFILE
The unwanted event has occurred frequently : Occurs in order of (1) or more
(5) ALMOST CERTAIN per year & is likely to reoccur within 1 year 5 (M) 10 (H) 15 (Ex) 20 (Ex) 25 (Ex)
The unwanted event has occurred infrequently : Occurs in order of less than
(4) LIKELY once per year & is likely to reoccur within 5 yrs. 4 (M) 8 (H) 12 (H) 16 (Ex) 20 (Ex)
The unwanted event has occurred in the business at some time: or could
(3) POSSIBLE happen within 10 years. 3 (L) 6 (M) 9 (H) 12 (H) 15 (Ex)
The unwanted event has occurred in the business at some time: or could
(2) UNLIKELY happen within 20 years. 2 (L) 4 (M) 6 (M) 8 (H) 10 (H)
The unwanted event has never known to occur in the business or it is highly
(1) RARE unlikely to occur within 20 years. 1 (L) 2 (L) 3 (L) 4 (M) 5 (M)
RA TEAM (Names) DESIGNATION SIGNATURE RISK RATING RISK LEVEL GUIDELINES FOR RISK MATRIX
Stop operation and review controls- Eliminate, avoid risk & implement high
1. 15 to 25 (Ex) - Extreme priority action plans
Proactively manage & implement specific controls/action plans-Review after 7
2. 8 to 12 (H) - High days
Actively manage & monitor – Additional controls is advised & review after 14
3. 4 to 6 (M) - Medium days

4. 1 to 3 (L) - Low Risk acceptable – Monitor & manage as appropriate with frequent review

Review by: Signature: Date: APPROVED BY / MANAGER or SUPERVISOR: DATE: NEXT REVIEW DATE:
Identify the hazard on the given task and conduct assessment of the actual site condition, all identified risk should provide with a plan to eliminate or control the risk.
RISK
HAZARD IDENTIFICATION CONTROL ASSESSMENT RISK REDUCTION ACTION PLAN

Consequence

Consequence

Risk Ranking
Risk Issue

Likelihood

Likelihood
Controls

Ranking
Work Activity (Improve Existing Controls/ Follow up By Whom (Name) Implemented
Item #

(Process, Equipment, Materials)

Hazards (Possible Incident) (What can go wrong)
(Accident/ Ill health to person, fire or property
Existing Controls Implement new controls) & By When (Date) (Yes / No)
loss)
Site Manager
1 Obtain Permit to Work ⬧ Unauthorized work to be performed within ⬧ Accident resulting serious injury or death to ⬧ Permit to Work shall be obtained as a pre- ⬧ Permit Receiver shall be trained and Site
Site Engineer
Manager
3 2 6 2 1 2 YES
a defined location and boundary worker requisite to perform Safety Engineer
⬧ Significant property and appurtenances ⬧ A safe work practicework
shall be implemented to 3 2 6
authorized
⬧All workersbyattending the Manager to receive
the toolbox a
meeting 3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
damage reduce Permit to on
Work Safety Engineer
⬧ Uncontrolled personnel entering a ⬧ Loss of production ⬧ Permitthe to possibilities
Work shall be of displayed
accident /atincident
the worksite 3 2 6
shall
⬧ All workerssign the attendance
shall attend thesheettoolbox attached
3 1 3
Site Engineer
Site Manager
Foreman / Supervisor YES
restricted location ⬧⬧ Permit to the specific Permit to conducted
Work Safety Engineer
⬧ Significant cost due to damages Permit Receiver shallnot
Receiver shall leaveall
account theworkers
area forunder
the
3 2 6
meeting
⬧ RA andon JSPashall
daily basis
be conducted thrubyTBT
the
3 1 3
Site Engineer
Site Manager
Foreman / Supervisor YES
whole
his duration
Permit to of work
Work before the start of work Supervising
before Engineer, Foreman and Permit Safety Engineer
⬧ Unidentified hazards with unplanned safety ⬧ Governmental violation ⬧ Manager, Supervisor, Foreman and all workers 2 2 4 ⬧ a copystart
Receiver
of any work
of Permit, RA and in JSP
daily basis
shall beper 2 1 2
Site Manager
Site Engineer
Foreman / Supervisor YES
activity Safety Engineer
⬧mitigating
Inadequatemeasures
coordination and area control ⬧ Environmental complaint ⬧shall Siteadhere
Manager,to allSupervising
requirements set forth
Engineer, in the
Foreman 3 2 6 ⬧available
a copy of onPermit,
site at RA
pointandofJSP
useshall be
3 1 3
Site Manager
Site Engineer
Foreman / Supervisor YES
protocol Permit to Work,aRisk Assessment, Method Safety Engineer
2 Mobilization and preparation of ⬧ Construction equipment malfunctioning, ⬧ Accident result in physical injury or death ⬧shall
Statement,
designate
Heavy Equipment Permit
Job Safety
Receiver
toProcedure
be used atand competent
the other
site must 4 2 8 ⬧available
Isolate on
thesite
areaatand
point of usesignboards.
provide 3 1 3
Site Manager
Site Engineer
Foreman / Supervisor YES
materials, hauling equipment enough
have to
a validtake responsibility in securing
third party inspection certification the ⬧⬧ Use mobile equipment if available Safety
Site Engineer
Engineer
⬧ Fuel/oil leaks/ground contamination ⬧ Environmental pollution due to leaking of ⬧ Daily
Permit inspection
to Work of equipment by operator/driver 3 2 6 Conduct a spot inspection to all tools and 3 1 3 Site Manager
Foreman / Supervisor YES
such as TUV Safety Engineer
⬧ Reversing trailer and crane without spotter. fuel/oil
⬧ May collide to anything on the area resulting using
⬧ General checklist specific
condition aretoSatisfactorily
their equipment acceptedshall be
3 2 6
equipment
⬧ Conduct aprior spottoinspection
commence to the work.
all equipment 3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
⬧ Improper set-up of crane to
⬧ May Property damaged
tip over during lifting ⬧strictly
⬧ Provide
implemented.
equipment
All equipment spotter
Operators of in orange
Crane high
(where prior to commence the work.
⬧ All equipment operators shall attend the
Safety
Site
Site
Engineer
Engineer
Manager
reflective /vest. 3 2 6 3 1 3 Foreman / Supervisor YES
required) Heavy Equipment Operators shall Safety Engineer
⬧ Struck by other moving equipment and ⬧ Vehicular accident resulting Injury to ⬧ Establish equipment access and shall be freebe 3 2 6
toolbox meeting on plan
⬧ Site management a daily basis
shall be conducted
prepared, 3 1 3
Site Manager
Site Engineer
Foreman / Supervisor YES
vehicle TUV Certified. by the Supervising Engineer, to Foreman and Safety Engineer
⬧personnel
Property damage of adjacent structure or ⬧from any obstruction
Designate location for unloading of materials 3 2 6 ⬧approved
Barricades
Permit Receiver
andand
implemented
signages shall avoid
be provided 3 1 3
Site Manager
Site Engineer
Foreman / Supervisor YES
property damage and personnel accident Safety Engineer
⬧ Positioning of equipment ⬧appurtenances
Accident resulting injuries to the operator or Designate
⬧⬧ Driver and spotter
operator and flagman
shall to guide
be oriented to all
the site 4 2 8 ⬧inNo loading
flagmanandno unloading
movement areasof the 3 1 3
Site Manager
Site Engineer
Foreman / Supervisor YES
driver once struck thedamage
structureto adjacent equipment
condition and personnel movement equipment Safety Engineer
⬧ Significant property ⬧ Access must be properly compacted and even 3 2 6 ⬧ Foreman /policy supervisor must ensure the 3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
structure ⬧⬧ Workers areoperator
advised /andinstruct Safety Engineer
⬧ Injuries to other personnel involved to the Remind the drivertotomove
followawaythe 3 2 6
competency
⬧ Daily toolbox of meeting
the operator
must/be driver
conducted 3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
activity from the
signal equipment.
of the flagman by the Supervisor or Foreman discussing Safety Engineer
⬧ Damage to property by the equipment ⬧ Consider manual process to all those areas with 3 2 6 ⬧ Foreman / supervisor must ensure the the 3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
structures risk assessment
activity has been done safety Safety
Site Engineer
Engineer
3 Site clearing that involve removal of ⬧ Using multiple heavy equipment ⬧ Equipment failure during operation ⬧ All heavy equipment used on the project shall 3 2 6 ⬧ Site contractor management shall ensure 3 1 3 Site Manager
Foreman / Supervisor YES
trees, demolishing existing have a valid third party certification Safety Engineer
⬧ Accident resulting injury or death to ⬧ All drivers and equipment operator should have 4 3 12 ⬧equipment
Contractorand operator shall
management shallhold valid third
engage 3 2 6
Site Manager
Site Engineer
Foreman / Supervisor YES
structure, and any obstacle that party certification before allowing to work on Safety Engineer
might affect the construction ⬧ Defective heavy equipment ⬧personnel
Significant property damage ⬧attended Defensive
Driver shall conduct Driving training conducted
daily equipment inspection 3 2 6 ⬧equipment
Heavy
the
on a reputable
site equipment ownedrental company
and rented shall 3 1 3
Site Manager
Site Engineer
Foreman / Supervisor YES
internally
properly by the
documented contractor providing good condition equipment Safety Engineer
⬧ Vehicular accident or collision ⬧ Designate flagman towith a prescribe
control equipment checklist
access 3 2 6
undergo preventive driver
⬧ Heavy equipment maintenance on a shall
and operator 2 1 2
Site
Site Engineer
Manager
Foreman / Supervisor YES
⬧⬧ Designate spotter foraccess
each heavy equipment monthly
be oriented on how to fill-out properly Safety Engineer
⬧ Simultaneous manoeuvring of heavy ⬧ Vehicular accident or collision Establish equipment and shall be free 4 2 8 ⬧ Contractor management shall conductthe daily 3 1 3
Site Engineer
Foreman / Supervisor YES
equipment from any obstruction equipment
site dailybriefing
orientation checklistto discuss specific Safety Engineer
1 HIRA-Hazard ID and Risk Assessment Form and Register OHS-PR-09-03-F02 (A) assignment of heavy equipment Foreman / Supervisor Rev. 0 Revision Date (May 2021)
 Site Manager
⬧ Struck or hit working personnel or other ⬧ Accident resulting Injury to personnel ⬧ Designate location for unloading of materials ⬧ Each driver and operator should know the Site Manager
Site Engineer
3 2 6 3 1 3 YES
heavy equipment access, parking area and work Safety Engineer
⬧ Property damage of adjacent structure and ⬧ Designate spotter and flagman to guide all 3 2 6 ⬧ As a PME requirement, therelocation
shall only ofbethe
3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
day Safety Engineer
⬧ Exposure to mechanical hazard of power equipment
⬧ Accident resulting injury to personnel / equipment
⬧ Check all tools and personnel
prior eachmovement
use for any defects or 3 2 6
maximum
⬧ Trees shall of be
5 combustion
cut gradually, engine to operate
branches by 2 1 2
Site Engineer
Site Manager
Foreman / Supervisor YES
tools such as chain saw when cutting trees Property simultaneously Safety Engineer
⬧ Tinnitusdamage sign
⬧ Chainsaw of defects operator shall wear leather gloves, 3 2 6
branches
⬧ Operatortoshall prevent the whole
maintain tree toin good
equipment 3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
apron, collapse on the worker Safety Engineer
⬧ Exposure to dust and other airborne ⬧ Eyes, Skin and Respiratory irritation ⬧ All workers including driverorand
face shield, ear plugs earmuff
operators shall 3 2 6
condition
⬧ Safety Officer shall ensure that adequate 3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
particles through inhalation and skin Safety Engineer
⬧ Ill health to personnel ⬧beNIOSH provided and wear
approved dustsafety
mask glass
shall at
beall times to
provided 3 2 6 ⬧stock is available
Workers shall beattrained
the siteon tohow
issuetoworkers
use a 3 1 3
Site Manager
Site Engineer
Foreman / Supervisor YES
absorption as necessary Safety Engineer
⬧ Accident resulting injury to personnel ⬧allAll personnel
workers shall exposed weartothedustprescribe working 3 2 6 ⬧dusk mask shall
Workers properly
be trained on how to use and 3 1 3
Site Manager
Site Engineer
Foreman / Supervisor YES
uniform Safety Engineer
⬧ Visual impairment ⬧ Goggleswith shalllong sleeve and
be provided if free from torn
too much dust orthat 3 2 6
maintain
⬧ Supervisor their PPE
and Foreman shall ensure that 3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
damage
can impaired Safety Engineer
⬧ Exposure to excessive noise from ⬧ Tinnitus ⬧ Issuance andthe visual of
wearing of the workers
ear plug or
/ defender ANSI 3 2 6
all
⬧ Workers workersshall are adequate
be oriented provided
on howwith right
to wear 2 1 2
Site
Site Engineer
Manager
Foreman / Supervisor YES
simultaneous equipment operation temporary
S3.19 – 1974stopor the work immediately until it will
equivalent) PPE earplug
the for the hazard
properly being exposed Safety
Site Engineer
Engineer
⬧ Chronic hearing loss ⬧ Avoid
back more than 8hrs exposure to sound 85dB
to normal 3 2 6 ⬧ Provide adequate earplug that would 3 1 3 Site Manager
Foreman / Supervisor YES
above level reduce noise Safety Engineer
⬧ Working in extreme hot environment ⬧ Heat exhaustion ⬧ Adjust work timing and exposure of the workers 3 2 6 ⬧ Provision oflevel to permissible
air-conditioned exposure
shelter if 2 1 2
Site
Site Engineer
Manager
Foreman / Supervisor YES
limit Safety Engineer
⬧ Heat cramps ⬧toProvide extremesupplemental
environmental temperature
hydration powder or 3 2 6 ⬧needed Allow frequent rest time if needed 2 1 2
Site Manager
Site Engineer
Foreman / Supervisor YES
Safety Engineer
⬧ Heat stress ⬧liquids Establish a complete heat illness prevention 3 2 6 ⬧⬧ Safety Provideawareness
rest shelter with shade
/ training neartotoheat
related the
3 1 3
Site Manager
Site Engineer
Foreman / Supervisor YES
workplace Safety Engineer
4 Grading the ground to level the ⬧ Simultaneous manoeuvring of heavy ⬧ Vehicular accident or collision resulting to ⬧program Establish equipment access and shall be free 3 2 6 ⬧stress, etc. management shall conduct daily
Contractor 3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
surface in preparation for land equipment Property Safety Engineer
⬧ Struck or hit working personnel or other ⬧ Accidentdamage of Injury
resulting adjacent structure and
to personnel from
⬧ Designate any obstruction
spotter and flagman to guide all 3 2 6
site
⬧ Asorientation briefing tothere
a PME requirement, discuss specific
shall only be 3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
survey heavy equipment equipment equipment and personnel movement assignmentofof5 heavy
maximum equipment to operate Safety Engineer
⬧ Exposure to dust and other airborne ⬧ Eyes, Skin and Respiratory irritation ⬧ All workers including driver and operators shall⬧ 3 2 6 ⬧ Safety Officercombustion shall ensureengine that adequate 2 1 2
Site
Site Engineer
Manager
Foreman / Supervisor YES
particles through inhalation and skin ⬧⬧ Ill health resulting
to personnel Designate
be parking areasafety glass at all times simultaneously Safety Engineer
Accident injury to personnel ⬧ All workersand
provided shallwear
wear the prescribe working 3 2 6
stock is available at the
⬧ Supervisor and Foreman shall ensure that site to issue workers
2 1 2
Site
Site Engineer
Manager
Foreman / Supervisor YES
absorption as necessary Safety Engineer
⬧ Visual impairment ⬧uniform Goggleswith shalllong sleeve and
be provided if free from torn
too much dust orthat 3 2 6 ⬧allSupervisor
workers are andadequate
Foremanprovided
shall ensurewiththatright
3 1 3
Site Manager
Site Engineer
Foreman / Supervisor YES
damage PPE for the arehazard being exposed Safety Engineer
5 Conduct land survey with the use of ⬧ Excessive manual lifting of survey ⬧ Body sprain ⬧can impaired
Surveyor to the
be invisual of the
regular workers
contact withormanager 3 2 6 ⬧allAssistant
workers adequate
or helper shallprovided
be provided withtoright
help 2 1 2
Site Manager
Site Engineer
Foreman / Supervisor YES
Transit and other related survey temporary stop the work immediately until it will PPE for the hazard being exposed Safety Engineer
⬧equipment
Contact with sharp edges of tools and ⬧ Hand laceration or bruise ⬧throughout
back Conduct survey.
site
to normal visit, orientation and familiarization 3 2 6 ⬧carry andthat
Ensure position
toolstheandequipment
equipmenttoare the right
3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
equipment and line out exactly equipment on the are before the actual site survey using the location
inspected prior beto use Safety
Site Engineer
Engineer
where the structure is to be built ⬧ Uneven and soft ground surface ⬧ Broken ankle ⬧ Warning signs and safety barricades should be 3 2 6 ⬧ Hazards shall discussed to all workers 3 1 3 Site Manager
Foreman / Supervisor YES
equipments
used whenever Safety Engineer
⬧ Loose soil ⬧ Eye, Skin and Respiratory irritation ⬧ Required PPE’Sa must
slip, trip or fallathazard
be worn all timehas been
3 2 6
thru
⬧ Supervisor TBT before andstart of anyshall
Foreman work ensure that 3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
identified but cannot be corrected or removed all Safety Engineer
⬧ Exposure to surrounding dust and other ⬧ Health Hazards ⬧ Proper PPE specially good condition safety shoes
immediately 3 2 6 ⬧ Contact the site area in provided
workers are adequate advance and withagree
right
3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
airborne particles shall beplenty
provided and water
worn by the surveyor PPE for
that the to
access hazard
the being exposed
specific area is acceptable Safety Engineer
Site Manager
Engineer
⬧ Exposure to extreme temperature or heat ⬧ Heat exhaustion ⬧ Drink of cool regularly 3 2 6 ⬧ Monitor the surrounding temperature and 3 1 3 Site
Foreman / Supervisor YES
of the sun Do notsure wear thick and dark color clotheswithout
as it Safety Engineer
6 Installation of markings by ⬧ Struck by the hammer or broken pole ⬧ Hand laceration or bruises ⬧⬧ Make hammer is in good condition 3 2 6 ⬧doSurveyor
not workand beyond 54 degrees
assistant shall have heat index
a constant 3 1 3
Site Manager
Site Engineer
Foreman / Supervisor YES
hammering the pole to the ground ⬧ Exposure to surrounding dust absorbs the heat ofsigns
the sun Safety Engineer
⬧ Respiratory irritation ⬧bent, Workercracksshallor have
any of defects
a presence of mind when 3 2 6 ⬧and well heat
Follow communication on the right
stress management marking
to avoid 2 1 2
Site
Site Engineer
Manager
Foreman / Supervisor YES
hammering location Safety Engineer
⬧ Damage tools and equipment ⬧ Damage to property ⬧ Check toolsthe andpole to the ground
equipment before bringing and 3 2 6
heat
⬧ Damaged exhaustiontools shall be identified and 3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
using it on the site for manual handling. removed Safety Engineer
7 Housekeeping, clearing the area ⬧ Manual handling ⬧ Manual handling can lead to musculoskeletal ⬧ Facilitate training 3 2 6 ⬧ Trainingfrom site
/ awareness regarding the 3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
with all used materials, tools and disorder ⬧⬧ Observe Safety Engineer
⬧ Materials lying on the ground ⬧ Property damage Provide storage box for cables manual lifting,
proper posture during
3 2 6
ergonomics
⬧ Daily inventory shall of
be the
done equipment 2 1 2
Site
Site Engineer
Manager
Foreman / Supervisor YES
equipment and brought to the ⬧pushing, pulling, etc. box (good items, scrap / Safety Engineer
designated storage and disposal ⬧ Protruding object / materials at the site ⬧ Accident resulting injury to worker ⬧ Labelling
Remove all of unwanted
storage / protruding materials / 3 2 6
⬧⬧ Training
Good housekeeping atregarding
/ awareness the site the 2 1 2
Site Manager
Site Engineer
Foreman / Supervisor YES
damage atitems, by capacity, etc.) segregation of waste Safety Engineer
area ⬧ Uncollected / scattered rubbish ⬧ Fire ⬧object
Provision theofsite
standby fire extinguisher 3 2 6
Daily toolbox
⬧⬧ Records meetingfor fire extinguisher
and registry 2 1 2
Site Manager
Site Engineer
Foreman / Supervisor YES
Periodical inspection Safety Engineer
8 Closing of Permit to Work ⬧ Unsecured electrical equipment, energized ⬧ Significant property and appurtenances ⬧⬧ Permit Receiver shall and
ensure/ orthat
color coding for fire
housekeeping 3 2 6
Records
⬧⬧ LOTO / registry
system shallforbe the quantity ofand
implemented waste
3 1 3
Site Manager
Site Engineer
Foreman / Supervisor YES
equipment damage extinguisher
in done before, duringgenerated
and afterfrom the work disposed
discussed to all concernand parties Safety
Site Engineer
Engineer
⬧ Undisposed waste materials ⬧ Governmental violation ⬧ All waste materials the work 3 2 6 ⬧ Supervising Engineer Foreman shall 3 1 3 Site Manager
Foreman / Supervisor YES
shall be disposed Safety Engineer
⬧ Unaccounted workers ⬧ Accident resulting serious injury or death to ⬧ Permit Receiver properly and shall
shall account not beunder
all worker left
3 2 6
adhere to theshall
⬧ All workers proper housekeeping
attend and signedand on a 3 1 3
Site
Site Engineer
Manager
Foreman / Supervisor YES
worker unattended
his Permit to atWork
the worksite
and ensure all have signed out storage
daily TBToftomaterials at the designated Safety
Site Engineer
Engineer
⬧ Inadequate communication ⬧ Loss of production ⬧ Site Manager shall be responsible on the 3 2 6 Permit
⬧location work shall be discussed to 3 1 3 Site Manager
Foreman / Supervisor YES
on the attendance
effective implementation sheet andthe clear of thetoarea Safety Engineer
⬧ Poor storage of chemical, flammable and ⬧ Environmental complaint ⬧ All materials used at theof Permit
site such Work
as chemicals, 3 2 6
workers before start of any work
⬧ MSDS/SDS shall be provided in the chemical in order for
3 1 3
Site Manager
Site Engineer
Foreman / Supervisor YES
combustible them to aware the required safety Safety Engineer
⬧ Unattendedmaterials and etc.
unsafe condition ⬧ Significant cost due to damages ⬧flammable
Permit Issuer and shall
combustible
visit thematerials
work locationshall to
be
3 2 6 ⬧storage
Mobile equipment shall
requirement listed on the permit properly parked on 3 1 3
Site Engineer
Foreman / Supervisor YES
stored at thehousekeeping
verify good designated storage at the end
was conducted of
before a designated equipment laydown Safety Engineer
each day 0 Select Control Method 0 0 0 Foreman / Supervisor ###
closing the Permit to Work
0 Select Control Method 0 0 0 ###

2 HIRA-Hazard ID and Risk Assessment Form and Register OHS-PR-09-03-F02 (A) Rev. 0 Revision Date (May 2021)
 SEVERITY / CONSEQUENCE (Impact/Hazard Effect) (Where an event has more than one ' Loss Type ', choose the ' Consequence' with the highest ra
Loss Type Additional "Loss Types" may exist for
an event: Identify & rate accordingly (1) Insignificant (2) Minor (3) Moderate (4) Major
Medical Treatment Case Loss Time Injury / Single Fatality or
(S/H) Harm to People (Safety/Health)
First Aid Case/Exposure to Minor Exposure to Major Health Risk Reversible Impact on Loss of Quality of
Health Risk Health Life / Irreversible
impact on Health
Material Environment
(EI) Environmental Impact
Minimal environment harm incident Material Environment harm (RST) harm (RST) Serious Major environmental
with workplace environmental harm incident (RLT)
incident (RMT)

Partial Loss of
(BI/MD) Business Interruption / Material / Fire Damage & No disruption to operation / 1000 SR Brief Disruption to Operation / 10k Partial Shutdown/100k Operation/1M SR
Other Consequential Losses to Less than 10k SR SR to Less Than 100k SR SR to Less than 1M SR To Less than10M SR

LIKELIHOOD Examples (Consider Near-Hits as well as actual events) RISK RATING / PROFILE
The unwanted event has occurred frequently : Occurs in order of (1)
(5) ALMOST CERTAIN or more per year & is likely to reoccur within 1 year 5 (M) 10 (H) 15 (H)
The unwanted event has occurred infrequently : Occurs in order of
(4) LIKELY less than once per year & is likely to reoccur within 5 yrs. 4 (M) 8 (H) 12 (H)

The unwanted event has occurred in the business at some time: or

(3) POSSIBLE could happen within 10 years. 3 (L) 6 (M) 9 (H)
The unwanted event has occurred in the business at some time: or
(2) UNLIKELY could happen within 20 years. 2 (L) 4 (M) 6 (M)
The unwanted event has never known to occur in the business or it is
(1) RARE highly unlikely to occur within 20 years. 1 (L) 2 (L) 3 (L)

RISK
RISK LEVEL GUIDELINES FOR RISK MATRIX
RATING
Stop operation and review controls- Eliminate, avoid risk &
15 to 25 (Ex) - Extreme implement high priority action plans
Proactively manage & implement specific controls/action
8 to 12 (H) - High plans-Review after 7 days
Actively manage & monitor – Additional controls is advised
4 to 6 (M) - Medium & review after 14 days
 Risk acceptable – Monitor & manage as appropriate with
1 to 3 (L) - Low frequent review
quence' with the highest rating)

(4) Major (5) Catastrophic

Single Fatality or
Loss of Quality of Multiple Fatalities / Impact on
Life / Irreversible health Ultimately Fatal
impact on Health

Major environmental Major environmental harm –

incident (RLT) Incident Irreversible

Partial Loss of
Operation/1M SR Substantial or Total Loss of
To Less than10M SR Operation / 10M SR and more

ATING / PROFILE
15 (H) 20 (Ex) 25 (Ex)

12 (H) 16 (Ex) 20 (Ex)

9 (H) 12 (H) 15 (Ex)

6 (M) 8 (H) 10 (H)

3 (L) 4 (M) 5 (M)

Area/Department
Date Compiled Date Revised
Compliled by:
Management Action
Priority
Ref No. Description of Risk Risk Score Action Responsible person
Rating
 Target Action
Responsible person
date complete