HAZARD IDENTIFICATION RISK ASSESSMENT No.

Form : FM-K3-RS-
17 Revisi : 0 Tgl.Eff : 27
November 2017

Project /Work Description :

Departement & Exact Location Of The Work Performed :
Approved By Supervisor / Reporting Officer : (name, Date &
Risk Asessment Team (Name/s) : Siganture)
Date Control : Next Review Date :

Hazard Identification Risk Evaluation/assessment Risk Control

1a 1b 1c 1d 2a 2b 2c 2d 3a 3b 3c 3d 3e 3f
S/N Work Activity Hazard Possible Accident/ill Health to Existing Risk Severity Likelih RPN* Additional Risk Control Severity Likelih RPN* Follow Up by Remarks
person, Fire or property loss Control ood Measures ood (name) & date