Hirarc Form Sample Clinic PDF Free

HAZARD IDENTFICATION, RISK ASSESSMENT AND RISK CONTROL (HIRARC) FORM
Doc No.
Prepared by Revision No :
JOB TITLE Working in Clinic Verified by Date :
HAZARD IDENTIFICATION RISK ASSESSMENT RISK CONTROL
No PIC (Due
Activities / Equipment/ Risk Recommended
R/NR* Hazard Consequences Current Risk Control Likelihood Severity Type of Control Date /
Facilites Level Control Measures
Status)
handling patients, Infectious Hepatitis B, 13 a) wash hands 13 a) Provide a
contaminated objects, Diseases Hepatitis C and frequently (proper written “Routine
body secretions, Human handwashing is the Practices” document
tissue or fluids Immunodeficienc best way to prevent that is easily
y Virus (HIV) can communicable accessible
be spread by diseases)
infected blood 13 b) Ensure
and body fluids availability of gloves
when they come 13 b) Follow and other protective
into direct “Routine Practices” equipment and Mr. F
13 R contact with at all times for all 3 3 9 (M) Adminstrative cleansing agents
(30/12/2011)
broken, scraped, patients
chapped or 13 c) Establish a
inflamed skin or 13 c) Check with sharps program
when skin is your Occupational
punctured by a Health Nurse 13 d) Establish an
sharp object regarding immunization
such as a immunizations program for all
needle. workers
*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
Doc No.
No Activities / Equipment/ Risk Type of Recommended PIC (Due Date /

R/NR* Hazard Consequences Current Risk Control Likelihood Severity
Facilites Level Control Control Measures Status)
Receive & treat 9.1 a) Exposure 9.1 a) Sick 9.1 a) Competency

patient to known & 9.1 b) Fatality & Proper PPE to be
9 R unknown worn 2 2 4 (L) NIL NIL
bacteria, fungal &
viruses
Clearing medical 10 a) Contact 10.1 a) Sick 10.1 a)Competency
waste with sharp object 10.1 b) Fatality & Proper PPE to be
10 R worn 2 2 4 (L) NIL NIL
Using X-ray machine 11 a) Exposure to 11.1 a) Cancer 11a) Competency &

radioactive and 11.1 b) Fatality Proper PPE to be
radiation worn
11 R 11b) Safe work 2 2 4 (L) NIL NIL
distance, allowable
exposure limit &
12 a) Pollution to 12a) Competency &

atmosphere, Proper PPE to be
Release
12 a) Scheduled sanitary sewer, worn
12 Contamination / R 2 2 4 (L) NIL NIL
waste ground water,
Hospital treated waste
fresh water, soil

LIKELIHOOD SEVERITY

Doc No.

No Activities / Equipment/ Risk Recommended PIC (Due Date
R/NR* Hazard Consequences Current Risk Control Likelihood Severity Type of Control
Facilites Level Control Measures / Status)
Handling patients & 14 a) Heavy lifting Back injuries 14 a) Use available 14 a) Provide
moving objects and frequent lifts accessible
bending or mechanical lifts
twisting when 14 b) Get help to lift (ceiling lifts preferred)
moving objects or if mechanical device
patients is not appropriate or 14 b) Ensure all staff
not available are trained to use Mr. G
14 R 3 3 9 (M) Administrative mechanical lifts
(30/12/2011)
14 c) Use proper
lifting technique 14 c) Train staff on
proper lifting
techniques

LIKELIHOOD SEVERITY

Doc No.
No Activities / Equipment/ Likeliho Severit Risk Recommended PIC (Due

R/NR* Hazard Consequences Current Risk Control Type of Control
Facilites od y Level Control Measures Date / Status)
Shiftwork 15 a) Changing 15 a) It can 15 a) Ask your 15 a) Avoid a

shifts and working contribute to doctor’s advice permanent night shift
at night disrupts digestion before becoming a
your body’s problems, heart shift worker if you 15 b) Limit the
natural rhythms. disease, and have diabetes, number of nights
sleep problems. asthma, epilepsy or worked
mental health in a row
15 b) It also problems
makes 15 c) Avoid an early
participation in 15 b) Improve your start for morning
social activities sleep by practising a shifts
and family life regular bedtime Mr. H
15 R difficult. ritual and avoid 4 2 8 (M) Administrative 15 d) Give as many (30/12/2011)
caffeine, smoking weekends off as
and sleeping pills. possible with at least
two days off in a row
15 e) Keep schedules
regular and give
workers plenty of
notice of the
schedules

LIKELIHOOD SEVERITY
Doc No.

Repetitive, forceful or 16 a) Repetitive 16 a) Injury 16 a) Organize your 16 a) Provide

awkward body Strain Injury (RSI) usually affects work day so ergonomically correct
movements when the wrist, hand, repetitive tasks are tools and equipment
handling patient or shoulder, elbow, done for short
equipment back, knee or periods throughout 16 b) Allow staff
ankle. the day control over how they
organize their work Mr. I
16 R 16 b) It can 16 b) Take regular 3 3 9 (M) Administrative day (30/12/2011)
cause pain, breaks
weakness, 16 c) Promote rest
numbness or breaks
difficulty in
grasping objects.

LIKELIHOOD SEVERITY
Doc No.

Dealing with angry 17 a) Health care 17 a) Workplace 17 a) Follow policies 17 a) Acknowledge

and stressed patients workers are at violence can and intervention that violence is an
and their families. risk from violence result in loss of guidelines issue
sleep, fear or
depression, post 17 b) Report 17 b) Work with the
traumatic stress incidents to your Health & Safety
disorder, and health and safety Committee to identify
sometimes even representative risks and develop
death. and/or committee. solutions
Mr. J
17 R 3 3 9 (M) Administrative 17 c) Post visible
(30/12/2011)
signs reminding all
that this is a
respectful workplace
17 d) Train staff on
diffusing situations
and intervention
procedures

LIKELIHOOD SEVERITY
Doc No.

18 a) Radiation is 18 a) Long term 18 a)can cause 18 a) Follow 18 a) Provide

used in diagnostic and repeated genetic dam age procedures and use personal protective
procedures such exposure to and reproductive PPE equipment (PPE)
as x-ray, fluoroscopy radiation health problems. such as shield aprons
and angiography. 18 b) Take all safety and safety glasses
18 b) Light beams 18 b) Can harm concerns to your
18 b) Used in tre atm from lasers the eyes and health and safety 18 b) Establish
ents using radioactive skin. representative procedures for use of
material. and/or committee diagnostic equipment
and PPE
Mr. K
18 18 c) Used in R 3 4 12 (M) Administrative
(30/12/2011)
microwaves, magnetic 18 c) Minimize
fields and lasers. exposure time to
radiation
18 d) Ensure warning
signs are posted
where appropriate

LIKELIHOOD SEVERITY
Doc No.

No
Activities / Equipment/ Likeliho Severit Risk Recommended PIC (Due
Exposure to 19 a) A chemical 19 a) Cause 19 a) Take concerns 19 a) Work closely
chemicals in the form can enter your serious illness to workplace health with the workplace
of dusts, vapours, body in three and in some & safety health & safety
gases or liquids. main ways cases, death. representative committee to identify
i) It can be and/or committee chemicals used and
breathed in 19 b) Often the find out what health
ii) It can go effects are not 19 b) Read labels of effects they may have
through your skin noticeable right all chemicals used
iii) It can be away. and if m ore 19 b) Maintain all
swallowed information is MSDS (material Mr. L
19 R 3 4 12 (M) Administrative
required, go to the safety data sheets) (30/12/2011)
MSDS
19 c) Eliminate toxic
chemicals or
substitute with less
toxic alternatives
when possible.

LIKELIHOOD SEVERITY
Doc No.
No
High levels of noise 20 a) Long term 20 a) Cause 20 a) Report any 20 a) Isolate noisy
from kitchens, exposure to high permanent equipment machines in a room
laundries and boiler levels of noise hearing loss. malfunction as soon where workers
rooms. (more than 80 as possible seldom need to be
decibels) 20 b) Noise can
distract workers 20 b) Wear hearing 20 b) Use noise
and make it protection dampeners
difficult to
communicate 20 c) Have hearing 20 c) Maintain
and concentrate. checked regularly equipment in good
Mr. M
20 R 3 2 6 (M) Administrative working order •
(30/12/2011)
provide hearing
protection

LIKELIHOOD SEVERITY
Doc No.

handling sharp 21) Needlestick / 21a) cause 21 a) Isolate or 21 a) Continously

devices or equipment Sharps Injuries - disease in remove the send worker training
such as scalpels, a) Unsafe needle humans. These bloodborne in appropriate
sutures, hypodermic devices. pathogens pathogens hazard engineering controls
needles, blood include Human from the workplace and work practices, to
collection devices, or b) Improper Immunodeficienc eliminate or minimize
phlebotomy devices handling and y Virus (HIV), 21 b) Employee worker exposure.
disposal of Hepatitis B Virus injury is later
needles and other (HBV), Hepatitis diagnosed with an
sharps. C Virus (HCV), infectious
and others. bloodborne disease Mr. N
(30/12/2011)
21 c) Use safer
needle devices and
needleless devices
to decrease
needlestick or other
sharps exposures.

LIKELIHOOD SEVERITY
Doc No.
No
Walking on the 22 a) Slip and 22 a) Slip and 22 a) Use the non a) Avoid slippery
slippery floor Falls trip slippery shoe or flooring
22 b) Body sandals.
injury b) Fix the side bars or
22 b) Avoid failing of handles on stair case
greasy liquids on
floor c) Clean floor
regularly to avoid the
contents of greasy
liquids Mr. O
(30/12/2011)

LIKELIHOOD SEVERITY
Doc No.

inappropriate or lack 23 a) Exposure to 23 a) cause 23 a) Wear gloves, 23 a) Provide

of PPE. hazardous disease in when handling personal protective
processes or humans through chemicals and/or equipment (PPE)
infectious pathogens body fluids. adequately and
materials or include Human appropriately
chemicals Immunodeficienc 23 b) Wear safety
y Virus (HIV), shoes/boots/covers 23 b) Establish PPE
Hepatitis B Virus if hazardous policy for use of PPE
(HBV), Hepatitis substance is likely
C Virus (HCV), to splash. 23 c) Ensure warning
and others. signs required PPE to
23 c) Wear an be worn are posted Mr. P
apron/gown/coverall where appropriate (30/12/2011)
s- if hazardous
substance is likely
to splash.
23 d) Use a
respirator: when
hazardous
substance is
airborne such as
tuberculosis.
LIKELIHOOD SEVERITY
Doc No.
Activities / Equipment/ Risk Recommended PIC (Due

R/NR* Hazard Consequences Current Risk Control Likelihood Severity Type of Control
Facilites Level Control Measures Date / Status)
No
Use Glutaraldehyde to 23 a) Exposure of Exposure of 23 a) Make sure 23 a) Ensure that the
disinfect and clean employees to employees to that rooms in which hazards of all
heat-sensitive glutaraldehyde. glutaraldehyde. glutaraldehyde is to chemicals are
medical, surgical and Short term be used are well evaluated and that
dental equipment. (acute) effects: ventilated this information is
Long-term transmitted to the
(chronic) effects: 23 b) Store employees by means
glutaraldehyde in of a hazards
closed containers in communication
well ventilated program which
areas. includes, labeling,
material safety data
23 c) Use specially sheets, and employee Mr. Q
23 R designed, mobile, 2 3 6 (M) Administrative training.
(30/12/2011)
compact,
disinfectant soaking
stations to facilitate
sterilization of heat
sensitive equipment
such as
endoscopes, or GI
scopes.
23 d) Use PPE

LIKELIHOOD SEVERITY

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

HAZARD IDENTIFICATION RISK ASSESSMENT RISK CONTROL

*R-Routine, NR - Non Routine

HAZARD IDENTIFICATION RISK ASSESSMENT RISK CONTROL

No Activities / Equipment/ Risk Type of Recommended PIC (Due Date /

Receive & treat 9.1 a) Exposure 9.1 a) Sick 9.1 a) Competency

Using X-ray machine 11 a) Exposure to 11.1 a) Cancer 11a) Competency &

12 a) Pollution to 12a) Competency &

*R-Routine, NR - Non Routine

RISK = LIKELIHOOD X SEVERITY 15 - 25 : HIGH RISK 5-12 MEDIUM 1 - 4 : LOW RISK

HAZARD IDENTIFICATION RISK ASSESSMENT RISK CONTROL

*R-Routine, NR - Non Routine

RISK = LIKELIHOOD X SEVERITY 15 - 25 : HIGH RISK 5-12 MEDIUM 1 - 4 : LOW RISK

HAZARD IDENTIFICATION RISK ASSESSMENT RISK CONTROL

No Activities / Equipment/ Likeliho Severit Risk Recommended PIC (Due

Shiftwork 15 a) Changing 15 a) It can 15 a) Ask your 15 a) Avoid a

*R-Routine, NR - Non Routine

HAZARD IDENTIFICATION RISK ASSESSMENT RISK CONTROL

No Activities / Equipment/ Likeliho Severit Risk Recommended PIC (Due

Repetitive, forceful or 16 a) Repetitive 16 a) Injury 16 a) Organize your 16 a) Provide

*R-Routine, NR - Non Routine

HAZARD IDENTIFICATION RISK ASSESSMENT RISK CONTROL

No Activities / Equipment/ Likeliho Severit Risk Recommended PIC (Due

Dealing with angry 17 a) Health care 17 a) Workplace 17 a) Follow policies 17 a) Acknowledge

*R-Routine, NR - Non Routine

HAZARD IDENTIFICATION RISK ASSESSMENT RISK CONTROL

No Activities / Equipment/ Likeliho Severit Risk Recommended PIC (Due

18 a) Radiation is 18 a) Long term 18 a)can cause 18 a) Follow 18 a) Provide

*R-Routine, NR - Non Routine

HAZARD IDENTIFICATION RISK ASSESSMENT RISK CONTROL

*R-Routine, NR - Non Routine

HAZARD IDENTIFICATION RISK ASSESSMENT RISK CONTROL

*R-Routine, NR - Non Routine

HAZARD IDENTIFICATION RISK ASSESSMENT RISK CONTROL

No Activities / Equipment/ Likeliho Severit Risk Recommended PIC (Due

handling sharp 21) Needlestick / 21a) cause 21 a) Isolate or 21 a) Continously

*R-Routine, NR - Non Routine

HAZARD IDENTIFICATION RISK ASSESSMENT RISK CONTROL

*R-Routine, NR - Non Routine

HAZARD IDENTIFICATION RISK ASSESSMENT RISK CONTROL

No Activities / Equipment/ Likeliho Severit Risk Recommended PIC (Due

inappropriate or lack 23 a) Exposure to 23 a) cause 23 a) Wear gloves, 23 a) Provide

HAZARD IDENTIFICATION RISK ASSESSMENT RISK CONTROL

Activities / Equipment/ Risk Recommended PIC (Due

*R-Routine, NR - Non Routine

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