APPENDIX 1

POLITEKNIK UNGKU OMAR

Manual Title: HAZARD IDENTIFICATION, RISK ASSESSMENT AND RISK CONTROL (HIRARC)
Procedure Number: QP-DSS-005 Rev No: 0 Effective Date: 07/04/2021

HIRARC FORM (Example)

Faculty/Location/Block PE(CFS-PJ) Campus PK / K-V

Fakulti /Lokasi/Blok Kampus
Conducted by Name: Sumayyah Name: Masreta Name: Sofea
Diselia oleh Designation/Dept: Designation/Dept: Designation/Dept:
SHO/DSS Lecturer Manager /DEF

Date: (from...to...) 2 Nov 2020 Time: 10 am to 2 pm

Tarikh: (Daripada… Masa:
Kepada…)
Next Review Date: 31 Nov 2020 Ref.No. for Follow Up Pe/4th Q 2020/1(2,3
Tarikh Semakan Action: and so on)
Seterusnya: No Rujukan Untuk
Tindakan Susulan:

Hazard Identification (HI) Risk Assessment Risk Control (RC)

Pengenalpastian Bahaya RA# Kawalan Risiko
Penilaian Risiko

NO Hazard/ Defect Identified Risk Recommended Control Action

and which can cause /effect (High/Medium/Low) Measures By & Due
Date
/Status
1 Poor Stair Design High Encourage the building DEF/
of well-designed 31 Dec
stairways 2020
2 Intention And Unsafe Medium See the Safer Work DSS
Behavior Stairs and Steps 31 Nov
Information Sheet for 2020
advice and
Signs should only be
used where hazards
cannot be avoided or
reduced
3 Inappropriate Footwear Medium Do not wear too high DEF/
heels for women, worn 9 Nov
shoe soles and roller 2020
skates