Date of issue

FACULTY OF ENGINEERING

DIPONEGORO UNIVERSITY
Page 1 of 3
Document No:

Hazard Identification Risk Assessment Control (HIRAC)

Originator : SHE Departement of ________________

Document Type :
P New Revision

Nature of revision(s):

Reason(s) of revision:

husein

Function Name Signature

SHE Departement of
Originator husein
________________
 SHE Departement of
Originator husein
________________

MR SHE Faculty of
Approved by
Engineering

Date of print:
 Date of issue
FACULTY OF ENGINEERING

DIPONEGORO UNIVERSITY
Page 1 of 3
Document No:

HIRAC) Hazard Identification Risk Assessment Control (HIRAC)

1.0 SCOPE
This form demonstrated the way of department to define the Hazard Identifica
Assessment Control

2.0 LIST OF FORM

3.0 RECORDS
The record of HIRAC is filed and kept in EHS Management System folder.

4.0 DOCUMENT
NIM Terakhir anda Lokasi Gedung KEGIATAN
0
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Date
Date of print:
 Date of issue

Page 2 of 3

ment Control (HIRAC)

efine the Hazard Identification Risk

gement System folder.

KEGIATAN
 DEPARTEMEN TEKNIK ELE

Departemen Teknik Elektro

HIRADC (Hazard Identification, Risk A

Location : Gedung A/B

Hazard / Bahaya (Sumber Bahaya) atau

Activity/Product/Services Aktivitas / Potential Incident / Kejadian yang tidak diinginkan atau
No Environmental Aspect / Aspek
Produk / Jasa Environmental Impact / Dampak pada Lingkungan
Lingkungan

RUTIN
 Dibuat Oleh, Diperiksa Oleh,

……………..Nama dan NIM Karnoto, ST. MT.

Calon Ahli K3 Listrik Ahli K3 Bidang Listrik
RTEMEN TEKNIK ELEKTROUNIVERSITAS DIPONEGORO

DC (Hazard Identification, Risk Assessment and Determining Control)

Current Risk / Risiko Saat Ini

Likelihood / Kemungkinan

Risk Rating / Tingkat

Condition /

Consequence /
Konsekuensi
Kondisi Operasi
Potential Incident / Kejadian yang tidak diinginkan atau

Terjadi
(Normal / Kendali yang ada saat ini / Existing Control

Risiko
Environmental Impact / Dampak pada Lingkungan
Abnormal /
Emergency)
ONEGORO

Document Number : HIRADC-001

Document taks

Revision : 00

Date Dec-20
Risk / Risiko Saat Ini Residual Risks / Risiko Residual
Likelihood / Kemungkinan

Risk Rating / Tingkat

Acceptable? / Dapat

Acceptable? / Dapat
Consequence /
Konsekuensi

Additional Controls
Diterima?

Diterima?
Terjadi

(recommended) / Pengendalian
Risiko

Tambahan (diusulkan)