BORANG HIRARC (HIRARC FORM)

Faculty/Department/Unit/Laboratory/Workshop: Conducted By:

Fakulti/Jabatan/Unit/Makmal/Bengkel: (Name, Position)
Work Process/Location/Block: Disediakan Oleh:
Proses Kerja/Lokasi/Blok: (Nama, Jawatan)

Approved By: Prepared Date: (from)

(Name, Position, Signature) Tarikh Disediakan: (dari)
Disahkan Oleh:
(Nama, Jawatan, Review Date:
Tandatangan) Tarikh Disemak:

Approved Date: Second Review Date:

Tarikh Disahkan: Tarikh Semakan Semula:

1. Hazard Identification 2. Risk Analysis

Pengenalpastian Hazard Analisis Risiko
Which can cause/effect
Existing Risk Control (if any) Likelihood Severity Risk
No. Work Activity Hazard Yang Boleh
Kawalan Risiko Kebarangkalian Keterukan Tahap Risiko
Bil. Aktiviti Kerja Hazad Mengakibatkan/Kesan
(sedia ada) (A) (B) (AxB)
Likelihood Scale
Skala Kemungkinan / Kebarangkalian
5 - Almost Certain / Paling Mungkin (Setiap Jam)
4 - Likely / Mungkin (Setiap Hari)
3 - Possible / Dapat Dijangka (Setiap Minggu)
2 - Unlikely / Jarang Sekali (Setiap Bulan)
1 - Rare / Tidak Mungkin (Setahun Sekali)
Severity Scale Preventive Measures (Control Scale)
Skala Keterukan / Ketenatan Langkah Kawalan (Hierarki Kawalan)
5 - Catastrophic / Malapetaka 1 - Elimination / Penghapusan
4 - Fatal / Kematian 2 - Substitution / Penggantian
3 - Serious / Serius (MC lebih 3 hari/Hilang Upaya Kekal) 3 - Engineering Control / Kawalan Kejuruteraan
2 - Minor / (MC kurang 3 hari/Kecederaan Tidak Kekal) 4 - Administrative Controls / Kawalan Pengurusan
5 - Personal Protective Equipment / Peralatan Perlindungan
1 - Negligible/ Lelasan Kecil, Lebam, Luka Ringan, Kecederaan Ringan
Diri

Risk / Tahap Risiko

A risk identified as LOW may be considered as acceptable and further reduction may not be necessary. However, if the risk can be resolved quickly and
1-4 - Rendah (Low)
recorded.

5-12 - Sederhana (Medium) A MEDIUM risk requires a planned approach to controlling the hazard and applies temporary measure if required. Actions taken must be documented o

15-25 - Tinggi (High) A HIGH risk requires immediate action to control the hazard as detailed in the hierarchy of control. Actions taken must be documented on the risk asse
 utm/oshe/hirarc/v01

(to)
(hingga)

3. Risk Control
Kawalan Risiko

Recommended Control Measures PIC (Due date/status)

Langkah Kawalan Yang Orang Bertanggungjawab
Disarankan (Tarikh Tamat/Status)
uickly and efficiently, control measures should be implemented and

umented on the risk assessment form including date for completion.

risk assessment form including date for completion

Contoh Pengisian Dokumen HIRARC
HIRARC