HIRARC FORM

HAZARD IDENTIFICATION , RISK ASSESSMENT

AND DETERMINING CONTROL FORM Rev. 0
(HIRARC FORM)
Page 1 of 1

Department: PROJECT SAFETY Function / Main Activity: WORK AT HEIGHT Date:

HAZARD IDENTIFICATION RISK ASSESSMENT CONTROL MEASURES
y
l
ilt y
t
Legal &
it i l
NO Activity Description Hazard Potential Potential ii
r a
t Controls Other
b
e
v Action By
Of Risk a Required Requireme
O
Hazard b
O e T nts
r
WORKING AT HEIGHT P
S
MAJOR i. PROVIDE
DURING CABLE GRAVITY FALL FROM HEIGHT INJURY OR 3 5 15
LAYING AND PULLING FATALITY
PROPER AND
ON THE CABLE TRAY SAFE WORKING i. Work
Supervisor
PLATFORM

ii. PROVDE ii. Safety

1
Supervisor FMA (SHW) 1970,
PROPER
Reg. 12
MINOR/ ACCESS AND
MAJOR EGRESS WITH
GRAVITY FALLING OBJECT 3 5 15 FMA (BOWEC)
INJURY 1986, Reg. 15
HANDRAIL
AND
ADEQUATE
OVERHEAD
PROTECTION

TRIP AND FALL DUE

MAJOR FMA (BOWEC)
MECHANICAL TO POOR INJURY
3 5 15 1986, Reg. 9
HOUSEKEEPING
1) HOUSEKEEPING
SHOULD BE
iii. Work
DONE
Supervisor
REGULARLY
 HIRARC FORM
HAZARD IDENTIFICATION , RISK ASSESSMENT
AND DETERMINING CONTROL FORM Rev. 0
(HIRARC FORM)
Page 1 of 1

Department: PROJECT SAFETY Function / Main Activity: WORK AT HEIGHT Date:

2) PROVIDE RAILING
OR BARRICADE
AT BUILDING
iv. Safety
Supervisor
EDGES