HAZARD IDENTIFICATION , RISK ASSESSMENT AND DETERMINING CONTROL FORM

(HIRARC FORM)

HIRARC FORM

Rev. 0

Page 1 of 1

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

HAZARD IDENTIFICATION RISK ASSESSMENT CONTROL MEASURES

NO Activity Description HazardPotential Of

Hazard Potential

Risk

Pro

bab

ility

Sev

erit

y

To

tal

ControlsRequired

Action By

Legal & Other

Requirements

1

WORKING AT HEIGHT DURING CABLE LAYING AND PULLING ON THE CABLE TRAY

GRAVITY FALL FROM HEIGHT

MAJOR

INJURY OR

FATALITY

3 5 15i. PROVIDE

PROPER AND

SAFE WORKING

PLATFORM

ii. PROVDE

PROPER

ACCESS AND

EGRESS WITH

HANDRAIL AND

ADEQUATE

OVERHEAD

PROTECTION

i. Work Supervisor

ii. Safety Supervisor FMA (SHW) 1970,

Reg. 12

FMA (BOWEC) 1986, Reg. 15

GRAVITY FALLING OBJECT

MINOR/

MAJOR

INJURY3 5 15

MECHANICALTRIP AND FALL DUE

TO POOR HOUSEKEEPING

MAJOR INJURY

3 5 151) HOUSEKEEPING

SHOULD BE DONE

REGULARLYiii. Work

Supervisor

FMA (BOWEC) 1986, Reg. 9

HAZARD IDENTIFICATION , RISK ASSESSMENT AND DETERMINING CONTROL FORM

(HIRARC FORM)

HIRARC FORM

Rev. 0

Page 1 of 1

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

2) PROVIDE RAILING

OR BARRICADE

AT BUILDING

EDGES

iv. Safety Supervisor