HIRARC Form

Hazard Identification, Risk Assessment and Risk Control. Layout follows the HIRARC form in the DOSH Guidelines for HIRARC 2008 (Appendix C).

Print on A4 landscape, or choose "Save as PDF" in the print dialog. Page 2 holds the rating tables and risk matrix. Use one form per work process.

Company		Conducted by (name, designation)
Process / location		Date (from ... to ...)
Approved by (name, designation)		Review date
Approval date		Next review date

1. Hazard identification				2. Risk analysis				3. Risk control
No.	Work activity	Hazard	Which can cause / effect	Existing risk control (if any)	Likelihood (L)	Severity (S)	Risk (L×S)	Recommended control measures	PIC (due date / status)
1
2
3
4
5
6
7

Rate L and S with the existing controls in place. Re-assess after the recommended controls are implemented. Include routine and non-routine activities (maintenance, cleaning, breakdowns).

Rating guide

Likelihood (L)	Example	Rating
Most likely	The most likely result of the hazard / event being realised	5
Possible	Has a good chance of occurring and is not unusual	4
Conceivable	Might occur at some time in future	3
Remote	Has not been known to occur after many years	2
Inconceivable	Is practically impossible and has never occurred	1

Severity (S)	Example	Rating
Catastrophic	Numerous fatalities, irrecoverable property damage and productivity	5
Fatal	Approximately one single fatality, major property damage if hazard is realised	4
Serious	Non-fatal injury, permanent disability	3
Minor	Disabling but not permanent injury	2
Negligible	Minor abrasions, bruises, cuts, first aid type injury	1

5×5 risk matrix (Relative risk = L × S)

Likelihood (L)	Severity (S)
Likelihood (L)	1	2	3	4	5
5	5	10	15	20	25
4	4	8	12	16	20
3	3	6	9	12	15
2	2	4	6	8	10
1	1	2	3	4	5

Action by risk level

Score	Risk	Action
15 to 25	High	Immediate action to control the hazard using the hierarchy of control. Record actions and completion date on this form.
5 to 12	Medium	Planned approach to control the hazard; apply temporary measures if required. Record actions and completion date.
1 to 4	Low	May be acceptable; further reduction may not be necessary. If it can be resolved quickly and efficiently, implement and record the control.

Hierarchy of control

1. Elimination · 2. Substitution · 3. Engineering controls (isolation, guarding, ventilation, lockout) · 4. Administrative controls (safe work procedures, permits, training, supervision, job rotation) · 5. PPE (last line of defence)

HIRARC team members (name, designation)
Person in charge of area (sign)
Management approval (sign, date)

DOSH guidance: communicate the HIRARC to employees, keep records for at least 3 years, and review every three years or whenever the process or activity changes. Risk assessment is a duty under section 18B of the Occupational Safety and Health Act 1994.