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7/25/2019 Sample Form-HIRARC 10.11.2010
1/21
nama company
M-3-00-A
Drafting Date : 8th September 2010 Drafter : Moh Ro!"y Ab #a"
Stanar $o% Re&% $o%
M-'(R-0)*3 5
1.Purpose
+o e!tab"i!h an maintain a proce,re for ongoing haar ientification. ri!/ a!!e!!ment an the imp"ementation
of nece!!ary contro" mea!,re! inc",ing ro,tine an non-ro,tine acti&itie! an faci"itie! in a"" ei!ting an ne ob
2.Scope +hi! proce,re i! app"icab"e for a"" ro,tine an non-ro,tine acti&itie! an faci"itie! in S(M hich a"!o inc",e!
acti&itie! carrie o,t by the contractor!. &enor! an &i!itor! ho!e or/ ta/e p"ace ithin S(M%
3.Definition Of Terms
3%1 aar
aar mean! !o,rce or !it,ation ith a potentia" for harm in term of h,man in,ry or i"" hea"th. amage
to property. amage to or/ p"ace en&ironment. or a combination of the!e%
3%2 aar 4entification
aar ientification mean! a proce!! of recogniing that a haar ei!t! an efine it! characteri!tic!%
3%3 Ri!/
Ri!/ mean! a combination of the "i/e"ihoo an con!e,ence! of a !pecifie haaro,! e&ent occ,rring%
3%6 Ri!/ A!!e!!ment
Ri!/ a!!e!!ment mean! o&era"" proce!! of e!timating the magnit,e of ri!/ an eciing hether or not the
ri!/ i! to"erab"e%
3%5 +o"erab"e Ri!/
+o"erab"e ri!/ mean! ri!/ that ha! been re,ce to a "e&e" that can be en,re by the organiation ha&ing
regar to it! "ega" ob"igation an it! on po"icy%
3%) 7S
7S mean! management !y!tem in 7cc,pationa" Safety an ea"th aim! to minimie an contin,a""y re,ce
incience of occ,pationa" in,rie!.i""ne!!e! an to integrate !afe or/ing practice! into a"" area! of organiatio
4.Related Standards
$o Stanar $ame Stanar $o
Title Planning for %azard 'dentification( Ris)*ssessment & Ris) +ontrol Procedure
4nterna" =!
7/25/2019 Sample Form-HIRARC 10.11.2010
2/21
M-3-00-A
Drafting Date : 8th September 2010 Drafter : Moh Ro!"y Ab #a"
Stanar $o% Re&% $o%
M-'(R-0)*3 5
,.Responsi-ilities and *utorities
,.1 $%S /anager
)%1%1 Re!pon!ib"e to en!,re that ientification of haar an ri!/ in a"" epartment i! in accorance ith thi!
proce,re%
)%1%2 Re!pon!ib"e to appro&e the aar 4entification. Ri!/ A!!e!!ment an Ri!/ (ontro" 4RAR(9 form%
)%1%3 Re!pon!ib"e to initiate re&ieing of the 4RAR( at "ea!t once a year%
)%1%6 Re!pon!ib"e to en!,re that a"" !ignificant haar an ri!/ ha&e appropriate contro" mea!,re! in orer to
re,ce the ri!/ to a to"erab"e ri!/%
)%1%5 Re!pon!ib"e to en!,re that the obecti&e! an target !etting ba!e from the !ignificant haar an ri!/ re!
,.2 $%S Personnel
a!!e!!ment an ri!/ contro" accorance to the proce,re%
appro&e by the ES Manager%
a!!e!!ment an ri!/ contro" one by the Departmenta" ES 4ncharger%
,.3 Department /anager
)%3%1 Re!pon!ib"e to en!,re that a"" acti&ite! an faci"itie! ithin hi!>her epartment ha! been ientifie an
a!!e!! for it! !ignificant haar an ri!/%
)%3%2 Re!pon!ib"e to chec/e the 4RAR( form%
)%3%3 Re!pon!ib"e to en!,re a"" !ignificant haar an ri!/ ha&e an appropriate contro" mea!,re! inc",ing !et
,p the epartmenta" obecti&e! an program! in orer to re,ce the ri!/ to a to"erab"e ri!/%
, 4 D t $%S '
Title Planning for %azard 'dentification( Ris)*ssessment & Ris) +ontrol Procedure
)%2%1 ES Dept er!onne"re!pon!ib"e to !,pport ; eec,te a"" the acti&itie! !,ch a! haar ientification. ri!
)%2%2 ES Dept er!onne" re!pon!ib"e to &erify the 4RAR( acti&itie! ith Departmenta" ES 4ncharger before
)%2%3 ES Dept er!onne"re!pon!ib"e to monitor an ,pate the progre!! of haar ientification. ri!/
7/25/2019 Sample Form-HIRARC 10.11.2010
3/21
M-3-00-A
Drafting Date : 8th September 2010 Drafter : Moh Ro!"y Ab #a"
Stanar $o% Re&% $o%
M-'(R-0)*3 5
. Procedure or) lo
operating in!tr,ction of machinerie!%
7/25/2019 Sample Form-HIRARC 10.11.2010
4/21
M-3-00-A
Drafting Date : 8th September 2010 Drafter : Moh Ro!"y Ab #a"
Stanar $o% Re&% $o%
M-'(R-0)*3 5
7/25/2019 Sample Form-HIRARC 10.11.2010
5/21
M-3-00-A
Drafting Date : 8th September 2010 Drafter : Moh Ro!"y Ab #a"
Stanar $o% Re&% $o%
M-'(R-0)*3 5
Score ?e&e" of Ri!/ Action to (ontro"
15-1) $ot +o"erab"e
Significant
7becti&e! an the corre!poning management program !ha"" b
e&e"ope an e!tab"i!he to contro" an pre&ent the ri!/!%
7perationa" contro" proce,re !ha"" be e!tab"i!he an e&e"op
11-16 igh
Significant
7perationa" contro" proce,re! or other re"e&ant !pecification !
e&e"ope an re&i!e to manage the ri!/%
Cor/er to contro"
the 4RAR( @orm or 4nformation an re!,bmit%
7/25/2019 Sample Form-HIRARC 10.11.2010
6/21
M-3-00-A
Drafting Date : 8th September 2010 Drafter : Moh Ro!"y Ab #a"
Stanar $o% Re&% $o%
M-'(R-0)*3 5
8%3 (,rrent (ontro" Metho
8%6 (orrecti&e Action > +ro,b"e Shooting
(on,ct interna" a,it once in Si month!%
8%5 Recor Retention +ime
8%5%1 #ob ?i!t to be /ept for < year!
8%5%2 4RAR( to be /ept for < year!%
*nne9es *ttacment
Attachment 1: aar 4entification. Ri!/ A!!e!!ment an Ri!/ (ontro" @"o%
Attachment 2: #ob ?i!t @orm%
Attachment 3: aar 4entification. Ri!/ A!!e!!ment an Ri!/ (ontro" 4RAR(9 @orm%
Title Planning for %azard 'dentification( Ris)*ssessment & Ris) +ontrol Procedure
Re&ie the 4RAR( proce!! at "ea!t once a yearor after the e&ent of accient!>incient!%
7/25/2019 Sample Form-HIRARC 10.11.2010
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7/25/2019 Sample Form-HIRARC 10.11.2010
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7/25/2019 Sample Form-HIRARC 10.11.2010
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-015 REV 3
i"
age
1>)
%
he
%
7n"y
7/25/2019 Sample Form-HIRARC 10.11.2010
10/21
-015 REV 3
i"
age
2>)
"t%
7/25/2019 Sample Form-HIRARC 10.11.2010
11/21
-015 REV 3
i"
age
3>)
ing
!
7/25/2019 Sample Form-HIRARC 10.11.2010
12/21
-015 REV 3
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age
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ar
e
7/25/2019 Sample Form-HIRARC 10.11.2010
13/21
-015 REV 3
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age
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e
e%
a"" be
!fer%
engineering
t of
r&i!or!>
i"" ha&e to r
the ES Ma
7/25/2019 Sample Form-HIRARC 10.11.2010
14/21
-015 REV 3
i"
age
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7/25/2019 Sample Form-HIRARC 10.11.2010
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nama company
Stanar $o% Re&% $o%
M-'(R-0)*3 5
%azard 'dentification( Ris) *ssessment and Ris) +ontrol lo +art
ha!e
Re"ate Department ES Dept Re"ate form
"an
Do
(hec/
Title Planning for %azard 'dentification( Ris)*ssessment & Ris) +ontrol Procedure
@i"" =p #oES-@
Agree$otAgree
Dept ES 4ncharger! +o 4entifyActi&ite! ; @aci"itie! at their on
epartment 4nto #ob ?i!t @orm !,cha! 7S Re,irement. 4nfo ofroce!!.!e,ence of each ob.potenta"
haar ; ob faci"itie!
ES 4ncharger! @i"" 4n 4RAR( @orm
E&a",ate robabi"itie! > ?i/e"ihoo
7S Ri!/ Ran/ Matri +ab"e("a!!ification !,ch a! :Very ?i/e"y .
=n"i/e"y robabi"ty9 an !e&erity@rom $eg"igence to @ata"ity9
(hec/e anAgree
$ot Appro&e
E&a",ate +he Se&erity Ri!/("a!!ification9 !,ch a! @ata"ity.Maor or
Minor Accient
@i"" =p 4RES-@@-
ES er!onne" i"" anno,ce 4RAR(4entify to a"" epartment ES
4ncharger
Significant aar Matri +ab"e("a!!ification !,ch a! :$ot
to"erab"e.high.mei,m."o oracceptab"e%
7/25/2019 Sample Form-HIRARC 10.11.2010
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age
1 > 1
! an note!
b ?i!t @orm-ES-0)9
AR( @ormES-0
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nama companyForm No EHS-F
Rev. No
Rev. Date 04/0
JOB LISTDIVISION DEPT SECT
PREPARED CHECKED APPROVED
Signature
Name
Date
No Name of Job/Facilitie Pe!on "#o $oe F!e%&ency Name of S&t#e Job (R/NR/F) *ana
7/25/2019 Sample Form-HIRARC 10.11.2010
20/21
-EHS-06
1
5/2005
e!'io!/e!
nama company Form No EHS FF EHS 07
7/25/2019 Sample Form-HIRARC 10.11.2010
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nama company Form No. EHS-FF-EHS-07Rev. No. 3
Revision Date 08/09/2010
HA,ARD IDENTIFICATION- RISK ASSESS*ENT AND RISK CONTRO.
Di'iion PREPARED 0 CHECKED 0 APPROVED 0
Name of Job/ (DEPT - EHS PIC) (MANAGER) (EHS MGR)
Dept A'ti'itie
Si+nat&!e
Section Title Pe!on "#o $oe t#e 1ob
Name
Name of S&pe!'io!/PIC
Date
SE23ENCE OF HA,ARD IDENTIFICATION C3RRENT RISK ASSESS*ENT RISK CONTRO.ASIC JO STEP RISK CONTRO. .E4A. AND
OTHER RECO**ENDED ACTION CO*P.ETION
HA,ARD EFFECTS PRO5 SEV5 RISK RE23IRE*ENTS ACTION 0 DATE
RANK
RISK RANKIN4 PROAI.IT0 SEVERIT0 HA,ARD .IST
Sore !eve" #ro$a$i"it% &n'e( Desri)tion Severit% &n'e( Desri)tion Dec!iption
15 - 16 Not *o era e+ER, !&E!,
Cou appen requent y 5 or more per Year F*!&*, Deat , Be r en, Loss amount > !"5# 1 # %sia aar NoiseHeatFirero en assFa o
11 - 14 Hi $%posures are e%&essi'e :;