ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
utm/oshe/hirarc/v01
2
 BORANG HIRARC (HIRARC FORM)
3
4
5
6
Faculty/Department/Unit/Laboratory/Workshop:
Fakulti/Jabatan/Unit/Makmal/Bengkel:		Conducted By:
(Name, Position)
Disediakan Oleh: (Nama, Jawatan)
7
Work Process/Location/Block:
Proses Kerja/Lokasi/Blok:
8
9
Approved By:
(Name, Position, Signature)
Disahkan Oleh: (Nama, Jawatan, Tandatangan)		Prepared Date: (from)
Tarikh Disediakan: (dari)		(to)
(hingga)
10
Review Date:
Tarikh Disemak:
11
Approved Date:
Tarikh Disahkan: 		Second Review Date:
Tarikh Semakan Semula:
12
13
14
1. Hazard Identification
Pengenalpastian Hazard 		2. Risk Analysis
Analisis Risiko 		3. Risk Control
Kawalan Risiko
15
No.
Bil. 		Work Activity
Aktiviti Kerja 		Hazard
Hazad 		Which can cause/effect
Yang Boleh Mengakibatkan/Kesan 		Existing Risk Control (if any)
Kawalan Risiko
(sedia ada) 		Likelihood
Kebarangkalian
(A)		Severity
Keterukan
(B) 		Risk
Tahap Risiko
(AxB)		Recommended Control Measures
Langkah Kawalan Yang Disarankan 		PIC (Due date/status)
Orang Bertanggungjawab (Tarikh Tamat/Status)
16
17
18
19
20
21
22
23
24
Likelihood Scale
Skala Kemungkinan / Kebarangkalian		Severity Scale
Skala Keterukan / Ketenatan		Preventive Measures (Control Scale)
Langkah Kawalan (Hierarki Kawalan)
25
5 - Almost Certain / Paling Mungkin (Setiap Jam)5 - Catastrophic / Malapetaka1 - Elimination / Penghapusan
26
4 - Likely / Mungkin (Setiap Hari)4 - Fatal / Kematian 2 - Substitution / Penggantian
27
3 - Possible / Dapat Dijangka (Setiap Minggu)3 - Serious / Serius (MC lebih 3 hari/Hilang Upaya Kekal)3 - Engineering Control / Kawalan Kejuruteraan
28
2 - Unlikely / Jarang Sekali (Setiap Bulan)2 - Minor / (MC kurang 3 hari/Kecederaan Tidak Kekal)4 - Administrative Controls / Kawalan Pengurusan
29
1 - Rare / Tidak Mungkin (Setahun Sekali)1 - Negligible/ Lelasan Kecil, Lebam, Luka Ringan, Kecederaan Ringan5 - Personal Protective Equipment / Peralatan Perlindungan Diri
30
31
Risk / Tahap Risiko
32
1-4 - Rendah (Low)
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 efficiently, control measures should be implemented and recorded.
33
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 on the risk assessment form including date for completion.
34
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 assessment form including date for completion
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100