This document is a hazard identification, risk assessment, and risk control (HIRARC) form for a company. It lists a work activity, identifies potential hazards and their effects, assesses existing risks on a likelihood, severity, and risk scale, and proposes additional control measures with names of those responsible and due dates to reduce risks.

1. HIRARC Form
Company: Conducted by:
(Name, Designation)
Process:
Location:
Approve by:
(Name, Designation)
Date from – to:
Date: Review Date:
No
Hazard Identification Risk Assessment Risk Control
Work Activity Hazard Effect Existing risk Control (L) (S) (R)
Recommended Control
Measure
PIC
Due Date/Status
1.
2.
3.
4.
5.