Hazard Identification and Risk Assessment Template

Fillable Printable Hazard Identification and Risk Assessment Template

Hazard Identification and Risk Assessment Template

Sample

HAZARD IDENTIFICATION AND RISK ASSESSMENT (HIRA) FORM

PART 1: HAZARD IDENTIFICATION

(to be completed by the Faculty/Service/Department Safety Advisor).

1) Title of Activity/Equipment Location (Building/Room)

River water sampling (for subsequent laboratory analysis)

2) Brief Description of the Activity/Equipment

(under assessment).

Collecting a river water sample; undertaking a site inspection as part of research

project



Taking river water samples

 Site inspection

 Transportation and storage of samples

3) Reference Method or Protocol (under assessment).

Based upon Environment Agency Guidance.

4) Persons Affected

(list all persons in your area, either staff or non staff who may perform the activity or use

the equipment).

a) Staff:

(Names, if possible, Job Titles plus numbers if not).

J. Bloggs, Senior Lecturer

A. N. Other, technician

b) Non Staff: (inc. students, (numbers, i.e. per year/per practical, etc.), visitors and

general public).

Post-graduate students (4 per visit)

5) Potential Significant Hazards

(list all hazards associated with the activity or

equipment).



Slips, trips and falls on uneven or slippery surfaces and steps

 Falling into watercourse

 Hit by mobile plant and vehicles



Contact with bacteria, pathogens, vermin

 Exposure to dangerous chemicals



Confrontation with aggressive persons

 Exposure to needles and sharp objects

 Injury from lifting



Asphyxiation in confined spaces

 Hit or trapped by moving machinery

Signed:

.........................................................

(Safety Advisor/Risk Assessor)

Date:..............................................................

Sample

PART 2: RISK ASSESSMENT

(to be completed by appropriate person)

Risk = likelihood (of event occurring) x hazard (severity)

Using the definition of Risk which covers both likelihood (chance) of

occurrence and severity of harm (taking into account population at risk and

level of injury possible) calculate the risk by grading the likelihood (1-4) and

the severity (1-4), (1=Low, 4=High), giving a final figure between 1 and 16.

Hazard Identified

(see list in Part 1, Section 5)

Likelihood of

occurrence

(grade 1-4)

(A)

Hazard

(Severity)

(grade 1-4)

(B)

Risk

(likelihood x

Hazard)

(A x B)

Slips, trips and falls on

uneven or slippery

surfaces and steps

Falling into watercourse

Hit by mobile plant and

vehicles

Contact with bacteria,

pathogens, vermin

Exposure to dangerous

chemicals

Confrontation with

aggressive persons

Exposure to needles and

sharp objects

Injury from lifting

Asphyxiation in confined

spaces

Hit or trapped by moving

machinery

Signed: .........................................................................

Dean/Head of

School/Service/Supervisor

Date: ..............................................

Sample

PART 3. CONTROL MEASURES

a) EXISTING (list all controls that are existing in place)

Slips, trips and falls on uneven or slippery surfaces

and steps

Wear safety footwear. Do not climb

steep surfaces whilst carrying

equipment. Be aware of risk of

surveying close to watercourses.

Hit by mobile plant and vehicles

Wear high visibility clothing. Keep to

marked footpaths where possible. If

a survey location is close to a road,

extra care must be taken.

Adverse weather conditions

Wear appropriate clothing. Ensure

that surveys are only conducted in

favourable weather conditions.

Ensure provision of waterproof

clothing if required.

Confrontation with aggressive persons/animals

Avoid confrontational situations and

adopt a non-confrontation manner.

Wherever possible, and particularly

in certain areas, ensure that surveys

are carried out in pairs.

Getting lost in an unfamiliar area

Make a preliminary site visit with a

person who knows the area or with a

map.

General control measures

Observe written and oral guidance

provided by staff. Inform a

nominated, reliable person where

and when survey is taking place and

over what time period. Carry

identification and a mobile telephone

(or have ready access to a public

telephone).

Existing Controls Satisfactory? YES

(if NO parts b) and c) must be completed)

b) SHORT TERM REQUIREMENTS

(implementation within six months)

IMPLEMENTATION

DATE

COMPLETION

DATE

Ensure all persons involved read risk assessment.

Before visiting site

Ensure all persons involved have received some

guidance on surveying.

Before visiting site

Check all persons involved in survey have

appropriate clothing and personal protective

equipment (PPE).

Before visiting site

and at site

c) LONG TERM REQUIREMENTS

(implementation within six to eighteen months)

IMPLEMENTATION

DATE

COMPLETION

DATE

Signed as Completed: ............................................................ Dean/HOS/HOD Date: ...............................

Comments: Original to be kept by Faculty/Department/Service

Assessment review date: Annual

Sample

PART 4. NOTIFICATION OF CHANGES

(To be completed by Line Manager and Risk Assessor)

Any significant change to the working activity or equipment must be suitably

assessed.

1) Description of Changes to Activity/Equipment

(Brief details only)

None at present

2) New Potential Hazards Associated with Changed Activity/Equipment

N/A

3) Control Measures to be Implemented

No new measures required

Signed: .............................................................................

Dean/HOS/HOD

Date: ............................