HIRA
Contractor/Company DATE
HIRA TEAM (NAME LIST)
DEPARTMENT CIVIL NAME POSITION
PERMIT TO WORK NO
TASK DESCRIPTION
Working at height
REFERENCES AND ANY OTHER RELEVANT INFORMATION ( e.g P & CONFIRMED ALARP
ID's , Drawings,Procedure , Work Instructions, Certificates , Special Tools or Equipment) HIRA APPROVED BY (Installation / Facility /Site Manager)
Name
Signature
Position
Date
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HIRA
Task Description Summary - Work at Height
1. 2. 3.
4. IR 5. 6.
7. RR
STEP
Activity Description Potential Hazard Hazard Effect L S R/I Existing Controls & Controls Required Responsible E P R
1.Obstructed access 1.Slip, trip and fall on same level. 1. Inspection of work location prior starting the job
2.Defective tools 2. Personal Injury 2 Clear the area and indentify safe access and display the safety signboard
3.Unsafe gound condition 3.Property damage. 3. No unauthorized movement Site Engineer /
1 Work Area prepration 4.Unsafe material stacking 3. Damage to equipments 2 2 4 4. Obtain valid permit. Performing 2 1 2
Authority
5.All materials shall be stacked properly at designated location
6.Dislplay of safety promotional sign boards be ensured.
1. Inadequate use of hand toola 1. Finger Caught in between 1.Inspect tools before using.
2. Failure to use PPE 2. Personal Injury 2.Use right tools for the job Site Engineer /
2 Use of hand tools 3. Using makeshift tools 3. Damage to equipment 2 2 4 3. Use appropriate PPE Performing 2 1 2
Authority
4.Pinch point 4. Do not use any makeshift or damaged tools at site
5.Only trained amd experienced person shall be engaged in the job.
1.Collapsing or toppling of scaffold. 1. Falling of materials. 1. Ensure engaged personnel have worn full body harness and anchored thelanyar
2.High wind 2. Falling of workforce
2. Scaffold shall be inspected by competent person before commencing the work.
3. Ergonomics 3. On the condition of bad weather such as high wind and poor visibility work at
4.Environmental concern 4. Trained personnel shall be engaged. Site Engineer /
3 Work at height 2 3 6 Performing 2 1 1
5.Vertigo 5. Adequate supervision need to be conducted. Authority
6. Full length of ladder shall be used for access/egress.
1.Accumulation of debris 1. Tripping /Falling hazard 1. Housekeeping shall be maintined continuously.
2. Non closure of permit 2 Remove all debris from the site
3 Permit must be closed and submitted. Site Engineer /
Housekeeping & close of work for
4 2 1 2 Performing 2 1 2
the day Authority
1. Extreme weather condition 1 Collapse of individual 1.Evacuation procedure shall be in place
2 Lack of supervision 2 Unvailbility of emergency 2. Effective TBT , shall include Emergency response.
vehcile 3. Ensure emergency vehicle arrangement Site Engineer /
5 Emergency Response 2 2 4 Performing 2 1 2
3. Ensure emergency vehicle arrangement is on place Authority
4.Emergerncy contact No. shall be displayed at site.
1. Poor communication 1. Human fatigue 1.Ensure enagaged crew is trained in working
1. Inadequate illumination 1.Stip/Trip 1. Ensure adequate lighting arrangementm are provided
2.Fatigue of workers. 2.Personal injury 2. Ensure effective night shift supervision
3.Reptiles 3. Property damage 3. Stop work in the event of adverse climate
4.Lack of supervision 4.Personal injury 4. Ensure night shift personnel get enough sleep or rest during day Site Engineer /
6 Night Shift Work 2 2 4 Performing 2 1 2
5.Working without extension of PTW 5. Ensure personnel are trained to meet any emergency that may occure at night Authority
6.Ensure availability and use of suitable rest area to safe workers from reptiles.
1. Lack of or inadequate rest shed 1.Cold related illness 1.Esnure plenty of Hot drinking water is available at site
2.Collapse of workmen 2. Ensure adeqaute rest shelter is available for workmen to take rest. Site Engineer /
7 Extreme cold weather 2 2 4 Performing 2 1 2
Authority
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RISK MATRIX
Severity
1. 2. 3. 4. 5.
Minor Moderate Serious Major Significant
No or Minor Off Site Serious Injury More than One Permanent Disability and
Injury Medical Treatment & LTI LTI Fatality
5.
Will Occur in 5 10 15 20 25
present state
Probability (Likelihood of the Occurance)
4.
More likely to 4 8 12 16 20
occur than not
3.
Possible 50/50 3 6 9 12 15
chance
2.
Unlikely Could
occur less than 2 4 6 8 10
50/50 chance
1.
Very Unlikely
little or no 1 2 3 4 5
chance of
occurrence
1-3 Low Risk Managed by routine procedures.May be acceptable,however review
to see if risk can be reduced further
4-6 Modrate Risk Task should only proceed with appropriate management
authorisation
8-12 High Risk Task needs further review and consultation with specialists and
where possible the task should be re-defined to take account
of the hazards involved or the risk should be reduced to further before
the task is allowed to commence
15-25 Extreme Risk Task should not proceed
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