HAZARD IDENTIFICATION AND RISK ASSESSMENT (HIRA)
RA TEAM NAME SIGNATURE
Department STORE RA Leader: Johan REVIEW & APPROVED BY: Reference No.
RA Member 1: Revi Diansyah
Process: Store Activity RA Member 2:
Process / Activity RA Member 3: Signature:
Warehouse
Location:
Original Assessment
RA Member 4: Name: HIRA-01
Date:
RA Member 5:
Last Review Date 31/10/2022 Designation: HSE
RA Member 6:
Next Review Date: 31/10/2023 RA Member 7: Date:
Personal Protective Equipment
(PPE):
Safety helmet Glove Eye protection Safety Shoe Respirator Safety
Belt/Harness
Hazard Identification Risk Evaluation Risk Control
Likelihood
Likelihood
Risk Level
Risk Level
Severity
Severity
Potential Possible Injury / Implement Remark
No. Activity Existing Risk Control Additional Control Due Date
Hazard Ill Health Person s
1 Mengoperasikan Titik Jepit Cidera tangan 1.Gunakan sarung tangan 2 1 2 Pertahankan
Forklift Pinch point Finger injury Wear safety gloves pengendalian risiko saat
Operating 2.Inspeksi sebelum kerja: Identifikasi ini
Forklift potensi titik jepit sebelum memulai Maintain current risk
pekerjaan control
Pre-work inspection: Identify
potential pinch points before
starting work
Tabrakan Orang terluka, 1.Terapkan kecepatan maksimal 20 5 1 5 (rekayasa engineering) 3 1 3
Collision Kematian km/jam (engineering control)
Injured person, Applied maximum speed 20 km/hrs 1. Pengecatan area
Fatality 2.Operator adalah orang yang pejalan kaki
kompeten Paint road the
Operator is competent person pedestrian walkway
3.Pastikan area operasional aman (engineering control)
Ensure area of operation is clear 2. Sediakan kaca di titik
4.Tetapkan spotter saat bergerak buta
CM-FM-HSE-01-01/Rev.01/26.03.2020 Page 1 of 7
HAZARD IDENTIFICATION AND RISK ASSESSMENT (HIRA)
Assign spotter while mobile Provide mirror at blind
spot
3. Implement ALARP
(refer to SWP Risk
Identification
Assessment and
Control – CM-HSE-
SWP-11, Re-assess
regularly
Terapkan ALARP, nilai
ulang secara teratur
Operator Cidera fisik 1.Kencangkan sabuk pengaman 2 1 2 Pertahankan
terjatuh Bodily injury Fasten seat belt pengendalian risiko saat
Operator 2.Operator menjaga tiga titik kontak ini
falling Operator maintain 3 point contact Maintain current risk
control
Benda jatuh Cidera fisik Amankan material dengan tali 2 1 2 Pertahankan
Falling object Bodily injury Secure material with lashing pengendalian risiko saat
ini
Maintain current risk
control
Penerangan Penglihatan buruk 1.Sediakan tambahan lampu untuk 2 1 2 Pertahankan
Lighting Poor visibility Shift malam pengendalian risiko saat
Provide additional lighting for night ini
shift Maintain current risk
2.Cek lampu forklift control
Check forklift lamp
Kegagalan 1.Tersengat listrik Lakukan pengecekan sebelum mulai 4 1 4 Supervisor 2 1 2
alat electrical shock Perform pre-start checklist memastikan
Failure 2.Kerusakan pengecekan harian
equipment property sudah dilakukan
Property damage Supervisor to ensure
pre-start checklist has
been perform
Implement ALARP
(refer to SWP Risk
Identification
Assessment and
Control – CM-HSE-
SWP-11, Re-assess
regularly
CM-FM-HSE-01-01/Rev.01/26.03.2020 Page 2 of 7
HAZARD IDENTIFICATION AND RISK ASSESSMENT (HIRA)
Terapkan ALARP, nilai
ulang secara teratur
Peralatan 1.Cidera fisik 1. Jangan melampaui kapasitas 3 1 3 Pertahankan
tumbang Bodily injury beban pengendalian risiko saat
Equipment 2.Hitting others Never exceed the load capacity ini
tumbling Menimpa yang 2. Mematuhi standar & prosedur Maintain current risk
lain penggunaan control
3.Kerusakan Comply with the usage standard &
property procedure
Property damage
2 Mengoperasikan Titik buta 1.Tabrakan Tetapkan spotter saat bergerak 4 1 4 (rekayasa engineering) 3 1 3
truk crane Blind spot Collision Assign spotter while mobile (engineering control)
Operating truck 1. Pengecatan area
crane pejalan kaki
Paint road the
pedestrian walkway
(engineering control)
2. Sediakan kaca di titik
buta
Provide mirror at blind
spot
3. Implement ALARP
(refer to SWP Risk
Identification
Assessment and
Control – CM-HSE-
SWP-11, Re-assess
regularly
Terapkan ALARP, nilai
ulang secara teratur
Benda Menimpa orang 1. Pasang barikade di area 3 1 3 Pertahankan
mengayun lain pengangkatan pengendalian risiko saat
Swinging Hitting others Install barricade at lifting zone ini
object 2. Pindahkan beban perlahan Maintain current risk
Move the load and controls control
smoothly
3. Gunakan tagline untuk mencegah
rotasi atau Gerakan tak terkendali
lainnya
Use a tagline to prevent rotation or
other uncontrolled motion
CM-FM-HSE-01-01/Rev.01/26.03.2020 Page 3 of 7
HAZARD IDENTIFICATION AND RISK ASSESSMENT (HIRA)
4. Operator harus mengikuti
instruksi dari penunjuk sinyal
yang ditunjuk
Operator should follow
instructions from designation
signalman
Benda jatuh Cidera fisik 1. Pastikan tidak ada objek lain pada 3 1 3 Pertahankan
Falling object Bodily injury objek pengangkatan pengendalian risiko saat
Ensure no others object on the ini
lifting object Maintain current risk
2. Pastikan kait pengaman ditutup control
Ensure the safety latch is closed
3. Jangan meninggalkan beban
(atau crane) tanpa pengawasan
saat beban ditangguhkan
Do not leave the load (or the
crane) unattended while the load
is suspended
Kegagalan 1.Tersengat listrik Lakukan pengecekan sebelum mulai 2 1 2 Pertahankan
alat electrical shock Perform pre-start checklist pengendalian risiko saat
Failure 2.Kerusakan ini
equipment property Maintain current risk
Property damage control
Peralatan 1. Cidera fisik 1. Jangan melampaui kapasitas 3 1 3 Pertahankan
tumbang Bodily injury beban pengendalian risiko saat
Equipment 2.Hitting others Never exceed the load capacity ini
tumbling Menimpa yang 2. Mematuhi standar & prosedur Maintain current risk
lain penggunaan control
3.Kerusakan Comply with the usage standard &
property procedure
Property damage
Operator Cidera fisik 1. Kencangkan sabuk pengaman 3 1 3 Pertahankan
terjatuh Bodily injury Fasten seat belt pengendalian risiko saat
Operator 2. Operator menjaga tiga titik kontak ini
falling Operator maintain 3 point contact Maintain current risk
control
Tabrakan Orang terluka 1. Terapkan kecepatan maksimal 20 3 1 3 Pertahankan
Collision Injured person km/jam pengendalian risiko saat
Applied maximum speed 20 ini
km/hrs Maintain current risk
2. Operator adalah orang yang control
CM-FM-HSE-01-01/Rev.01/26.03.2020 Page 4 of 7
HAZARD IDENTIFICATION AND RISK ASSESSMENT (HIRA)
kompeten
Operator is competent person
3. Pastikan area operasional aman
Ensure area of operation is clear
3 Penanganan Titik Jepit Cidera tangan 1. Gunakan sarung tangan 3 1 3 Pertahankan
Manual Pinch point Finger injury Wear safety gloves pengendalian risiko saat
2. Inspeksi sebelum kerja: ini
Identifikasi potensi titik jepit Maintain current risk
sebelum memulai pekerjaan control
Pre-work inspection: Identify
potential pinch points before
starting work
Metode salah Sakit punggung Ikuti prosedur penanganan manual, 3 1 3 Pertahankan
(posisi badan) Back pain tidak mengangkat beban lebih dari pengendalian risiko saat
Wrong method 25kg/ perorang, ini
(body Maintain current risk
position) Perform proper manual lift technique control
and not exceeded 25kg/ per person
4 Penyusunan Titik Jepit Cidera tangan 1. Gunakan sarung tangan 3 1 3 Pertahankan
material Pinch point Finger injury Wear safety gloves pengendalian risiko saat
Stacking 2. Inspeksi sebelum kerja: ini
material Identifikasi potensi titik jepit Maintain current risk
sebelum memulai pekerjaan control
Pre-work inspection: Identify
potential pinch points before
starting work
Material jatuh Cidera fisik 1. Jangan tumpuk material lebih dari 3 1 3 Pertahankan
Falling Bodily injury 3 lapis atau lebih dari 1 meter pengendalian risiko saat
material Do not stack material more than 3 ini
layer or above 1 meter Maintain current risk
2.Pastikan kestabilan material control
Make sure the stability of stacking
material
3.Permukaan pendukung harus stabil
Supporting surface must stable
5 Bekerja di Jetty Jatuh ke laut Berpotensi 1.Lakukan training bekerja di dekat 3 1 3 Pertahankan
Working at jetty Falling to the tenggelam air sebelum melakukan aktifitas pengendalian risiko saat
sea Possible to Conduct working near sea ini
drowned awareness training before Maintain current risk
performing the activity control
2.Kenakan jaket pelampung
CM-FM-HSE-01-01/Rev.01/26.03.2020 Page 5 of 7
HAZARD IDENTIFICATION AND RISK ASSESSMENT (HIRA)
Wearing life jacket
A GUIDE TO SEVERITY RATING RISK MATRIX WITH NUMERIC RATINGS
CM-FM-HSE-01-01/Rev.01/26.03.2020 Page 6 of 7
HAZARD IDENTIFICATION AND RISK ASSESSMENT (HIRA)
A GUIDE TO LIKELIHOOD RATING RECOMMENDED ACTION FOR RISK LEVELS
CM-FM-HSE-01-01/Rev.01/26.03.2020 Page 7 of 7
