HIRARC FORM

Company Name JBR ELECTRO-MECHANICAL

Conducted
CHRISTIAN KERR G. AGOT
SERVICES, INC. by: (Name, JBR-EMSI SAFETY OFFICER

designation)
Process/Location PUROK 4, LOOC, PANGLAO, BOHOL
Date:
(from…to ..)
Approved by: Last Review 1.
(Name, Date
2.
designation)
Date DD MM YYYY

No 1.) Hazard Identification 2.)Risk Analysis 3.) Risk Control

Work Activity Hazard Potential Existing Likeliho Sever Risk Recommend Person In
Effect Risk od ity Control Measure Charge
Control (Due Date)
(if any)
1 Example: Spra Example: Example: Exampl Example:
ying Hazardous Accident e: Safe Appropriate
chemicals al work facemasks/respir
are used contact practice ators, goggles,
with and face double-sided
chemical mask aprons, nitrile
s (eyes, gloves
inhalatio
n, etc.)
2