hirarc form sample clinic

HAZARD IDENTFICATION, RISK ASSESSMENT AND RISK CONTROL (HIRARC) FORM

Doc No.

Prepared by Revision No :

JOB TITLE Verified by Date :

Activities / Equipment/

FacilitesR/NR* Hazard Consequences Current Risk Control Likelihood Severity

Risk

LevelType of Control

Recommended

Control Measures

PIC (Due

Date /

Status)

R

Infectious

Diseases

Hepatitis B,

Hepatitis C and

Human

Immunodeficienc

y Virus (HIV) can

be spread by

infected blood

and body fluids

when they come

into direct

contact with

broken, scraped,

chapped or

inflamed skin or

when skin is

punctured by a

sharp object

such as a

needle.

13 a) wash hands

frequently (proper

handwashing is the

best way to prevent

communicable

diseases)

13 b) Follow

“Routine Practices”

at all times for all

patients

13 c) Check with

your Occupational

Health Nurse

regarding

immunizations

3 3 9 (M) Adminstrative

13 a) Provide a

written “Routine

Practices” document

that is easily

accessible

13 b) Ensure

availability of gloves

and other protective

equipment and

cleansing agents

13 c) Establish a

sharps program

13 d) Establish an

immunization

program for all

workers

Mr. F

(30/12/2011)

*R-Routine, NR - Non Routine

LIKELIHOOD SEVERITY

Most Likely (5) The most likely result of the hazard / event being realised Catastropic (5) Numerous fatalities

Possible (4) Has a good change of occuring and is not unusual (1-5 years) Fatal (4) Approximately one single fatality

Conceivable (3) Might be occur at sometime in future (5-10 years) Serious (3) Non-fatal injury, permanent disability or > 4 days MC

Remote (2) Has not been known to occur after many years (10 yrs) Minor (2) Disabling but not permanent injury or 1-4 days MC

Inconceivable (1) Is practically impossible and has never occurred Negligible (1) Minor abrasions, bruises, cut, first aid type injury

RISK = LIKELIHOOD X SEVERITY 15 - 25 : HIGH RISK 5-12 MEDIUM 1 - 4 : LOW RISK

RISK CONTROL

13

handling patients,

contaminated objects,

body secretions,

tissue or fluids

Working in Clinic

No

HAZARD IDENTIFICATION RISK ASSESSMENT


Doc No.





Risk

Level

Type of

Control

Recommended

Control Measures

PIC (Due Date /

Status)

R

9.1 a) Exposure

to known &

unknown

bacteria, fungal &

viruses

9.1 a) Sick

9.1 b) Fatality

9.1 a) Competency

& Proper PPE to be

worn 2 2 4 (L) NIL NIL

10

Clearing medical

wasteR

10 a) Contact

with sharp object

10.1 a) Sick

10.1 b) Fatality

10.1 a)Competency

& Proper PPE to be

worn 2 2 4 (L) NIL NIL

11

Using X-ray machine

R

11 a) Exposure to

radioactive and

radiation

11.1 a) Cancer

11.1 b) Fatality

11a) Competency &

Proper PPE to be

worn

11b) Safe work

distance, allowable

exposure limit &

2 2 4 (L) NIL NIL

12

Release

Contamination /

Hospital treated waste

R12 a) Scheduled

waste

12 a) Pollution to

atmosphere,

sanitary sewer,

ground water,

fresh water, soil

12a) Competency &

Proper PPE to be

worn2 2 4 (L) NIL NIL


LIKELIHOOD SEVERITY







RISK CONTROL

No

Working in Clinic

9

Receive & treat

patient



Doc No.





Risk


Recommended

Control Measures

PIC (Due Date

/ Status)

R

14 a) Heavy lifting

and frequent

bending or

twisting when

moving objects or

patients

Back injuries 14 a) Use available

lifts

14 b) Get help to lift

if mechanical device

is not appropriate or

not available

14 c) Use proper

lifting technique

3 3 9 (M) Administrative

14 a) Provide

accessible

mechanical lifts

(ceiling lifts preferred)

14 b) Ensure all staff

are trained to use

mechanical lifts

14 c) Train staff on

proper lifting

techniques

Mr. G

(30/12/2011)


LIKELIHOOD SEVERITY







RISK CONTROL

14

Handling patients &

moving objects

Working in Clinic

No



Doc No.




FacilitesR/NR* Hazard Consequences Current Risk Control

Likeliho

od

Severit

y

Risk


Recommended

Control Measures

PIC (Due

Date / Status)

15

Shiftwork

R

15 a) Changing

shifts and working

at night disrupts

your body’s

natural rhythms.

15 a) It can

contribute to

digestion

problems, heart

disease, and

sleep problems.

15 b) It also

makes

participation in

social activities

and family life

difficult.

15 a) Ask your

doctor’s advice

before becoming a

shift worker if you

have diabetes,

asthma, epilepsy or

mental health

problems

15 b) Improve your

sleep by practising a

regular bedtime

ritual and avoid

caffeine, smoking

and sleeping pills.


15 a) Avoid a

permanent night shift

15 b) Limit the

number of nights

worked

in a row

15 c) Avoid an early

start for morning

shifts

15 d) Give as many

weekends off as

possible with at least

two days off in a row

15 e) Keep schedules

regular and give

workers plenty of

notice of the

schedules

Mr. H

(30/12/2011)


LIKELIHOOD SEVERITY







RISK CONTROL

Working in Clinic

No



Doc No.





Likeliho

od

Severit

y

Risk


Recommended

Control Measures

PIC (Due

Date / Status)

R

16 a) Repetitive

Strain Injury (RSI)

16 a) Injury

usually affects

the wrist, hand,

shoulder, elbow,

back, knee or

ankle.

16 b) It can

cause pain,

weakness,

numbness or

difficulty in

grasping objects.

16 a) Organize your

work day so

repetitive tasks are

done for short

periods throughout

the day

16 b) Take regular

breaks


16 a) Provide

ergonomically correct

tools and equipment

16 b) Allow staff

control over how they

organize their work

day

16 c) Promote rest

breaks

Mr. I

(30/12/2011)


LIKELIHOOD SEVERITY







16

Repetitive, forceful or

awkward body

movements when

handling patient or

equipment

RISK CONTROL

Working in Clinic

No



Doc No.





Likeliho

od

Severit

y

Risk


Recommended

Control Measures

PIC (Due

Date / Status)

R

17 a) Health care

workers are at

risk from violence

17 a) Workplace

violence can

result in loss of

sleep, fear or

depression, post

traumatic stress

disorder, and

sometimes even

death.

17 a) Follow policies

and intervention

guidelines

17 b) Report

incidents to your

health and safety

representative

and/or committee.


17 a) Acknowledge

that violence is an

issue

17 b) Work with the

Health & Safety

Committee to identify

risks and develop

solutions

17 c) Post visible

signs reminding all

that this is a

respectful workplace

17 d) Train staff on

diffusing situations

and intervention

procedures

Mr. J

(30/12/2011)


LIKELIHOOD SEVERITY







17

Dealing with angry

and stressed patients

and their families.

RISK CONTROL

Working in Clinic

No



Doc No.





Likeliho

od

Severit

y

Risk


Recommended

Control Measures

PIC (Due

Date / Status)

R

18 a) Long term

and repeated

exposure to

radiation

18 b) Light beams

from lasers

18 a)can cause

genetic dam age

and reproductive

health problems.

18 b) Can harm

the eyes and

skin.

18 a) Follow

procedures and use

PPE

18 b) Take all safety

concerns to your

health and safety

representative

and/or committee


18 a) Provide

personal protective

equipment (PPE)

such as shield aprons

and safety glasses

18 b) Establish

procedures for use of

diagnostic equipment

and PPE

18 c) Minimize

exposure time to

radiation

18 d) Ensure warning

signs are posted

where appropriate

Mr. K

(30/12/2011)


LIKELIHOOD SEVERITY







18

18 a) Radiation is

used in diagnostic

procedures such

as x-ray, fluoroscopy

and angiography.

18 b) Used in tre atm

ents using radioactive

material.

18 c) Used in

microwaves, magnetic

fields and lasers.

RISK CONTROL

Working in Clinic

No



Doc No.





Likeliho

od

Severit

y

Risk


Recommended

Control Measures

PIC (Due

Date / Status)

R

19 a) A chemical

can enter your

body in three

main ways

i) It can be

breathed in

ii) It can go

through your skin

iii) It can be

swallowed

19 a) Cause

serious illness

and in some

cases, death.

19 b) Often the

effects are not

noticeable right

away.

19 a) Take concerns

to workplace health

& safety

representative

and/or committee

19 b) Read labels of

all chemicals used

and if m ore

information is

required, go to the

MSDS


19 a) Work closely

with the workplace

health & safety

committee to identify

chemicals used and

find out what health

effects they may have

19 b) Maintain all

MSDS (material

safety data sheets)

19 c) Eliminate toxic

chemicals or

substitute with less

toxic alternatives

when possible.

Mr. L

(30/12/2011)


LIKELIHOOD SEVERITY







19

Exposure to

chemicals in the form

of dusts, vapours,

gases or liquids.

RISK CONTROL

Working in Clinic

No



Doc No.





Likeliho

od

Severit

y

Risk


Recommended

Control Measures

PIC (Due

Date / Status)

R

20 a) Long term

exposure to high

levels of noise

(more than 80

decibels)

20 a) Cause

permanent

hearing loss.

20 b) Noise can

distract workers

and make it

difficult to

communicate

and concentrate.

20 a) Report any

equipment

malfunction as soon

as possible

20 b) Wear hearing

protection

20 c) Have hearing

checked regularly


20 a) Isolate noisy

machines in a room

where workers

seldom need to be

20 b) Use noise

dampeners

20 c) Maintain

equipment in good

working order •

provide hearing

protection

Mr. M

(30/12/2011)


LIKELIHOOD SEVERITY







20

High levels of noise

from kitchens,

laundries and boiler

rooms.

RISK CONTROL

Working in Clinic

No



Doc No.





Likeliho

od

Severit

y

Risk


Recommended

Control Measures

PIC (Due

Date / Status)

R

21) Needlestick /

Sharps Injuries -

a) Unsafe needle

devices.

b) Improper

handling and

disposal of

needles and other

sharps.

21a) cause

disease in

humans. These

pathogens

include Human

Immunodeficienc

y Virus (HIV),

Hepatitis B Virus

(HBV), Hepatitis

C Virus (HCV),

and others.

21 a) Isolate or

remove the

bloodborne

pathogens hazard

from the workplace

21 b) Employee

injury is later

diagnosed with an

infectious

bloodborne disease

21 c) Use safer

needle devices and

needleless devices

to decrease

needlestick or other

sharps exposures.


21 a) Continously

send worker training

in appropriate

engineering controls

and work practices, to

eliminate or minimize

worker exposure.

Mr. N

(30/12/2011)


LIKELIHOOD SEVERITY







21

handling sharp

devices or equipment

such as scalpels,

sutures, hypodermic

needles, blood

collection devices, or

phlebotomy devices

RISK CONTROL

Working in Clinic

No



Doc No.





Likeliho

od

Severit

y

Risk


Recommended

Control Measures

PIC (Due

Date / Status)

R

22 a) Slip and

Falls

22 a) Slip and

trip

22 b) Body

injury

22 a) Use the non

slippery shoe or

sandals.

22 b) Avoid failing of

greasy liquids on

floor


a) Avoid slippery

flooring

b) Fix the side bars or

handles on stair case

c) Clean floor

regularly to avoid the

contents of greasy

liquids Mr. O

(30/12/2011)


LIKELIHOOD SEVERITY







22

Walking on the

slippery floor

RISK CONTROL

Working in Clinic

No



Doc No.





Likeliho

od

Severit

y

Risk


Recommended

Control Measures

PIC (Due

Date / Status)

R

23 a) Exposure to

hazardous

processes or

infectious

materials or

chemicals

23 a) cause

disease in

humans through

pathogens

include Human

Immunodeficienc

y Virus (HIV),

Hepatitis B Virus

(HBV), Hepatitis

C Virus (HCV),

and others.

23 a) Wear gloves,

when handling

chemicals and/or

body fluids.

23 b) Wear safety

shoes/boots/covers

if hazardous

substance is likely

to splash.

23 c) Wear an

apron/gown/coverall

s- if hazardous

substance is likely

to splash.

23 d) Use a

respirator: when

hazardous

substance is

airborne such as

tuberculosis.


23 a) Provide

personal protective

equipment (PPE)

adequately and

appropriately

23 b) Establish PPE

policy for use of PPE

23 c) Ensure warning

signs required PPE to

be worn are posted

where appropriate Mr. P

(30/12/2011)


LIKELIHOOD SEVERITY






23

inappropriate or lack

of PPE.

RISK CONTROL

Working in Clinic

No



Doc No.





Risk


Recommended

Control Measures

PIC (Due

Date / Status)

R

23 a) Exposure of

employees to

glutaraldehyde.

Exposure of

employees to

glutaraldehyde.

Short term

(acute) effects:

Long-term

(chronic) effects:

23 a) Make sure

that rooms in which

glutaraldehyde is to

be used are well

ventilated

23 b) Store

glutaraldehyde in

closed containers in

well ventilated

areas.

23 c) Use specially

designed, mobile,

compact,

disinfectant soaking

stations to facilitate

sterilization of heat

sensitive equipment

such as

endoscopes, or GI

scopes.

23 d) Use PPE


23 a) Ensure that the

hazards of all

chemicals are

evaluated and that

this information is

transmitted to the

employees by means

of a hazards

communication

program which

includes, labeling,

material safety data

sheets, and employee

training. Mr. Q

(30/12/2011)


LIKELIHOOD SEVERITY






RISK CONTROL

23

Use Glutaraldehyde to

disinfect and clean

heat-sensitive

medical, surgical and

dental equipment.

Working in Clinic

No


hirarc form sample clinic

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