Hiradc Form
Hiradc Form
Hiradc Form
Department/Section :
Risk Assessment Team
Names Dept - Position Sign Off Names Dept. - Position Sign Off Approved By
Date Developed & Update:
Facilitator : :
Context :
Team Members : :
5. Tingkat Kendali
5. Tingkat Kendali
Hirarchy Control
Hirarchy Control
2. Resiko Terhadap Risk Identified Raw Risk Assessment Residual Risk Assessment
Manusia /
1. Proses / Aktifitas / Tugas Lingkungan 3.1 Bahaya / Penyebab Efek 3.2 Insiden / Efek Buruk / 6. Kendali Memperingan saat ini 7, Pengendalian Tambahan yangdiperlukan Oleh Siapa Kapan 8, Referensi Persyaratan hukum dan lainnya
Status
Process / Activity / Task People / Tingkat Current Mitigating Controls Tingkat Additional Controls Required By whom By When Legal and Other Requirements Reference
Buruk Aspek Lingkungan Dampak Lingkungan
Environment at L C Resiko L C Resiko
Hazard / Cause of Adverse Incident / Adverse Effect /
Risk Risk Level Risk Level
Effect / Environmental Aspect Environmental Impact
Department/Section :
Risk Assessment Team
Names Dept - Position Sign Off Names Dept. - Position Sign Off Approved By
Date Developed & Update:
Facilitator : :
Context :
Team Members : :
5. Tingkat Kendali
5. Tingkat Kendali
Hirarchy Control
Hirarchy Control
2. Resiko Terhadap Risk Identified Raw Risk Assessment Residual Risk Assessment
Manusia /
1. Proses / Aktifitas / Tugas Lingkungan 3.1 Bahaya / Penyebab Efek 3.2 Insiden / Efek Buruk / 6. Kendali Memperingan saat ini 7, Pengendalian Tambahan yangdiperlukan Oleh Siapa Kapan 8, Referensi Persyaratan hukum dan lainnya
Status
Process / Activity / Task People / Tingkat Current Mitigating Controls Tingkat Additional Controls Required By whom By When Legal and Other Requirements Reference
Buruk Aspek Lingkungan Dampak Lingkungan
Environment at L C Resiko L C Resiko
Hazard / Cause of Adverse Incident / Adverse Effect /
Risk Risk Level Risk Level
Effect / Environmental Aspect Environmental Impact
Konsekuensi
Kemungkinan 1 - Tidak 2 - Kecil 3 - Sedang 4 - Berat
signifikan
B - Sering Terjadi S T T E
C - Dapat Terjadi R S T E
D - Kadang-kadang R R S T
E - Jarang sekali R R S T
Standard AN/NZS 4360
RISK MATRIX
(TT-OHS-ATP-003)
KEMUNGKINAN
E B Sering Terjadi
E C Dapat Terjadi
E D Kadang-kadang
T E Jarang sekali
2 Kecil
3 Sedang
4 Berat
5 Bencana
PERINGKAT RISIKO
Tingkat Risiko
E Extrim
T Tinggi
S Sedang
R Rendah
KEMUNGKINAN
Contoh Rinci
PERINGKAT RISIKO
Tindakan
4 5
E E
E E
E E
T E
T T