Hazard Identification and Risk Assessment Template

Sample
HAZARD IDENTIFICATION AND RISK ASSESSMENT (HIRA) FORM
PART 1: HAZARD IDENTIFICATION
(to be completed by the Faculty/Service/Department Safety Advisor).
1) Title of Activity/Equipment Location (Building/Room)
River water sampling (for subsequent laboratory analysis)
2) Brief Description of the Activity/Equipment
(under assessment).
Collecting a river water sample; undertaking a site inspection as part of research
project
Taking river water samples
Site inspection
Transportation and storage of samples
3) Reference Method or Protocol (under assessment).
Based upon Environment Agency Guidance.
4) Persons Affected
(list all persons in your area, either staff or non staff who may perform the activity or use
the equipment).
a) Staff:
(Names, if possible, Job Titles plus numbers if not).
J. Bloggs, Senior Lecturer
A. N. Other, technician
b) Non Staff: (inc. students, (numbers, i.e. per year/per practical, etc.), visitors and
general public).
Post-graduate students (4 per visit)
5) Potential Significant Hazards
(list all hazards associated with the activity or
equipment).
Slips, trips and falls on uneven or slippery surfaces and steps
Falling into watercourse
Hit by mobile plant and vehicles
Contact with bacteria, pathogens, vermin
Exposure to dangerous chemicals
Confrontation with aggressive persons
Exposure to needles and sharp objects
Injury from lifting
Asphyxiation in confined spaces
Hit or trapped by moving machinery
Signed:
.........................................................
(Safety Advisor/Risk Assessor)
Date:..............................................................
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