📍 When to use this template
- Before starting any new or non-routine construction activity.
- Whenever there is a change in work method, machinery, material, or site conditions.
- Prepared by the Site Engineer/Supervisor for the activity, reviewed by the Safety Officer, and approved by the Project Manager/Site In-charge.
Sections & fields
Preview of the template structure. Download Excel to fill on site.
1Header & Project Information8 fields
Project Name
_____________
Contract / Package No.
_____________
HIRA Document No.
_____________
Revision No.
_____________
Date of Assessment
_____________
Prepared By (Name & Designation)
_____________
Reviewed By (Safety Officer)
_____________
Approved By (Project Manager)
_____________
2Activity Details7 fields
Activity Name (e.g., 'PCC for Raft Foundation')
_____________
Location / Grid Line / Area
_____________
Scheduled Start Date & Time
_____________
Scheduled End Date & Time
_____________
Tools & Plants (T&P) to be Used
_____________
Manpower Involved (Skilled, Unskilled)
_____________
Associated Permits Required (e.g., Excavation, Confined Space)
_____________
3Hazard Identification4 fields
Task / Step-wise Activity Breakdown
_____________
Potential Hazard (e.g., 'Fall of person from height', 'Contact with live electrical line', 'Collapse of trench')
_____________
Potential Consequence / Effect (e.g., 'Fatality', 'Major Injury', 'Property Damage')
_____________
4Initial Risk Assessment (Without Controls)5 fields
Likelihood (L) [Scale 1-5]
_____________
Severity (S) [Scale 1-5]
_____________
Risk Score (R = L x S)
_____________
Risk Level (e.g., Low, Medium, High, Very High)
_____________
5Control Measures4 fields
Proposed Control Measures (Based on Hierarchy: Elimination, Substitution, Engineering, Administrative, PPE)
_____________
Responsibility for Implementation (e.g., 'Site Engineer', 'Electrical Supervisor')
_____________
Target Date for Completion
_____________
6Residual Risk Assessment (With Controls)6 fields
Residual Likelihood (L) [Scale 1-5]
_____________
Residual Severity (S) [Scale 1-5]
_____________
Residual Risk Score (R = L x S)
_____________
Residual Risk Level (e.g., Low, Medium)
_____________
Acceptability (Yes/No)
_____________
7Communication & Review4 fields
HIRA Communicated To (e.g., 'All workmen via Toolbox Talk')
_____________
Date of Communication
_____________
Review Frequency (e.g., 'Daily', 'Weekly', 'If conditions change')
_____________
Signature of Site In-charge / Executing Engineer
_____________
💡 Sample filled excerpt
Activity: Manual Excavation (Depth 2.0m)
Hazard: Collapse of trench sides
Initial Risk: Likelihood=4, Severity=5, Risk Score=20 (High)
Control Measure: Provide shoring & strutting as per IS 3764 design; maintain safe slope; no surcharge within 1.5m of edge.
Residual Risk: Likelihood=2, Severity=5, Risk Score=10 (Medium)
⚖ Compliance notes
- Fulfills the employer's duty to ensure a safe work environment under Section 40 of the BOCW Act, 1996.
- A mandatory prerequisite for high-risk activities like excavation (Rule 55), lifting (Rule 46), and work on scaffolds (Rule 39) as per BOCW (Central) Rules, 1998.
- Serves as primary evidence of proactive safety management during client safety audits, third-party inspections, or inquiries by the Labour Department.
- Most PMC/Client contracts require submission and approval of HIRA before issuing a Permit to Work (PTW) for the activity.