013 - Activity Hazard Analysis (AHA) Form.pdf
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- Solicitation number
- N4008524R2666
About this file
This document is an Activity Hazard Analysis (AHA) form, which is used to identify and assess potential hazards and safety controls for a specific work activity. The AHA includes a Risk Assessment Code (RAC) matrix to determine the overall risk level based on the severity and probability of potential incidents. The form lists job steps, associated hazards, and corresponding safety controls. It also specifies the required equipment, training, inspections, and personnel for the work.
The related federal contract opportunity is for the removal and disposal of Zebra Mussels and marine deposits from the Raw Water Intake (RWI) and associated timber crib structure to ensure unrestricted water flow to a Great Lakes Water Treatment Plant. The solicitation, issued by the Department of the Navy Naval Facilities Engineering Command, requires the contractor to provide all labor, tools, transportation, supervision, materials, inspections, equipment, and safety compliance necessary to perform the work.
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Text version
Activity Hazard Analysis (AHA)
Activity/Work Task: Overall Risk Assessment Code (RAC) (Use highest code)
Project Location: Risk Assessment Code (RAC) Matrix
Contract Number:
Severity
Probability
Date Prepared: Frequent Likely Occasional Seldom Unlikely
Prepared by (Name/Title
Catastrophic Critical
Reviewed by (Name/Title):
Marginal Negligible
Notes: (Field Notes, Review Comments, etc.)
Company Name:
Step 1: Review each “Hazard” with identified safety “Controls” and determine RAC (See above)
“Probability” is the likelihood to cause an incident, near miss, or accident and identified as: Frequent, Likely, Occasional, Seldom or Unlikely. RAC Chart
“Severity” is the outcome/degree if an incident, near miss, or accident did occur and identified as: Catastrophic, Critical, Marginal, or Negligible
E = Extremely High Risk H = High Risk
Step 2: Identify the RAC (Probability/Severity) as E, H, M, or L for each “Hazard” on AHA. Annotate the overall highest RAC at the top of AHA.
M = Moderate Risk L = Low Risk
Job Steps Hazards Controls RAC 1.
2.
3.
4. (Add additional steps as necessary)
Equipment to be Used Training Requirements/Competent or Qualified Personnel name(s) Inspection Requirements
File details come from the government source that posted it. Updated .