PWS_W_ALL_APPENDICES.pdf

PERFORMANCE WORK STATEMENT (PWS)

FOR

JOB HAZARD ANALYSIS (JHA)

FLORIDA ARMY NATIONAL GUARD (FLARNG)

1.0 General:

1.1 Scope: The contractor shall provide all personnel, equipment, tools, materials, supervision, and quality control necessary, except as specified in Paragraph 2.0 as Government Furnished, to perform Job Hazard Analysis (JHA) Services, as defined in this Performance Work Statement (PWS).

1.2 Background: The FLARNG State Safety Office works to provide for a safe working environment, free from accidents and injuries that is compatible with the mission of the Florida Department of Military Affairs throughout all levels of command in every operation and activity. This program is designed to promote safe and healthful practices for personnel on and off duty and to preserve the fighting force.

1.3 Delivery Date: JHA reports shall be completed no later than 90 days after date of contract award.

1.4 General Information:

1.4.1 Recognized Holidays: the contractor shall not perform services on recognized federal holidays

1.4.2 Place and Performance of Services: The contractor will have access to facilities except on recognized US holidays or when the Government facility/installation is closed due to local or national emergencies, administrative closings, or similar Government-directed facility/installation closings. The contract schedule upon award of the contract

The four facilities requiring a Job Hazard Analysis are; FLARNG Army Aviation Support Facility (AASF) #1, 13650 Aerospace Way, Jacksonville, FL 32221 (See Appendix A for location of shops), AASF #2 16388 Helicopter Drive, Brooksville, FL 34604 (See Appendix B for location of shops), CSMS (Combined Support Maintenance Shop) 5629 State 16, Camp Blanding, Starke, FL 32091 (See Appendix C for location of shops), and UAS Facility 5629 SR 16 W, CBJTC, BLDG 3584 Starke, FL 32091 (See Appendix D for location of shops). It is up to the contractor to schedule with the Government Representative to gain access to the facilities in order to perform required work deemed appropriate by the contractor to fulfill the requirements of the PWS. It is estimated to take 3-4 days to complete each facility based on the number of JHAs annotated on Appendices A, B, C and D.

JHA Performance Work Statement

1.4.2.1 Unscheduled gate closures may occur at any time causing all personnel entering or exiting a closed installation to experience a delay. This cannot be predicted or prevented. Contractors are not compensated for unexpected closures or delays.

Vehicles operated by contractor personnel are subject to search pursuant to applicable regulations. Any moving violation of any applicable motor vehicle regulation may result in the termination of the contractor employee’s installation driving privileges.

1.4.2.2 The contractor’s employees shall become familiar with and obey the regulations of the installation; including fire, traffic, safety and security regulations while on the installation. Contractor employees should only enter restricted areas when required to do so and only upon prior approval. All contractor employees shall carry proper identification with them at all times. The contractor shall ensure compliance with all regulations and orders of the installation which may affect performance.

1.4.3 Security Requirements. The contractor shall comply with all applicable installation/facility access and local security policies and procedures, which may be obtained from the AASF #1, AASF #2, CSMS and UAS personnel. The contractor shall ensure compliance with all personal identity verification requirements as directed by DOD, HQDA and/or local policy. Should the Force Protection Condition (FPCON) change, the Government may require changes in contractor security matters or processes.

1.4.3.1 Information Systems: at no time will the contractor be provided or allowed access to the Florida National Guard (FLNG) Network. The contractor shall not attempt to introduce external devices to the FLNG Network. The contractor shall not be authorized access to the FLNG telephone network.

1.4.3.2 Protection of Personally Identifiable Information (PII). The contractor shall protect all Personally Identifiable Information (PII) encountered in the performance of services in accordance with DFARS 224.103 and DoDD 5400.11, Department of Defense Privacy Program, and DoD 5400.11-R. If a PII breach results from the contractor’s violation of the aforementioned policies, the contractor shall bear all notification costs, call-center support costs, and credit monitoring service costs for all individuals who’s PII has been compromised.

1.4.4 Physical Security. The contractor shall safeguard all Government property provided for contractor use. At the close of each work period, Government facilities, equipment and materials shall be secured.

1.4.5 Special Qualifications: Contractor must be certified as a Certified Safety Professional, at a minimum. Desired OSHA certifications: OSHA 511, OSHA 2045, OSHA 2225, OSHA 2255, OSHA 3095, OSHA 3115, OSHA 2264, and OSHA 7115.

1.4.6 Post Award Conference/Periodic Progress Meetings: The contractor agrees to attend any post award conference convened by the Knowledgeable Official (KO) in accordance with Federal Acquisition Regulations Subpart 42.5. The KO or other Government personnel, as appropriate, may meet periodically with the contractor to review the contactor’s performance. At these meetings, the Contacting Officer will apprise the contractor of how the Government views the contractor’s performance and the contractor shall apprise the Government of problems, if any, being experienced The contractor shall resolve outstanding issues raised by the Government. Contractor attendance at these meetings shall be at no additional cost to the Government.

1.4.7 Contract Manager (CM): The contractor shall designate a CM who shall ensure performance under this contract. The name of this person, and an alternate who shall act for the contractor when the CM is absent, shall be designated in writing to the KO.

The CM or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The CM shall work through the COR, (or the KO if a COR is not assigned), to resolve issues, receive technical instructions, and ensure adequate performance of services. The CM shall ensure that contractor employees do not perform any services outside the scope of the contract without an official modification issued by the KO. The CM shall ensure contractor employees understand that services performed outside the scope of the contract are performed wholly at the expense of the contractor.

1.4.8. Combating Trafficking in Persons: The United States Government has adopted a zero tolerance policy regarding trafficking in persons. Contractors and contractor employees shall not engage in severe forms of trafficking in persons during the period of performance of the contract; procure commercial sex acts during the period of performance of the contract; or use forced labor in the performance of the contract. The Contractor shall notify its employees of the United States Government’s zero tolerance policy, the actions that will be taken against employees for violations of this policy. Such actions may include, but are not limited to, removal from the contract, reduction in benefits, or termination of employment. The Contractor shall take appropriate action, up to and including termination, against employees or subcontractors that violate the US Government policy as described at FAR 22.17.

1.4.9 Organizational Conflicts of Interest (OCI): The contractor and subcontractor personnel performing services under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent OCIs, as defined in FAR Subpart 9.5. The contractor shall notify the KO immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the KO to avoid or mitigate any such OCI. The contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the KO and in the event the KO unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the KO may affect other remedies as he or she deems necessary, including prohibiting the contractor from participation in subsequent contracted requirements which may be affected by the OCI.

2.0 Government Furnished Property, Material, Equipment and Services (GFP/M/E/S):

The Government will provide the property, material, equipment, and/or services listed below solely for the purpose of performance under this contract:

2.1 Property/Materials: A State Safety Office representative will provide controlled access while the contractor is on-site to the following necessary products: Facility maps and building diagrams; Standard Operating Procedures(SOPs); Facility hazard logs;

Facility accident reports; Trend analysis data; Previous internal and external inspections [Industrial Hygiene surveys, Aviation Resource Management Surveys (ARMS), Standard Army Safety and Occupational Health Inspections (SASOHI)]; Hazardous materials inventories; Technical manuals (for task analysis). These items will only be accessed in the presence of the State Safety Office representative and will be secured immediately after the contractor has reviewed the information for purposes of the contract service.

3.0 Contractor Furnished Property, Materials, and Equipment (CFP/M/E):

3.1 General: Except for those items specifically stated to be Government-Furnished in Paragraph 2.0, the contractor shall furnish everything required to perform these services as indicated in Paragraph 1.1.

4.0 Requirements of the contractor:

4.1 Create a detailed Job Hazard Analysis on individual tasks in facility shops (see Appendices A, B, C and D) that identifies occupational work area hazards to all Soldiers and Civilian Employees, develops controls based on hierarchy to risk control selection, specifies occupational safety and health training requirements based on hazard exposure, and determines the exact personal protective equipment necessary to protect the employees from identified hazards. The JHA must comply with requirements outlined in AR 350-1, AR 350-10, DA PAM 385-10, DA PAM 385-30, 29 CFR 1910, 29 CFR 1960. Consideration must be given to all hazardous materials or chemicals present in the organization that are used by unit maintenance personnel and constitute a risk to employees if exposed in the workplace.

4.1.1 Contractor responsibilities will include:

a. Post Award Conference/Periodic Progress Meetings

b. Conduct an hour in-brief with facility Commander/Supervisor, Aviation Safety Officer and supervisors that will serve as an induction period for both the facility personnel and the contractor, explain the scope tasks and objectives, deliverables, and serve as a period to conduct questions. Deliverable schedule is displayed in Technical Exhibit 1.

c. Create a detailed JHA for each shop that outlines a job description, task/equipment/material, detailed hazard and controls for each hazard. See paragraph 5.0 (Applicable Publications) and Appendix E for example of format.

d. Review the three Facility SOPs for relevancy of work performed in each shop.

e. Recommend changes to administrative controls (signage, procedures) as part of the final JHA.

f. Identify any areas that may require lock out/tag out operations or procedures.

g. Complete an assessment and provide recommendations for current controls to engineering, administrative and personal protective equipment as well as facility emergency action plans as they relate to JHA’s.

h. Provide a recommended training plan for each respective JHA for both operators and supervisors.

i. Provide an assessment and recommendations of facility/shop safety boards to include detailed listing of items needed per final JHA.

j. Provide JHA’s and assessments in both digital and paper formats. Digital copies will include at least 12 copies on CD of all deliverables. Paper copies will include 12 complete copies of each summary, JHA or other deliverable (distribution for ASO, Safety NCO, Commander, LMO, and JHA for each respective shops and one for SSO). Digital copies must be in Microsoft Office 2013 compatible format.

k. Conduct an out-briefing with first line supervisors and Aviation Safety Officer reviewing all deliverables to ensure all personnel understand the JHA provide as well as answer any questions concerning the JHA’s and deliverables.

4.2 Common facility hazards:

- Chemicals (toxic, flammable, corrosive)

- Electrical (shock/short circuit, fire, static, loss of power)

- Composite materials

- Ergonomics (strain, human error)

- Fall (slip, trip)

- Fire / heat

- Mechanical (vibration, crushing, pinching, failure)

- High pressure systems (compressed gasses, canisters, accumulators)

- Explosive hazards (cartridge activated devices)

- Confined space operations

- Noise

- Struck (by, against)

- Vehicle/mechanical handling equipment operations (aircraft tugs, fuel trucks, forklifts)

- Temperature (heat, cold)

- Weather (rain, wind, and lightning)

- Radiation

4.3 Contractor Manpower Reporting Application (CMRA):

4.3.1 The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the FLARNG via a secure data collection site to be provided.

4.3.2 The contractor shall completely fill in all required data fields using the following web address: http://www.ecmra.mil/. Reporting inputs shall be for the labor executed during the period of performance during each Government fiscal year (FY), which runs October 1 through September 30. While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year, beginning with 2018. Contractors may direct questions to the help desk at http://www.ecmra.mil.

4.3.3 Information regarding CMR, including contractor guides, can be found at the following website: https://cmra.army.mil/help/glossary.html

4.3.4 Unit Identification Code (UIC) for the Requiring Activity: W8AKAA Issuing Office DoDAAC: W911YN

5.0 Applicable Publications: Publications applicable to this PWS are listed below:

• AR 385-10

• AR 600-55

• NG Supplement 1 to AR 385-10

• DA PAM 385-10

• DA PAM 385-40

• DA PAM 385-30

• 29 CFR 1910 OSHA

• OSHA 3071

5.1 Publications can be accessed at the flowing sites:

Army Publications: http://www.apd.army.mil/

National Guard Publications:

http://www.ngbpdc.ngb.army.mil/pubs/NG%20Sup%20Series/NG%20Supplement%201 %20to%20AR%20385-10.pdf

OSHA:

https://www.osha.gov/pls/oshaweb/owastand.display_standard_group?p_toc_level=1&p _part_number=1910 https://www.osha.gov/Publications/osha3071.pdf

APPENDIX A

Army Aviation Support Facility #1 13650 Aerospace Way Jacksonville, FL 32221

- All employees perform work requiring heaving lifting

- All employees may be subject to operate/drive/work on equipment: Military wheeled vehicles, Trailers, Gator, Forklift, Overhead Crane etc.

- Most rooms have flammable lockers; most rooms contain chemicals (HAZMAT)

- 81 Total Employees

BLDG 860 (Facility)

- Various offices o Using walking surfaces around office areas o Using bookcase, shelves and cabinets o Using office equipment o Using electrical equipment o Computer work

- Flight Line o Aircraft Operations, Maintenance Operations Checks, Run-ups o Aircraft Servicing and Defueling Operations o Towing of Aircraft o Aircraft Maintenance o AGPU usage and Hydraulic Servicing o Chemical Use o Severe Weather o Sling Load Operations o Hoist Operations o Engine Break-in and Leak Checks o POL Operations

- Hangar o Sanding and Grinding Operations o Aircraft Maintenance o Aircraft Movement o Overhead Crane Operations o Tire Maintenance Pressurized Operations o Aircraft Power Cart Operations o Fuel Cell Maintenance refueling operations o Rescue Hoist Maintenance o Chemical Use o Nitrogen Servicing Cart o Degreasing Operations, Spray Gun Cleaner operations o Jack Maintenance o Paint Mixer o Confined Space Entry

- Spot Painting o Spray Gun Operations o Degreasing Operations o Spray Gun Cleaner Operation

- RM 116-A Technical Supply o Using walking surface around office areas o Using bookcases, shelves and cabinets o Using office equipment o Parts storage shelving system o Using electrical equipment o Lifting/moving material

- RM 119-A Avionics/Electrical Shop o Power Supply Operations o Aircraft Component, Maintenance operational Checks o Soldering Operations o Wiring Operations o Chemical Use o Heavy Lifting o Pressurized Air Operations

- RM 121-A Battery Shop o Battery Charging Operations, Battery Maintenance o Battery Storage Operations o Battery Maintenance Operational Checks o Chemical Use (Acid Products)

- RM 133-A ALSE Shop o Drilling Operations o Pressurized Air Services o Using Bookcases, shelves and cabinets o Lifting/moving materials o Soldering

- RM 136-B Sheet Metal Shop o Bench Grinder Operations o Drill Grinder Operations o Drill Press Operations o Belt/Drum Sander Operations o Metal Lathe Operations o Metal Shear Operations o Metal Brake Operations o Band Saw Operations o Slip Roll Operations o Riveting Operations o Chiseling Operations o Chemical Uses o Shrinker / Stretcher o Hole Punch o Air Pressure Tool Operations o Band Saw Blade Welder

- RM 142-B Power Plant Shop o Overhead Crane Operations o Chemical Use o Degreasing Operations, Spray Gun Cleaner Operations o Pressurized Air o Ultra-Sonic Cleaner vat

- RM 143-A NDI SHOP

o Black Light Use o Ultrasonic Testing o Eddy Currant Testing o Dye Penetrate o Chemical Use

- RM 150-A Power Train Shop o Bench Grinding Operations o Over Head Crane Operations o Hydraulic press Operations o Hammering, chiseling Operations o Pressurized Air Uses

- RM 152-A Hydraulic Shop o Rigid/Flexible Tube manufacturing o Hydraulic Line Pressure Testing Operations o Cutting Operations

- RM 161-A GSE SHOP

o Sanding Operations o Tire Changer operations o Jack Maintenance o Under Vehicle Maintenance o Chemical Use o Tire Maintenance and Pressurized Air Service o PD680 Vat

- RM 304 – Electronics o Electronic device Repair

Soldering Iron

Soldering Machine Set

Testing Equipment

Nitrogen Tanks o Laser Vault

NVG Testing

- RM 314 (316) – Calibration o Calibration equipment service/repair

Radiation Hazard

Testing Equipment

- RM 322 – Instrument Repair o Weapon Sight Repair

Radiation Hazard

Testing Equipment

- RM 330 – Support Bay o Automotive/Misc Repair Bays

General Tools

BLDG 862

- BLDG 862 Welding shop east of Hanger o Bench Grinding o Drill Press, Drilling Operations o Sanding Operations Air Tools o Band Saw Operations o Plasma Gun Operations o Mig, Rod, Torch Welding Operations o Bead Blasting Operations o Chiseling Operations o Autoclave Oven o Over Hoist o BLDG Vent System o Overhead Vent System

BLDG 861

- BLDG 861 Hazmat o Numerus Chemicals o Heavy Lifting

BLDG 866

- BLDG 866 Storage outside Supply o Fork Lifts o Heavy Lifting

BLDG 864

- BLDG 864 Wash rack o Air Pressure Operations o Power Supply o Aircraft Cleaner Solvent o Engine Cleaning Solvent

APPENDIX B

Army Aviation Support Facility #2 16388 Helicopter Drive Brooksville, FL 34604 wheeled vehicles, Trailers, Gator, Forklift, Overhead Crane etc.

- Most rooms have flammable lockers; most rooms contain chemicals (HAZMAT)

- 40 Total Employees

BLDG 16388 (Facility)

Various offices o Using walking surfaces around office areas o Using bookcase, shelves and cabinets o Using office equipment

Flight Line o Aircraft Servicing and Defueling Operations o Towing of Aircraft o Aircraft Maintenance o AGPU usage and Hydraulic Servicing o Chemical Use o Severe Weather o Sling Load Operations o Hoist Operations o Engine Break-in and Leak Checks o POL Operations

Hangars A and B o Sanding and Grinding Operations o Aircraft Maintenance o Aircraft Movement o Tire Maintenance Pressurized Operations o Aircraft Power Cart Operations o Fuel Cell Maintenance refueling operations o Rescue Hoist Maintenance o Chemical Use o Nitrogen Servicing Cart o Degreasing Operations, Spray Gun Cleaner operations o Jack Maintenance o Pressing Operations o Confined Space Entry

RM 04 ALSE Shop o Pressurized Air Services o Using Bookcases, shelves and cabinets o Lifting/moving materials o Soldering o Chemical Use o Grinding Operations o Sanding Operations

RM 46 Technical Supply o Using walking surface around office areas o Using bookcases, shelves and cabinets o Using office equipment o Parts storage shelving system o Using electrical equipment o Computer work o Forklift Operations o Lifting/moving material

RM 50 Sheet Metal Shop o Bench Grinder Operations o Drill Grinder Operations o Drill Press Operations o Belt/Drum Sander Operations o Metal Lathe Operations o Metal Shear Operations o Metal Brake Operations o Band Saw Operations o Slip Roll Operations o Riveting Operations o Chiseling Operations o Chemical Uses o Air Pressure Tool Operations

RM 50 Welding Shop o Bench Grinding o Drill Press, Drilling Operations o Sanding Operations Air Tools o Band Saw Operations o Plasma Gun Operations o Mig, Rod, Torch Welding Operations o Chiseling Operations o Hole Punch Operations o Laser Engraver Operations o Chemical Use o BLDG Vent System o Overhead Vent System

RM 53 Hydraulic Shop o Rigid/Flexible Tube manufacturing o Hydraulic Line Pressure Testing Operations o Cutting Operations o Chemical Use o Hydraulic Purification Operations o Servo Nulling Operations

RM 54 Spot Painting o Spray Gun Operations o Bead Blasting Operations o Spray Gun Cleaner Operations o Paint Shaker Operations

RM 56 Battery Shop o Battery Charging Operations, Battery Maintenance o Battery Storage Operations o Battery Maintenance Operational Checks o Chemical Use (Acid Products)

RM 58, 59 Avionics/Electrical Shop o Aircraft Component, Maintenance operational Checks o Soldering Operations o Wiring Operations o Chemical Use o Pressurized Air Operations

RM 60 NVG Shop o Testing Equipment o Nitrogen Tanks o NVG Testing

RM 62 Power Train Shop o Bench Grinding Operations o Over Head Crane Operations o Hydraulic press Operations o Hammering, chiseling Operations o Pressurized Air Uses o Drill Press Operations

RM 65 GSE SHOP

o Sanding Operations o Tire Changer operations o Jack Maintenance o Under Vehicle Maintenance o Tire Maintenance and Pressurized Air Service

RM 66 Power Plant Shop o Chemical Use o Degreasing Operations, Spray Gun Cleaner Operations o Pressurized Air o Grinding Operations o Drilling Operations o Degreasing Operations

RM 68 NDI SHOP

o Black Light Use o Ultrasonic Testing o Eddy Currant Testing o Dye Penetrate o Ultrasonic Cleaner Use

POL Shed

SR01, SR02, SR03 Hazmat o Numerus Chemicals

Wash Rack

Flight Line Wash Rack o Air Pressure Operations o Power Supply o Aircraft Cleaner Solvent o Engine Cleaning Solvent

APPENDIX C

Combined Support Maintenance Shop (CSMS)

- All employees may be subject to operate/drive/work on equipment: Military wheeled vehicles, military tracked vehicles, Trailers, Gator, Kubota, Forklift, etc.

- Most rooms have flammable lockers; all rooms contain chemicals (HAZMAT)

- 70 Total Employees

BLDG 4104

- RM 214 - Small Arms Repair o 1.4 Explosives Vault o Test Fire Room o Inspect/Repair Weapons

Drill Press

Part Washer

Vise

Bench Grinder

- RM 212 – Carpenter Shop o Address Sawdust Hazard o Woodwork/Fabrication

Plunge Router Jigsaw Electric hand drill Circular Saw Bench Grinder Belt Sanders Scroll Saw Nail Gun Air Gun

- RM 211 – Canvas Shop o Fabricate/Repair Canvas

Sewing machine (3 types)

Belt Sander

Overhead Crane o Fabricate Signage

Stencil Cutting Machine

- RM 209 – Machine Shop

Band Saw

Hydraulic Press

Metal Punching Machine

Swinging Crane

Power hack saw

Solvent Tank

- RM 205 – Support Bay

20+ FT ladder

High work stands

Sheet Metal Brake

Sheet Metal Shear

AC/DC Welding machine

Oxy/Ace Torch

Other Welding Devices

Drill Press

Bench Grinder

Roll-in Saw

Metal Punch

- RM 203 – Paint Preparation o Paint Booth

Sand Blaster

Paint Sprayers

Stencil Roller

Paint Agitator

Steam Power Washer

Sandblast collection point

Compressor

Forklift

High Work Platforms

BLDG 4109 – Cure Oven

4110 – Wash Rack

BLDG 4105

- RM 304 – Electronics o Electronic device Repair

Soldering Iron

Soldering Machine Set

Testing Equipment

Nitrogen Tanks o Laser Vault

NVG Testing

- RM 314 (316) – Calibration o Calibration equipment service/repair

Radiation Hazard

Testing Equipment

- RM 322 – Instrument Repair o Weapon Sight Repair

Radiation Hazard

Testing Equipment

- RM 330 – Support Bay o Automotive/Misc Repair Bays

General Tools

BLDG 4106

- RM 419 – Support Bay o Automotive Shop

Hydraulic Press

Hydraulic Hose Crimp

Circular Saw

Wash Tank

Solvent Tank

Oil dispensing pump

A/C Refrigerant Recovery Machine

35 Ton Overhead Crane

7.5 Ton Overhead Crane

Vehicle Pneumatic Lifts (large and small)

- RM 421 Bulk POL Storage

Gator ATV

POL Recovery Pumps

55 gal Drum clamps/lifts

- RM 440 - Support Bay

Hydraulic Floor Lift 15 Ton

Hydraulic Cylinder Servicer

- RM 441 – Trans & Power Pack Rebuild

Overhead Crane

Parts Washer

APPENDIX D

Unmanned Aircraft Systems Facility

5629 SR 16 W, CBJTC, BLDG 3584

Starke, FL 32091 wheeled vehicles, Trailers, Generators etc.

- Two flammable lockers, and one Battery Storage locker; all contain chemicals

(HAZMAT)

- 27 man Platoon which includes 5 Full Time Support Staff, and 22 M-Day Soldiers

BLDG 3584 (Facility)

- Various offices o Using walking surfaces around office areas o Using bookcase, shelves and cabinets o Using office equipment

- Flight Line o Aircraft Servicing and Defueling Operations o Towing of Aircraft o Aircraft Maintenance o Launcher usage and Hydraulic Servicing o Chemical Use o Severe Weather o POL Operations o Generator Usage o Launch and Recovery Operations o System Emplace and Displace

- Hangar o Aircraft Maintenance o Aircraft Movement o Tire Maintenance o Nitrogen Servicing o Aircraft Cleaning o Corrosion Removal and Control Operations o Aircraft Battery Maintenance o Pneumatic Equipment Use o Jackhammer Usage o Military Vehicle Operator Level Maintenance

APPENDIX E

Date:

YYYMMDD

a. TASK DESCRIPTION: Aircraft Specific:

a. Name

(Last, First)

c. Reviewed By

(Last, First, Position)

b. BODY

PART at

Risk

c. HAZARD

d. RISK

LEVEL

2. ANALYSIS CONDUCTED BY

JOB HAZARD ANALYSIS (JHA)

1. JOB DESCRIPTION

3. JOB TASK STEPS HAZARD ANALYSIS

b. Title/Position

d. Date YYYYMMDD

The JHA process follows the first 3 steps of the Risk

Management process as detailed in ATP 5-19. The JHA is similar in form and function to the Deliberate Risk

Assessment Worksheet DD FORM 2977

Step 1–Identify the hazards

Step 2–Assess the hazards

Step 3–Develop controls and make risk decisions

a. SUBTASK/SUBSTEP e. PPE

JHA FORM, 27 NOV 17 Page 1 of 2

New Assessment Revised Assessment

3. JOB TASK STEPS HAZARD ANALYSIS (continued)

3. Hazardous Commodities used during this task MSDS/SDS #

4. OTHER SAFETY PRECAUTIONS (ENGINEERING OR ADMINISTRATIVE CONTROLS)

5. TRAINING/LICENSING/CERTIFICATION REQUIRED

6. JOB TASK RESIDUAL RISK LEVEL IF CONTROLS ARE IMPLEMENTED:

JHA FORM, 27 NOV 17 Page 2 of 2

EXTREMELY HIGH (EH) HIGH (H) MEDIUM (M) LOW (L)

No Yes (Identify below)