ACTIVITY HAZARD ANALYSIS (AHA) FORM.pdf

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Attached to
Garrison Project Transformer Repair Federal contract opportunity
Solicitation number
W9128F21Q0081
Issued by
Department of the Army Corps of Engineers Engineering District Omaha

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W9128F21Q0081_AM0003.pdf PDF
QA_Updated 09 September.pdf PDF
W9128F21Q0081 AM0002 - 1 Sep 21.pdf PDF
W9128F21Q0081_Amendment 0001.pdf PDF
Appendix B - Autotransformer Documents.pdf PDF
Solicitation_W9128F21Q0081.pdf PDF
Appendix A - GSU5 Documents.pdf PDF
Appendix C - Station Service Tranformer Documents.pdf PDF
Appendix D - GSU2 Documents.pdf PDF
Technical Specification Section 26 11 14.00 10.pdf PDF
Abbreviated Accident Prevention Plan Checklist from Safety Manual EM385-1-1.pdf PDF
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E= Extremely High Risk H= High Risk M= Moderate Risk L= Low Risk S e v e r i t y

PROBABILTY

E E H H M E H H M L H M M L L M L L L L

U.S. ARMY CORPS OF ENGINEERS

OMAHA DISTRICT

ACTIVITY HAZARDS ANALYSIS

RISK ASSESSMENT CODE MATRIX

Reference EM 385-1-1, Section 01.A.13/14

Form Revised: 4/12/2016 8.2.1.4029.1.523496.503679 406-526-3431 ext 3204 Lara Smith AHA Form 10/20/2015 10/20/2015 Page of Print Employee Name Employee Signature * Date Print Employee Name Employee Signature * Date Page of

* Employee signatures certify they have read and understood the corresponding AHA.

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Date the AHA was prepared.:
Date the AHA was revised.:
For multiple job steps, use the highest obtained Risk Code. Note: the risk code is the residual risk after controls have been implemented. The following codes require the appropriate personnel approvals:

E = Division Commander (E = Extremely High Risk). Equates to loss of ability to accomplish mission if hazards occur during mission.

H = District Commander (H = High Risk). Results in significant degradation of mission capabilities if hazards occur during mission.

M = Program Manager, Project Manager, Project Engineer (M = Moderate). Minor injury, lost workday accident, compensable injury or illness, minor system damage, or minor property damage.

L = First Line Supervisor, Quality Assurance Representative (L = Low). Little or no impact on mission accomplishment.:

Name of person(s) preparing this AHA form.:
Name of person(s) revising this AHA form.:
Name of person(s) revising this AHA form.:
AHANumber:
Describe specific job in which this AHA is being prepared, i.e.., Unit 2 Annual Maintenance:
Responsible person who has reviewed the AHA form for accuracy and completeness. Note: the AHA does not need to list minor hazards but should list major hazards most likely to result in personal injury, damage to property, materials, or the environment.:
WONum:
Describe specific job in which this AHA form is being prepared for, i.e., Unit 2 Annual Maintenance:
Responsible person who has reviewed the AHA form for accuracy and completeness. Note: the AHA does not need to list minor hazards but should list major hazards most likely to result in personal injury, damage to property, materials, or the environment.:
Responsible person who has reviewed the AHA form for accuracy and completeness. Note: the AHA does not need to list minor hazards but should list major hazards most likely to result in personal injury, damage to property, materials, or the environment.:
Responsible person who has reviewed the AHA form for accuracy and completeness. Note: the AHA does not need to list minor hazards but should list major hazards most likely to result in personal injury, damage to property, materials, or the environment.:
Responsible person who has reviewed the AHA form for accuracy and completeness. Note: the AHA does not need to list minor hazards but should list major hazards most likely to result in personal injury, damage to property, materials, or the environment.:
Responsible person who has reviewed the AHA form for accuracy and completeness. Note: the AHA does not need to list minor hazards but should list major hazards most likely to result in personal injury, damage to property, materials, or the environment.:
Date the AHA was revised.:
Name of person(s) revising this AHA form.:
Name of person(s) revising this AHA form.:
Name of person(s) revising this AHA form.:
Name of person(s) revising this AHA form.:
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List equipment needed for the job.:
List any specialized training or certifications needed for the job.:
List any inspection requirements, before, during, or after the job is complete.:
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