Activity Hazard Analysis-Blank Work Sheet.docx
DOCX document 37 KB Posted
- Solicitation number
- 19KE5025Q0088
- Issued by
-
Department of State
About this file
The document is an Activity Hazard Analysis (AHA) blank worksheet template designed for risk assessment in workplace safety. The template provides a structured approach to evaluating job steps, potential hazards, and corresponding controls using a Risk Assessment Code (RAC) matrix. The matrix categorizes risk levels from Extremely High (E) to Low (L) based on probability (Frequent to Unlikely) and severity (Catastrophic to Negligible). The worksheet includes sections for job steps, specific hazards, control measures, equipment usage, training requirements, personnel qualifications, and inspection requirements, enabling comprehensive safety planning and documentation for contract or project work.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| EM 385-1-1 _EFFECTIVE 15March2024.pdf | ||
| SS-Maint_UCF Potable Water Testing v3.pdf | ||
| SHEM Drinking Water Safety Program (1).pdf | ||
| AHA Sample Scaffolding.doc | DOC document | |
| Risk Matrix.doc | DOC document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 |
| E |
| E |
| H |
| H |
| M |
| Critical |
| E |
| H |
| H |
| M |
| L |
| Reviewed by (Name/Title): |
| Marginal |
| H |
| M |
| M |
| L |
| L |
| Negligible |
| M |
| L |
| L |
| L |
| L |
| Notes: (Field Notes, Review Comments, etc.) |
| 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 |
| 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 .