Activity Hazard Analysis Form (2015).pdf

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ACTIVITY HAZARD ANALYSIS

SPK SO Form 385-17 June 2014 S e v e r i t y Risk Assessment Code (RAC) Matrix Assess the impact of each hazard in terms of potential loss and cost, based on the probability and severity should an incident occur.

E = Extremely High Risk H = High Risk Probability M = Moderate Risk L = Low Risk E E H H M E H H M L H M M L L M L L L L

PRINCIPLE STEPS

Break down the job into individual steps, e.g., mobilization, erect forms, erect scaffolding, install reinforcement bar, remove forms, demobilization.

HAZARDS

(Recognized/Anticipated) Identify the hazards, what are the man, machine, and environmental hazard factors of an operation. Note: include hazards that could potentially change the risk, such as weather, changing site conditions, abnormal operating procedures, etc. Do a change analysis when site conditions change.

CONTROLS

(ACTIONS TO ELIMINATE OR MINIMIZE HAZARDS)

List the controls needed to eliminate or reduce the risks. Controls can be in the form of educational controls (training), physical controls (barriers, guards, signs, etc.), Administrative Controls, Personal Protective Equipment, or Engineering Controls. Risk avoidance is another alternative, are there ways to do the job differently so that risks aren't encountered.

RAC

EQUIPMENT TO BE USED

List equipment needed for the job.

TRAINING REQUIREMENTS

List any specialized training or certifications needed for the job.

INSPECTION REQUIREMENTS

List any inspection requirements, before, during, or after the job is completed.

INSTRUCTIONS FOR COMPLETING THE ACTIVITY HAZARDS ANALYSIS FORM

Activity Hazard Analysis (AHA) is an important accident prevention tool that works by assisting with hazard identification, elimination and control methods before an activity.

Contractor Risk Management Process (AHAs) - 'Risk management is a business process that includes the identification, assessment, and prioritization of risks, followed by coordinated and economical application of resources to minimize, monitor, and control the probability and/or impact of unfortunate events to an acceptable level. The USACE uses the Activity Hazard Analysis (AHA) as part of a total risk management process.

a. The AHA shall identify;

(1) The activity to be performed (Any activities listed in the project schedule, activities requiring and AHA by specific sections of EM 385-1-1 and as otherwise directed by GDA).

(2) The Principle step of the activity (Work sequences)

(3) Hazards (Recognized and anticipated hazards for each principle step)

(4) The action to eliminate or minimize the hazards (Site specific control measures to eliminate or reduce each hazards to an acceptable risk level)

(5) The Risk Assessment Code (RAC) for each principle step (See RAC Process below)

(6) Equipment to be used (Identify all equipment, PPE, signage, etc)

(7) Training Requirement (General and specific training, for ex. current CP/QP certifications and qualification cards)

(8) Inspection Requirement (Daily/Periodic as required by the manufacturer, the contractor's APP, and CP/QP).

b. Once the process has occurred, an overall Risk Assessment Code (RAC) will be assigned to this AHA.

c. Acceptance of risk. The residual risk is that which remains after controls have been applied. This residual risk must be communicated to the proper authority for acceptance in order to proceed with the activity.

d. No work will begin on the activity until the initial AHA has been accepted by the GDA addressing the activity-specific hazards.

e. Detailed requirements for the AHA process is identified in Section 01 of the EM 385-1-1. You are responsible for the review of those requirements prior to the submittal of the AHA.N

Risk Assessment Code (RAC) Matrix Step 1: Review each "Hazards" with identified safety "Controls" and determine RAC

a. Probability - is the likelihood to cause an accident, near miss, or accident and identified as: Frequent, Likely, Occasional, Seldom or Unlikely

b. Severity - is the outcome/degree if an incident, near miss, or accident did occur and identified as: Catastrophic, Critical, Marginal, or Negligible Step 2: Identify the RAC (Probability/Severity) as E, H, M, or L for each "Hazards" on the AHA. Annotate the overall highest RAC at the top of AHA.

E - Extremely High Risk H = High Risk M = Moderate Risk L = Low Risk

Use the AHA for activity clarification and hazard awareness, as a guide in new worker training, for retraining of experienced workers, as a refresher on activities performed infrequently, and as an accident investigation tool. Set priorities for doing AHA's: activities that have a history of incidents, activities with high potential for injury, and new or non-routine activities. Key value for AHA process: Focus more on activity specific hazards and challenges, and the solutions for the same.

NOTE:

1. This Activity Hazard Analysis is a fillable form.

2. Click on drop down box for appropriate RAC.

3. Click in date box to enter date.

EMPLOYEE DOCUMENTATION SHEET

This AHA serves as the hazard assessment required by EM 385-1-1, Section 01. The employees covered by this AHA have been instructed in the tasks to be performed, the hazards that may be encountered, the potential adverse effects of exposure to such hazards and the controls to be used. It also confirms that the employees have received adequate training specifically related to safe work practices, administrative and engineering controls and PPE to be used in order to ensure assigned work tasks are conducted in a safe and healthful manner. This Employee Documentation Sheet provides (1) the names of each employee performing work under this AHA, and (2) the training received, dates of such training, and the subject matter taught. By entering your name below, the contractor Site Safety & Health Officer and the employees performing the work, verify they full understand the content of the AHA and will follow the guidance contain therein.

EMPLOYEES PERFORMING WORK ACTIVITY

NAME

(Print: Last, First, Mi)

OCCUPATION

(Trade or Job Title)

DESIGNATED

(Competent or Qualified Person)

TRAINING DOCUMENTATION

(Attach)

DATE

8.0.1291.1.339988.308172 d2_del2@yahoo.com 17 June 2014 U.S. Army Corps of Engineers Del H. Dayrit & Robert E. Stout Activity Hazard Analysis

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.: