Appendix III- Blank AHA Form.pdf
PDF 716 KB Posted
- Attached to
- Medical Surveillance Federal contract opportunity
- Solicitation number
- W911WN23Q3005
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| W911WN23Q30005 Amendment 0006.pdf | ||
| Amendment 0006 Summary of Changes.pdf | ||
| W911WN23Q3005 Amendment 0005.pdf | ||
| W911WN23Q3005 0004.pdf | ||
| W911WN23Q30005 0003.pdf | ||
| Price Schedule 0003.xlsx | XLSX spreadsheet | |
| W911WN23Q3005 Amendment 0002.pdf | ||
| Attachment 2- Exam Services.pdf | ||
| W911WN23Q3005 Amendment 0001.pdf | ||
| Appendix I- Quality Control Plan Template.pdf | ||
| Appendix II- PIEE Vendor Registration.pdf | ||
| Attachment 1- USACE LRP Facilities and Contacts.pdf | ||
| Attachment 2- Exam Services.pdf | ||
| Price Schedule.xlsx | XLSX spreadsheet | |
| Attachment 3 - Medical Clearance Determination Form.pdf | ||
| Attachment 5 - Performance Requirements Summary.pdf | ||
| W911WN23Q3005.pdf | ||
| Performance Work Statement (PWS).pdf | ||
| Appendix IV - How to Submit an Electronic Invoice.pdf | ||
| Attachment 4 - ENG Form 6227- Diver Medical Instructions and Authorization.pdf | ||
| Attachment 6 - Wage Determinations.pdf |
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ACTIVITY HAZARD ANALYSIS (AHA)
S e v e r i t y Risk Assessment Code 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
JOB STEPS
Break the overall activity down into the steps required to complete.
HAZARDS
(Recognized/Anticipated) Identify the hazards: what are the man, machine, and environmental hazard factors of the activity. Include hazards that could potentially change the risk, such as weather, changing site conditions, abnormal operating procedures, etc.
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 (PPE), or engineering controls. Risk avoidance is another alternative; are there ways to do the job differently so that risks aren't encountered. Follow the Hierarchy of Controls when selecting which controls to implement.
RAC
Select the Risk Assessment Code of the risk that remains when the controls are implemented.
EQUIPMENT
List equipment needed for the job.
TRAINING
List any specialized training or certifications needed for the job.
INSPECTION
List any inspection requirements, before, during, or after the job is completed.
NAME
Enter name of personnel that reviewed the AHA.
OCCUPATION / DESIGNATION
(Job Title) / (Competent or Qualified Person) Enter job title and/or designation (competent or qualified person).
SIGNATURE
Signature of personnel who reviewed AHA.
DATE
Date of AHA review.
DOCUMENTATION SHEET
8.0.1291.1.339988.308172
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| For multiple job steps, use the highest obtained Risk Code. Note: the risk code is the residual risk after controls have been implemented. : |
| Continuously experiences or occurs very often. Likely to occur often in the life of an item with a probability of occurrence greater than 10-1 in that life.: |
| Occurs frequently. Several times in the life of an item with a probability of occurrence less than 10-1 but greater than 10-2 in that life.: |
| Occurs several times. Likely to occur some time in the life of an item with a probability of occurrence less than 10-2 but greater than 10-3 in that life.: |
| Unlikely but can reasonably be expected to occur. Unlikely but possible to occur in the life of an item with a probability of occurrence less than 10-3 but greater than 10-6 in that life.: |
| Unlikely to occur but possible. So unlikely, it can be assumed occurrence may not be experienced with a probability of occurrence less than 10-6 in that life.: |
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| Could result in injury or occupational illness resulting in one or more lost work days, loss exceeding $10K but less than $200K, or mitigable (minor) environmental damage without violation of law or regulation where restoration activities can be accomplished for the environment. Lost day due to injury or illness not exceeding 3 months (accident risk).: |
| Could result in injury or illness not resulting in a lost work day, loss exceeding $2K but less than $10K, or minimal environmental damage not violating law or regulation. A first aid or minor medical treatment (accident risk). Slight equipment or system damage but fully functional and serviceable. Little or no property or environmental damage.: |
| Describe specific activity in which this AHA form is being prepared for.: |
| Date AHA was signed for approval.: |
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| JobSteps: |
| Hazards: |
| Actions: |
| Select risk assessment code from drop down list based on matrix above: |
| Equipment: |
| Training: |
| Inspections: |
| List any personal protective equipment that is required to complete the activity.: |
| Person with the authority to approve the activity given the residual risk determined.: |
File details come from the government source that posted it. Updated .