Attachment 4_ RDAX Deliberate Risk Assessment Worksheet.pdf

DELIBERATE RISK ASSESSMENT WORKSHEET

1. MISSION/TASK DESCRIPTION 2. DATE (DD/MM/YYYY)

3. PREPARED BY

a. Name (Last, First, Middle Initial) b. Rank/Grade c. Duty Title/Position

d. Unit e. Work Email f. Telephone (DSN/Commercial (Include Area Code))

g. UIC/CIN (as required) h. Training Support/Lesson Plan or OPORD (as required) i. Signature of Preparer

Five steps of Risk Management: (1) Identify the hazards (2) Assess the hazards (3) Develop controls & make decisions

(4) Implement controls (5) Supervise and evaluate (Step numbers not equal to numbered items on form)

4. SUBTASK/SUBSTEP

OF MISSION/TASK

How:

Who:

Additional entries for items 5 through 9 are provided on page 2.

10. OVERALL RESIDUAL RISK LEVEL (All controls implemented):

11. OVERALL SUPERVISION PLAN AND RECOMMENDED COURSE OF ACTION

a. Name (Last, First, Middle Initial) b. Rank/Grade c. Duty Title/Position d. Signature of Approval Authority

12. APPROVAL OR DISAPPROVAL OF MISSION OR TASK

e. Additional Guidance:

DD FORM 2977, JAN 2014

APPROVE DISAPPROVE

EXTREMELY HIGH HIGH MEDIUM LOW

Page 1 of ____ Pages

5. HAZARD

6. INITIAL

RISK

7. CONTROL

9. RESIDUAL

RISK LEVEL

8. HOW TO IMPLEMENT/

WHO WILL IMPLEMENT

Adobe Professional X

LEVEL

4. SUBTASK/SUBSTEP

OF MISSION/TASK

5. HAZARD

6. INITIAL

RISK

LEVEL

7. CONTROL

9. RESIDUAL

RISK LEVEL

8. HOW TO IMPLEMENT/

WHO WILL IMPLEMENT

DELIBERATE RISK ASSESSMENT WORKSHEET

Who:

How:

Who:

How:

Who:

How:

Who:

How:

Who:

How:

Who:

How:

Who:

How:

Who:

How:

Who:

How:

Who:

How:

Who:

How:

Who:

How:

DD FORM 2977, JAN 2014 Page ____ of ____ Pages

13. RISK ASSESSMENT REVIEW (Required when assessment applies to ongoing operations or activities)

b. Last Name c. Rank/Grade d. Duty Title/Position e. Signature of Reviewer a. Date

14. FEEDBACK AND LESSONS LEARNED

15. ADDITIONAL COMMENTS OR REMARKS

Risk Assessment Matrix

Probability (expected frequency)

Frequent:

Continuous, regular, or inevitable occurrences

Likely:

Several or numerous occurrences

Occasional:

Sporadic or intermittent occurrences

Seldom:

Infrequent occurrences

Unlikely:

Possible occurrences but improbable

Severity (expected consequence)

Catastrophic: Death, unacceptable loss or damage, mission failure, or unit readiness eliminated

I

Critical: Severe injury, illness, loss, or damage; significantly degraded unit readiness or mission capability

II EH L

Moderate: Minor injury, illness, loss, or damage; somewhat degraded unit readiness or mission capability

III L L

Negligible: Minimal injury, loss, or damage; little or no impact to unit readiness or mission capability

IV L L L L

Legend:

EH – extremely high risk H – high risk M – medium risk L – low risk

DELIBERATE RISK ASSESSMENT WORKSHEET

A B C D E

DD FORM 2977, JAN 2014 Page ____ of ____ Pages

EH

EH

H

H H

H H

M

M

EH

M M

M

1. Mission/Task Description: Briefly describe the overall

Mission or Task for which the deliberate risk assessment is being conducted.

9. Residual Risk Level: After controls are implemented, determine resulting probability, severity, and residual risk level.

2. Date (DD/MM/YYYY): Self Explanatory.

10. Overall Risk After Controls are Implemented: Assign an overall residual risk level. This is the highest residual risk level (from block 9).

3. Prepared By: Information provided by the individual conducting the deliberate risk assessment for the operation or training .

Legend: UIC = Unit Identification Code; CIN = Course ID

Number; OPORD = operation order; DSN = defense switched network; COMM = commercial

11. Supervision Plan and Recommended Course of Action:

Completed by preparer. Identify specific tasks and levels of responsibility for supervisory personnel and provide the decision authority with a recommend course of action for approval or disapproval based upon the overall risk assessment.

4. Sub-task/Sub-Step of Mission/Task: Briefly describe all subtasks or substeps that warrant risk management.

12. Approval/Disapproval of Mission/Task: Risk approval authority approves or disapproves the mission or task based on the overall risk assessment, including controls, residual risk level, and supervision plan. Space provided for authority to provide additional guidance; use continuation page if needed.

5. Hazard: Specify hazards related to the subtask in block 4.

13. Risk Assessment Review: Should be conducted on a regular basis. Reviewers should have sufficient oversight of the mission or activity and controls to provide valid input on changes or adjustments needed. If the residual risk rises above the level already approved, operations should cease until the appropriate approval authority is contacted and approves continued operations.

6. Initial Risk Level: Determine probability and severity.

Using the risk assessment matrix (page 3), determine level of risk for each hazard specified. probability, severity and associated Risk Level; enter level into column.

14. Feedback and Lessons Learned: Provide specific input on the effectiveness of risk controls and their contribution to mission success or failure. Include recommendations for new or revised controls, practicable solutions, or alternate actions. Submit and brief valid lessons learned as necessary to persons affected.

7. Control: Enter risk mitigation resources/controls identified to abate or reduce risk relevant to the hazard identified in block 5.

15. Additional Comments or Remarks: Preparer provides additional comments, remarks, or information to support the risk assessment. If block 15 is used as a continuation of block 14, strike through the block number and title.

8. How to Implement / Who Will Implement: Briefly describe the means of employment for each control

(i.e., OPORD, briefing, rehearsal) and the name of the individual unit or office that has primary responsibility for control implementation.

Additional Guidance: Block 4-9 continuance page may be reproduced as necessary for processing of all subtasks/ substeps of the mission/task. If a complete page is not utilized, write “NOTHING FOLLOWS” on the first unused row, immediately after the final item assessed.

Instructions for Completing DD Form 2977, "Deliberate Risk Assessment Worksheet"

DD FORM 2977 INSTRUCTIONS, JAN 2014