Attachment F_ORNL Activity Hazard Analysis (AHA) Blank Form (Rev 2 04-15-2025).pdf
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Department of Energy
About this file
This is a template form used by UT-Battelle (Oak Ridge National Laboratory) for subcontractors to conduct Activity Hazard Analysis (AHA) prior to commencing work on federal contracts. The form is designed to systematically identify, evaluate, and control occupational health and safety (ES&H) hazards associated with planned work activities.
The form requires subcontractors to document the project title, subcontract number, and subcontractor name, followed by a comprehensive description of planned activities and task scope. Subcontractors must identify which Environment, Safety & Health (ES&H) clauses apply to their work from a checklist that includes hazards such as asbestos, beryllium, bloodborne pathogens, confined spaces, explosives, hoisting and rigging, lasers, lead, lockout/tagout, noise, respiratory protection, welding/cutting/hot work, and water/boating activities, among others. The core of the form consists of a table where subcontractors break down work into discrete activity/task steps and identify applicable hazards and corresponding controls organized into three categories: engineering controls (such as local exhaust ventilation or HEPA filtration), administrative controls (work methods, procedures, training), and personal protective equipment (safety glasses, hearing protection). The completed AHA must be submitted to the UT-Battelle Technical Project Officer (TPO) for review and approval before work commences, with additional concurrence required from the UT-Battelle ES&H/QHSP Representative. The form is currently in Revision 2, dated April 15, 2025, and consists of four pages with the activity/task table spanning multiple pages to accommodate comprehensive hazard documentation.
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Text version
Activity Hazard Analysis (AHA) Form Page 1 of 4 Rev. 2 – April 15, 2025
Project Title Subcontract Number Subcontractor Name
Description of Planned Activities/Task for the Scope-of-Work for the Entire Project
ES&H Clauses Amended to Subcontract ☐ Accessible - Exposed Electrical Hazards ☐ Lead ☐ Asbestos ☐ Lockout/Tagout ☐ Beryllium ☐ Noise ☐ Biohazards ☐ NRC Exemption ☐ Bloodborne Pathogens ☐ Outages of Emergency Evacuation-Notification Systems ☐ Confined Space ☐ Outages of Fire Protection Systems ☐ Cooling Towers ☐ Penetration through Fire Barrier ☐ Cryogenics ☐ Peroxide Forming Chemicals ☐ Dosimetry ☐ Powder Actuated Tools & Equipment ☐ Electrical – Post Receipt Field Evaluation ☐ Respirable Crystalline Silica ☐ Explosives – Blasting ☐ Respiratory Protection ☐ Firearms ☐ Unbound Engineered Nanoparticles ☐ Hoisting & Rigging Cranes ☐ Water/Boating Activities ☐ Lasers ☐ Welding, Cutting, & Hot Work ☐ Other Hands-on Work – No ES&H Clauses, No Purchase Rec, etc.
Directions
1. Break planned work scope into activity/task steps in the table below
2. Evaluate possible troubleshooting activities/tasks which may be needed
3. For each task step identify the applicable hazards and define the controls which will be used
4. Ensure requirements from ES&H Clauses identified in the subcontract are addressed in the appropriate task step
5. Additional guidance can be found here (link)
6. Submit completed AHA to UT-Battelle Technical Project Officer (TPO) for review and approval prior to commencement of work
AHA Author Date Completed
UT-Battelle TPO signature indicates approval of activity-specific hazard controls identified in the subcontractor AHA
Name: Signature: Date:
UT-Battelle ES&H/QHSP Representative Concurrence https://contracts.ornl.gov/activity-hazard-analysis-aha/
Activity Hazard Analysis (AHA) Form Page 2 of 4
Name: Signature: Date:
Activity/Task Step Hazard(s) Control(s) Engineering Controls (Local Exhaust Ventilation, HEPA Filtration, etc.)
Administrative Controls (Work Methods, Operation Procedures, Training, etc.)
Personal Protective Equipment (Safety Glasses, Hearing Protection Devices, etc.)
Activity Hazard Analysis (AHA) Form Page 3 of 4
Activity Hazard Analysis (AHA) Form Page 4 of 4
File details come from the government source that posted it. Updated .