Attachment G_ORNL Activity Hazard Analysis (AHA) Blank Form (Rev 2 04-15-2025).pdf
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- Solicitation number
- RFQSSPR474450
- Issued by
-
Department of Energy
About this file
This is a blank Activity Hazard Analysis (AHA) Form template used by UT-Battelle at Oak Ridge National Laboratory for subcontractor work planning and safety compliance. The form (Rev. 2 – April 15, 2025) serves as a standardized tool for identifying hazards and defining control measures for subcontract activities and tasks.
The form requires subcontractors to document project details including project title, subcontract number, and subcontractor name, followed by a comprehensive description of planned activities and tasks for the entire project scope. Subcontractors must identify applicable Environment, Safety & Health (ES&H) clauses amended to their subcontract from a checklist that includes 28 hazard categories ranging from accessible electrical hazards and asbestos to welding and hot work. The core analysis section consists of a table with three columns: Activity/Task Step, Hazard(s), and Control(s). For each identified control measure, subcontractors must specify engineering controls (such as local exhaust ventilation or HEPA filtration), administrative controls (work methods, operating procedures, training), and personal protective equipment (safety glasses, hearing protection). The form requires completion and submission to the UT-Battelle Technical Project Officer (TPO) for review and approval prior to work commencement, with additional concurrence required from the UT-Battelle ES&H/QHSP Representative. The form includes signature blocks for the AHA author, TPO approval, and ES&H representative concurrence, and provides guidance that subcontractors should evaluate possible troubleshooting activities and ensure all ES&H clause requirements are addressed in appropriate task steps.
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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 .