Eng_Form_6206 Activity Hazard Analysis.pdf
ENG Form PDF 31 KB Posted
- Attached to
- De-Water Maintenance By-Pass at Orwell Dam, MN
- Solicitation number
- W912ES25Q0053
About this file
The document is an Activity Hazard Analysis (AHA) form (ENG Form 6206) related to a U.S. Army Corps of Engineers solicitation for de-watering maintenance by-pass services at Orwell Dam in Minnesota. The solicitation (W912ES25Q0053) requires a contractor to provide a by-pass flow system capable of maintaining 80 cubic feet per second around the dam's control structure during a planned dewatering inspection, with specific operational parameters. The project is scheduled for September 2025, with system installation required by September 15, 2025, and continuous operation until September 19, 2025.
Key requirements include providing submersible pumps, a generator, leak-free piping approximately 350 feet long, and staging equipment on the north side of the dam. The contractor must submit several detailed plans for approval, including a by-pass system layout, construction schedule, spill control plan, and a comprehensive safety plan with an Accident Prevention Plan. Additional requirements include having a designated Site Safety and Health Officer, conducting an Activity Hazard Analysis, and adhering to environmental protection guidelines. The project is being managed by the U.S. Army Corps of Engineers St. Paul District, with a site visit available and post-award site visit mandatory for the selected contractor.
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ENG FORM 6206, SEP 2024
U.S. Army Corps of Engineers (USACE)
ACTIVITY HAZARD ANALYSIS (AHA)
For use of this form, see EM 385-1-1; the proponent agency is CESO.
PREVIOUS EDITIONS ARE OBSOLETE.
ENG FORM 6206, SEP 2024
Page of Purpose: The Activity Hazard Analysis is a tool used in the Risk Management Process. Risk management is a business process that includes the identification, assessment, and prioritizing 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 overall residual risk assessment code (RAC) must be communicated and accepted by the proper approval authority before beginning the activity.
AHAs must be provided to, and reviewed by, all involved employees prior to starting the task. Each employee must document their review with a signature in the last section of form.
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 = Medium 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.
RESIDUAL 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.
Approval Authority (digital signature) Approval Authority information is based on overall RAC according to EM 385-1-1, para 1-6 or 2-6, as applicable.
EMPLOYEE DOCUMENTATION SHEET
AHAs must be provided to and reviewed by all involved employees prior to starting the task. Each employee must document their review with a signature.
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.
PREVIOUS EDITIONS ARE OBSOLETE.
1.0 darwin.chen@usace.army.mil 2023-04-17 Forms Design Team Eng Form 6206 Darwin Chen
ACTIVITY HAZARD ANALYSIS (AHA)
2024-09-30
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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. : |
| Describe specific activity in which this AHA form is being prepared for.: |
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| 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.: |
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| List any personal protective equipment that is required to complete the activity.: |
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