27. Risk Assessment - CCSFS FES Contract Staffing Levels.pdf

Page 1 of 2AF FORM 4437, 20181012 Prescribed by: AFI 90-802

DELIBERATE RISK ASSESSMENT WORKSHEET

AGENCY DISCLOSURE NOTICE: Voluntary, however, failure to use may have a negative effect on mission effectiveness at all levels and lead to failure of preserving assets and safeguarding health and welfare.

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AUTHORITY: DoDI 6055.01, AFPD 90-8 and AFI 90-802. PRINCIPAL PURPOSE: Conduct a formal risk assessment and ensure the assessment is properly documented for future evaluation and reference. ROUTINE USES: Used to develop and enhance awareness and understanding of at-risk activities and behavior of personnel both on- and off-duty. SYSTEM OF RECORDS NOTICE: Not applicable.

1. EVENT/MISSION/TASK OF RISK ASSESSMENT:

A. EVENT DESCRIPTION

CCSFS FES Staffing Levels at Main Fire Station

B. EVENT DATE

2. PREPARED BY:

A. LAST NAME, FIRST, MI

Palm, Mark S.

B. RANK/GRADE

GS-13

C. DUTY TITLE/POSITION

FEMS FM

D. WORK EMAIL

mark.palm@spaceforce.mil

E. PHONE DSN/COMM

321-494-2370

F. UNIT

45 CES/CEF

G. UIC/CIN (as required) H. TRAINING SUPPORT/LESSON PLAN OR OPORD (as required)

DODI 6055.06 / AFI 32-2001

3. SUB-TASK/SUB-STEP AND RISK ASSESSMENT (Fields expand as needed, Add, Remove and Move Sub-Task/Steps with left side controls)

# A. SUB-TASK/SUB-STEP B. HAZARD C. INITIAL

RISK LEVEL D. CONTROL E. HOW TO IMPLEMENT

WHO WILL IMPLEMENT

F. RESIDUAL

RISK LEVEL

1 Reduced FES staffing at the Main Fire Station to 11 including 2 Paramedics.

IC- 1

Engine- 4

ARFF- 2

ARFF- 1

ARFF- 1

ALS Transport- 2

Reduced staffing levels present increased risk of loss and may prevent meeting F&ES objectives.

M (II, D) Fire stations 2 & 3 shall be used to augment manning shortfalls during sustained emergency operations.

Use additional qualified personnel from the Main Fire Station.

Incident Commanders shall use Mutual Aid Agreements as needed.

The Fire Chief shall provide in writing staffing requirements for emergency operations. The Incident Commander shall ensure compliance with staffing requirements and request additional support and or Mutual Aid assets as needed. During ALS transport, Kennedy Space Center Mutual Aid agreement shall be used to request an ALS transport unit on standby.

L (II, E)

G. COURSE OF ACTION

AFI 32-2001, Fire and Emergency Services Program states in 2.9. Contract Firefighting Operations. At installations where firefighting is provided by contract, minimum staffing levels must be determined by a risk assessment accomplished by the AFIMSC Detachment Fire Chief and approved by the detachment commander IAW 10 U.S.C. 2465 and DoDI 6055.06. Through this RA the IMSC Detachment Fire Chief has determined minimum staffing at the main fire station to be 11 including 2 paramedics. During an ALS transport it is an accepted risk to operate at 9 personnel at the main station.

H. OVERALL RISK LEVEL AFTER CONTROLS ARE IMPLEMENTED

LOW (II-E; III-D&E; IV-B to E)

I. PREPARER SIGNATURE

4. ATTACHMENTS (Once the preparer has signed files can be viewed only)

ADD ATTACHMENTS

(Include supporting files and/or photos to create a complete electronic file)

Add File/Photo Remove File/Photo

Open File/Photo

5. RISK ACCEPTANCE AUTHORITY (Once the approver has signed, the form will lock except "Risk Assessment Review" and "Feedback and Lessons Learned")

A. APPROVAL/DISAPPROVAL OF EVENT/MISSION

APPROVED

B. APPROVER LAST NAME, FIRST, MI

Reich, Gregory T.

C. RANK/GRADE

Colonel/O6

D. ADDITIONAL INFORMATION/APPROVER COMMENTS

Fire Chief (22 Apr 21) confirmed this will not drop them below RLS//AFIMSC/IZPE (22 Apr 21) also recommended approval.

E. DUTY TITLE/POSITION

Commander, AFIMSC Detachment 1

F. APPROVER SIGNATURE

6. RISK ASSESSMENT REVIEW (To be conducted when Risk Assessment applies to on-going Operations/Activities)

A. DATE B. LAST NAME, FIRST, MI C. RANK/GRADE D. DUTY TITLE/POSITION

E. REVIEWER COMMENTS

7. FEEDBACK AND LESSONS LEARNED

Page of

DELIBERATE RISK ASSESSMENT WORKSHEET

AGENCY DISCLOSURE NOTICE: Voluntary, however, failure to use may have a negative effect on mission effectiveness at all levels and lead to failure of preserving assets and safeguarding health and welfare.

AUTHORITY: DoDI 6055.01, AFPD 90-8 and AFI 90-802. PRINCIPAL PURPOSE: Conduct a formal risk assessment and ensure the assessment is properly documented for future evaluation and reference. ROUTINE USES: Used to develop and enhance awareness and understanding of at-risk activities and behavior of personnel both on- and off-duty. SYSTEM OF RECORDS NOTICE: Not applicable.

1. EVENT/MISSION/TASK OF RISK ASSESSMENT:

2. PREPARED BY:

O:\SEG\SEGS - Stnds - Reference Materials Only\[02] Forms\Prescribed by 90-802\AF Form 4437, Deliberate Risk Assessment Worksheet\Supporting Docs\Risk Assessment Matrix.png O:\SEG\SEGS - Stnds - Reference Materials Only\[02] Forms\Prescribed by 90-802\AF Form 4437, Deliberate Risk Assessment Worksheet\Supporting Docs\RM 5-STEP WHEEL.JPG

3. SUB-TASK/SUB-STEP AND RISK ASSESSMENT (Fields expand as needed, Add, Remove and Move Sub-Task/Steps with left side controls)

A. SUB-TASK/SUB-STEP

B. HAZARD

C. INITIAL RISK LEVEL

D. CONTROL

E. HOW TO IMPLEMENT WHO WILL IMPLEMENT

F. RESIDUAL RISK LEVEL

4. ATTACHMENTS (Once the preparer has signed files can be viewed only) ADD ATTACHMENTS (Include supporting files and/or photos to create a complete electronic file)

5. RISK ACCEPTANCE AUTHORITY (Once the approver has signed, the form will lock except "Risk Assessment Review" and "Feedback and Lessons Learned")

6. "RELEASABILITY: Access to this form is restricted: this form is classified/FOUO; requests for accessibility must be approved."

6. RISK ASSESSMENT REVIEW (To be conducted when Risk Assessment applies to on-going Operations/Activities)

7. FEEDBACK AND LESSONS LEARNED

INSTRUCTIONS FOR COMPLETING WORKSHEET

This form has been designed to be completed digitally, fields will expand automatically to allow for more room, in addition some sections will allow instances as they are needed.

1. Event/Mission/Task of Risk Assessment:

A. Event Description: Briefly describe overall Mission, or Task that the Risk Assessment is being conducted for.

B. Event Date (YYYY/MM/DD):

2. Prepared By: This section shall be filled out by the individual completing the Deliberate Risk Assessment Worksheet:

A. Preparer’s Name:

B. Preparer’s Rank or Grade:

C. Preparer’s Duty Title or Position:

D. Preparer’s Work Email:

E. Preparer’s Phone (DSN or Commercial):

F. Preparer’s Unit/Squadron:

G. Preparer’s Unit Identification Code (UIC) or Course ID Number (CIN):

H. Required Training Support/Lesson Plan(s) or OPORD:

3. Sub-Task/Sub-Step and Risk Assessment: Buttons on the left control the instances of Tasks/Steps, add, remove move around as needed. Numbering will reorganize when clicking away from controls area.

A. Sub-Task/Sub-Step of Mission/Task: Briefly describe any Sub-Tasks associated with Primary Task that warrant risk mitigation consideration.

B. Hazard: Enter specific hazards related to the Sub-Task.

C. Initial Risk Level: Using the Risk Assessment Matrix, determine probability, severity and associated Risk Level; enter level into column.

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

E. How to Implement/Who Will Control: Provide brief description of sub-task means of employment (e.g., OPORD, Briefing, and Rehearsal) and the name of the individual, unit or office that has primary responsibility for control implementation.

F. Residual Risk Level: After controls are implemented, determine resulting probability, severity and revised Risk Level.

G. Course of Action (COA): Identify specific tasks/ levels of responsibility for supervisory personnel and provide the decision authority with a recommend COA for approval or disapproval based upon the overall risk assessment and impact to mission and personnel. "Risk vs. Reward" consideration based on real-time issues.

H. Overall Risk after Controls are Implemented: Assign an overall Risk Assessment Level. This is the highest Residual Risk Level (Block F) I. Signature of Preparer:

4. Add/View Attachments:

5. Risk Acceptance Authority:

A. Approval/Disapproval of Event/Mission:

B. Approver’s Name:

C. Approver’s Rank/Grade:

D. Additional Information/Approver Comments: Any comments or information the Decision Authorities desires to add including additional guidance.

E. Approver’s Duty Title/Position:

F. Approver’s Signature:

6. Risk Assessment Review: Should be conducted on a regular basis. Reviewers should have sufficient oversight of the mission/activity and controls to make valid remarks and inputs regarding needed changes or adjustments (as necessary). In the event “Residual Risk” rises above the level already approved, operations should cease until the appropriate approval authority is contacted and approves continued operations.

A. Date Reviewed:

B. Reviewer’s Name:

C. Reviewer’ Rank/Grade D. Reviewer’s Duty Title/Position:

E. Reviewer’s Comments:

7. Feedback and Lessons Learned: Provide specific inputs on the effectiveness of risk controls and their contribution to mission success or failure. Feedback-recommendations for new/revised controls, actionable solutions or alternate actions is essential for effective RM. Ensure valid lessons learned are submitted and briefed as necessary to affected personnel.

11.0.1.20130826.2.901444.899636

IC- 1

Engine- 4

ARFF- 2

ARFF- 1

ARFF- 1

ALS Transport- 2

Use additional qualified personnel from the Main Fire Station.

Incident Commanders shall use Mutual Aid Agreements as needed.