Attachment 5 AHA.pdf
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- Solicitation number
- N4008524B2505
About this file
This is an Activity Hazard Analysis (AHA) template form used for identifying and assessing safety risks on construction projects, specifically for an IDIQ paving maintenance contract at NSA Mechanicsburg/NSA Philadelphia sites. The form includes a Risk Assessment Code (RAC) matrix that evaluates hazard severity (catastrophic to negligible) against probability (frequent to unlikely) to determine risk levels from extremely high (E) to low (L). The template contains sections for documenting job steps, anticipated hazards, control measures, equipment to be used, training requirements, and inspection requirements. The form requires signatures from key personnel including the SSHO, Superintendent, QC Manager, and subcontractor foreman. Per the requirements, the AHA must be reviewed monthly at supervisory safety meetings, updated when procedures or hazards change, and signed by all employees before starting work.
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Text version
EM385-1-1 (30NOV14) UFGS 103526 11/15
Activity Hazard Analysis (AHA)
Frequent Likely Occasional Seldom Unlikely
Catastrophic E E H H M
E H H M L
H M M L L
M L L L L
Signature: Step 1: Review each Hazard with identified safety
"Controls". Determine RAC (see above).
Annotate the overall highest RAC at the top of the AHA
Notes: (Field Notes, Review Comments, etc)
Controls RAC
AHA Signature Log #
Overall Risk Assessment Code (RAC) (Use highest code )
Critical
Marginal
Superintendant Signature
Project Location
Severity
Contract Number Probability
Risk Assessment Code (RAC) Matrix
Negligible
Activity/Work Task
Specific Anticipated HazardsJob Steps (Work Sequences)
L = Low Risk
RAC CHART
Probability: Likelihood the activity will cause a
Mishap (Near Miss, Incident, or Accident).
Identify as Frequent, Likely, Occasional, Seldom or Unlikely
E = Extremely High Risk
H = High Risk
M= Moderate Risk
Severity: The outcome if a mishap occurred.
Identify as Catastrophic, Critical, Marginal, or
Negligible
Step 2: Identify the RAC (probability vs. severity) as E, H, M, or L for each "Hazard" on AHA.
Subcontractor Foreman Name:
Date Prepared
SSHO Signature
QA Reviewed by (Name/Title)
QC Manager Signature
Specific Anticipated Hazards Controls RAC Job Steps (Work Sequences)
UFGS 013526 11/15 1.9 Government reserves the right to require the Contractor to revise and resubmit the AHA if it fails to effectively identify the work sequences; specific anticipated hazards, site conditions, equipment, materials, personnel and the control measures to be implemented.
UFGS 013526 1.9.1 Review the AHA list periodically (at least monthly) at supervisory safety meetings, update when procedures, scheduling or hazards change.
UFGS 013526 1.9.2 Each employee performing work...must review the AHA and sign a signature log for that AHA prior to starting work. The SSHO must maintain a signature log on site for every
AHA
Equipment to be used Training Requirements & Competent or Qualified
Personnel Name(s) Inspection Requirements
| ActivityWork Task: |
| AHA Signature Log: |
| Project Location: |
| Contract Number: |
| Date Prepared: |
| SSHO Signature: |
| Superintendant Signature: |
| QC Manager Signature: |
| Subcontractor Forman Name: |
| Signature: |
| QA Reviewed by NameTitle: |
| Notes Field Notes Review Comments etc: |
| Job Steps Work SequencesRow1: |
| RACRow1: |
| Job Steps Work SequencesRow1_2: |
| Specific Anticipated HazardsRow1: |
| ControlsRow1: |
| RACRow1_2: |
| Equipment to be usedRow1: |
| Training Requirements Competent or Qualified Personnel NamesRow1: |
| Inspection RequirementsRow1: |
| Anticipated Hazards: |
| Controls: |
File details come from the government source that posted it. Updated .