SOW Attach 3_AHA Form.docx
DOCX document 28 KB Posted
- Attached to
- Temporary Modular Facility (With Lease) Federal contract opportunity
- Solicitation number
- N6449820R5000
About this file
This document contains an Activity Hazard Analysis (AHA) template for a federal contract opportunity to provide a Temporary Modular Facility with lease. The opportunity is solicitation number N6449820R5000 from the Department of the Navy Naval Sea Systems Command for commercial items. The AHA template requires identification of job steps, anticipated hazards, required controls, training needs, inspections, and an overall risk assessment code. It provides guidance on periodic review and signature logs to document employee review.
The federal contract opportunity is for a Temporary Modular Facility with lease to be procured as a commercial item under solicitation number N6449820R5000. Questions are due within 10 calendar days of issuance, with no further information provided on proposal due dates or period of performance. The solicitation incorporates provisions and clauses from Federal Acquisition Circular 2020-05 effective 30 March 2020.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amendment 0003.pdf | ||
| Amendment 0002.pdf | ||
| N6449820R5000 Amended Solicitation.pdf | ||
| N6449820R5000 Amended Solicitation.pdf | ||
| Amendment 0001.pdf | ||
| SOW Attach 5__Contractor Lift Plan Form.pdf | ||
| SOW Attach 8_Subsurface Information_rev02_12 Feb 2020.pdf | ||
| SOW Attach 1_SiteMap PNBC.pdf | ||
| SOW Attach 2_Contractor Production Report Form.doc | DOC document | |
| SOW Attach 6 Figure 1 Temporary Modular Facility Site Plan REV03022020b 11x17.pdf | ||
| Solicitation N6449820R5000.pdf | ||
| SOW Attach 4_Mobile Equipment Check List.pdf | ||
| SOW Attach 7_Figure 3 Temporary Modular Facility Suggested Floorplan REV03022020 11x17.pdf | ||
| Brand Name Justification Bldg 662 Temp Facility.pdf |
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Text version
Contractor Name ( Performing the Work):
Overall Risk Assessment Code (RAC) (Use highest code )
Foreman Signature (Pe r forming the Wor k):
AHA Prepared by (Name/Title):
| Activity/Work Task: |
| Risk Assessment Code (RAC) Matrix |
AHA Signature Log #
Probability
| Contract Number: |
| Severity |
| Frequent |
| Likely |
| Occasional |
| Seldom |
| Unlikely |
| Date Prepared: |
| Catastrophic |
| E |
| E |
| H |
| H |
| M |
| Project Location: |
| Critical |
| E |
| H |
| H |
| M |
| L |
| PRIME CONTRACTOR SECTION: REV IEW ED BY: SIGNATUR E REQUIRED |
| Marginal |
| H |
| M |
| M |
| L |
| L |
| SSHO Signature: |
| Negligible |
| M |
| L |
| L |
| L |
| L |
| QC Manager Signature: |
| Step 1: Review each Hazard with identified |
"Controls". Determine RAC (see above).
Prime Superintendent Signature:
RAC CHART
| Notes: |
| 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
| Identify as Catastrophic, Critical, Marginal, or Negligible |
| H = High Risk |
Step 2: Identify the RAC (probability vs. severity) as E, H, M, or L for each "Hazard" on AHA.
Annotate the overall highest RAC at the top of the AHA
M= Moderate Risk
L = Low Risk
| Job Steps (Work Sequences) |
| Specific Anticipated Hazards |
| Controls |
| RAC |
EM385-1-1 (30NOV14) UFGS 103526 11/15
Activity Hazard Analysis (AHA)
SOW ATTACHMENT 3
Sheet 1 of 3
| Job Steps (Work Sequences) |
| Specific Anticipated Hazards |
| Controls |
| RAC |
| Equipment to be used |
| Training Requirements & Competent or Qualified Personnel Name(s) |
| Inspection Requirements |
UFGS 013526 11/15 1.9 Government reserves the right to require the Contractor to revise and resubmit the AHA if it f ails to ef f ectively identif y the w ork 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 w hen procedures, scheduling or hazards change.
UFGS 013526 1.9.2 Each employee perf orming w ork...must review the AHA and sign a signature log f or that AHA prior to starting w ork. The SSHO must maintain a signature log on site f or every AHA
File details come from the government source that posted it. Updated .