SOW Attach 5_AHA Form.docx
DOCX document 25 KB Posted
- Attached to
- Bldg 77H Split System HP-3 Replacement, NSWCPD Federal contract opportunity
- Solicitation number
- N6449821Q0195
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| N64498-21-Q-0195 Amendment 0001.pdf | ||
| SOW Attach 4_Mobile Equipment Check List.pdf | ||
| SOW Attach 6_NSWCPD ENTRY SCREENING ASSESSMENT 26 APR 2021 Rev 10.pdf | ||
| SOW Attach 9_Sketch 1 -- Bldg 77H Split System HP-3.pdf | ||
| Attach 10_ Construction Cost Breakdown.xlsx | XLSX spreadsheet | |
| N64498-21-Q-0195.pdf | ||
| SOW Attach 7_Photographs - B-77H Split System HP-3 Replacement.docx | DOCX document | |
| SOW Attach 1_SiteMap PNBC.pdf | ||
| SOW Attach 2_Contractor Production Report Form.doc | DOC document | |
| SOW Attach 3_Contractor Lift Plan Form.pdf | ||
| SOW Attach 8_Instrumentation Drawings - Split HP-3 DDC Schematic.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 5
Sheet 3 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
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