SOW Attachment (6) Activity Hazard Analysis Form.docx
DOCX document 26 KB Posted
- Attached to
- NSWCPD Building 77H Fuel Pump Controller Repairs Federal contract opportunity
- Solicitation number
- N6449823R4003
About this file
This document contains a federal contract opportunity notice for repairs to a fuel pump controller system located at the Naval Surface Warfare Center in Philadelphia, Pennsylvania. The Navy seeks a contractor to replace various piping, instrumentation, controls, and system elements to return the fuel distribution system to an operable state where equipment can be monitored and operated locally and remotely. The period of performance is 160 days from notice to proceed. The solicitation will utilize lowest price technically acceptable evaluation criteria and seek initial price proposals along with technical proposals. The solicitation number is expected to issue on December 19, 2022 with a closing date of January 25, 2023.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| N6449823R4003 Amendment 0001.pdf | ||
| N6449823R4003.pdf | ||
| SOW Attachment (3) Historical Reference Drawing.pdf | ||
| SOW Attachment (7) Mobile Construction Equipment Checklist.pdf | ||
| SOW Attachment (10) Eng_Form_4025-R.pdf | ||
| SOW Attachment (1) Contract Drawings.pdf | ||
| SOW Attachment (4) NSWCPD Entry Screening Assessment 1 SEPT 2022 Rev 13.pdf | ||
| Attachment (11) Bid Bond SF24.pdf | ||
| Attachment (12) Past Performance Questionnaire (PPQ).doc | DOC document | |
| SOW Attachment (2) Control Panel As-Built Dwgs.pdf | ||
| SOW Attachment (5) Requirements for Contractor Lift Operations.pdf | ||
| SOW Attachment (9) SECNAV 5512.pdf | ||
| SOW Attachment (8) Contractor Production Report Form.doc | DOC document | |
| Attachment (13) Construction Cost Breakdown.xlsx | XLSX spreadsheet |
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Text version
EM385-1-1 (30NOV14) UFGS 103526 11/15
Activity Hazard Analysis (AHA)
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 |
| 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
SOW Attachment (7) Activity Hazard Analysis Form
File details come from the government source that posted it. Updated .