SOW Attachment (6) Activity Hazard Analysis Form.docx
DOCX document 34 KB Posted
- Attached to
- Bldg 77L HVAC Repair Federal contract opportunity
- Solicitation number
- N6449824Q5065
About this file
The document provided is an Activity Hazard Analysis (AHA) form that is a standard attachment to a federal construction contract. The AHA details the specific work activities, associated hazards, and control measures required to mitigate risks. It includes a Risk Assessment Code (RAC) matrix to evaluate the probability and severity of potential hazards. The AHA must be reviewed and signed by the contractor's Superintendent, Quality Control Manager, and Site Safety and Health Officer prior to the start of work. The federal contract opportunity this AHA is associated with is for the repair of the HVAC system in Building 77L at the Philadelphia Navy Yard. This is a competitive, 100% small business set-aside, firm-fixed-price construction contract solicited by the Naval Surface Warfare Center Philadelphia Division.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| N6449824Q5065 Amendment 0002.pdf | ||
| Amendment P0001.pdf | ||
| Copy of Copy of SOW Attachment (5) Schedule of Values.xlsx | XLSX spreadsheet | |
| RFQ N6449824Q5065.pdf | ||
| SOW Attachment (2) Photographs - Existing HVAC.docx | DOCX document | |
| SOW Attachment (8) Requirements for Contractor Lift Operations.pdf | ||
| SOW Attachment (1) Site Map - PNBC.pdf | ||
| SOW Attachment (4) ENG FORM 4025R Transmittal Form_rev1.pdf | ||
| SOW Attachment (11) Insulation Resistance Test Report.pdf | ||
| SOW Attachment (3) SECNAV 5512.pdf | ||
| SOW Attachment (9) Mobile Construction Equipment Checklist.pdf | ||
| Attachment 12 PPQ Past Performance Questionnaire.docx | DOCX document | |
| SOW Attachment (10) Contractor Production Report Form.docx | DOCX document | |
| SOW Attachment (7) Contract Progress Report.pdf |
Show all 14
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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 6 Activity Hazard Analysis Form Bldg 77L – Room 800 HVAC Repairs
File details come from the government source that posted it. Updated .