Attachment_3.pdf

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Building & Grounds Maintenance Services
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W911WN-16-T-3000
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ATTACHMENT 3

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CELRL Form 1259, November 2001 Previous Versions are Obsolete and Should Not Be Used

ATTACHMENT 3

Risk Assessment Code (RAC):

S e v e r i t y

L = Low Risk

Recommended Protective Clothing & Equipment:

H = High Risk

Prepared By: Reviewed By:

M

L

L

L

Project: Job:

E = Extremely High Risk

M = Moderate Risk

H

H

M

H

M

L

HAZARDS

E

H

M L

E

H

M

L

(PARA REF)

Date Prepared (dd-mmm-yy):

ACTIVITY HAZARDS ANALYSIS

JOB STEPS

Catastrophic

Critical

Marginal

Negligible

ACTIONS TO ELIMINATE OR

MINIMIZE HAZARDS

EM 385-1-1

E

L

P r o b a b i l i t y Frequent Likely Occasional UnlikelySeldom

JOB STEPS HAZARDS

ACTIONS TO ELIMINATE OR EM 385-1-1

MINIMIZE HAZARDS (PARA REF)

ACTIVITY HAZARDS ANALYSIS

Date Prepared (mm-dd-yyyy):

Project: Job:

ACTIVITY HAZARDS ANALYSIS

Date Prepared (mm-dd-yyyy):

Project: Job:

JOB STEPS HAZARDS

ACTIONS TO ELIMINATE OR EM 385-1-1

MINIMIZE HAZARDS (PARA REF)

JOB STEPS HAZARDS

ACTIONS TO ELIMINATE OR EM 385-1-1

MINIMIZE HAZARDS (PARA REF)

Date Prepared (mm-dd-yyyy):

ACTIVITY HAZARDS ANALYSIS

JOB STEPS HAZARDS

ACTIONS TO ELIMINATE OR EM 385-1-1

MINIMIZE HAZARDS (PARA REF)

ACTIVITY HAZARDS ANALYSIS

Date Prepared (mm-dd-yyyy):

AHA

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