Activity/Work Task: AHA Signature Log Number Overall Risk Assessment Code (RAC) (Use highest code) Project Location: Risk Assessment Code (RAC) Matrix Contract Number: Probability Severity Frequent Likely Occasional Seldom Likely Catastrophic E E H H M Date Prepared: Critical E H H M L SSHO: Marginal H M M L L Signature: Negligible M L L L L Superintendent: Signature: QC Manager: Signature Subcontractor Forman: Name: Signature: QA Reviewed by (Name/Title): Step 1; Review each with identified safety Determine RAC (See above) “Hazard” “Controls” Notes: (Field Notes, Probability: likelihood the activity will cause a Mishap (near Review Comments, etc.) miss, incident or accident). Identify as Frequent, Likely, RAC Chart Occasional, Seldom or Unlikely E = Extremely High Risk Severity: the outcome if a mishap occurred. Identify as Catastrophic, Critical, Marginal, or Negligible H = High Risk Step 2: Identify the RAC (probability vs. severity) as E, H, M = Moderate Risk M, or L for each on AHA. Annotate the overall “Hazard” highest RAC at the top of the AHA L = Low Risk Job Steps (Work Sequences) Specific Anticipated Hazards Controls RAC 1. 1. 1. 1. 2. 2. 2. 2.
Activity/Work Task: AHA Signature Log Number Overall Risk Assessment Code (RAC) (Use highest code) Project Location: Risk Assessment Code (RAC) Matrix Contract Number: Severity Probability Frequent Likely Occasional Seldom Likely Date Prepared: Catastrophic E E H H M Critical E H H M L SSHO: Signature: Marginal H M M L L Superintendent: Signature: Negligible M L L L L QC Manager: Signature Subcontractor Forman: Name: Signature: QA Reviewed by (Name/Title): Step 1; Review each “Hazard” with identified safety “Controls” Determine RAC (See above) Notes: (Field Notes, Review Comments, etc.) Probability: likelihood the activity will cause a Mishap (near miss, incident or accident). Identify as Frequent, Likely, Occasional, Seldom or Unlikely RAC Chart Severity: the outcome if a mishap occurred. Identify as Catastrophic, Critical, Marginal, or Negligible E = Extremely High Risk 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 1. 2. 1. 2. 1. 2. 1. 2.