Fillable Printable Army Risk Assessment Form Sample
Fillable Printable Army Risk Assessment Form Sample
Army Risk Assessment Form Sample
RISK MANAGEMENTWORKSHEET
(CDTCMD Reg 385-10; proponent agency is Cadet Command Safety)
1.Organization and UnitLocation:
2.Page
1
of
2
3.Mission/Task:
4. Begin Date:
5.End Date:
6.Date Prepared:
7.Operational Phase in which the Mission/Task willbe conducted:
8. Tasks
9.Identify Hazards
10. Initial
Risk Level
11.Develop Controls
12. Residual
Risk Level
13. Implement Controls (“How To”)
14. Who/How Supervised
15.DetermineOverall Mission/Task Risk Level AfterCountermeasuresAre Implemented:
(Circle Highest Remaining Risk Level)
LOW (L)
MODERATE(M)
HIGH (H)
EXTREMELY HIGH (E)
16.MedicalSupport:Advanced Trauma Life Support (ATLS) isrequiredwithin 1hour.On-siteMedicalSupportprovided(Circle one):MedicCombat LifesaverARC/NSCFirst-Aid ResponderNone
17.Prepared by:(Rank,Last Name,DutyPosition)
18.Reviewed byAction Officer/Commander:(Rank,Last Name,DutyPosition and Signature):
19.Risk Decision Authority (SignatureBlock and Signature):
Extremely HighRisk:Not Applicable for Cadet Command
High Risk:CG or DCG
ModerateRisk: Brigade Cdr (0-6).At Advanced/Basic Camp– RegionCdr orCofS
Low Risk:BattalionCdr.At Advanced/Basic Camp–Committee Chief or Regimental Cdr/TAC Officer
CDTCMD Form 385-1-R-E, Apr 01Risk Assessment and RiskManagement Countermeasure Worksheets inCC Reg 145-3 are OBSOLETE
Sample Risk Management Worksheet
RISK MANAGEMENT WORKSHEET
(CDTCMD Reg 385-10; proponent agency is Cadet Command Safety)
1. Organization and Unit Location:
ROTC Battalion
2. Page
1
of
2
3. Mission/Task:
Conduct Rappel Training (include Transportation to and from Tower)
4. Begin Date:5. End Date:6. Date Prepared:
7. Operational Phase in which the Mission/Task will be conducted:
Throughout training phase
8. Tasks9. Identify Hazards
10. Initial
Risk Level
11. Develop Controls
12. Residual
Risk Level
13. Implement Controls (“How To”)14. Who/How Supervised
Transportation to
tower.
Rappelling from a
34-ft Tower
Driver Fatigue
Traffic/Congestion
Weather Conditions
(rain/ice on road)
Inexperienced
cadets
Equipment failure
resulting in falls.
Heat Injury/
Dehydration
Wildlife, insects and
plants
M
M
H
H
H
H
M
Ensure driver gets adequate rest.
Drive slower and defensively.
Drive slower than posted speed limit.
Instruct and demonstrate: (1) Fundamentals
of rappelling, (2) How to properly tie knots
and (3) Safety requirements.
Always require use of helmets and gloves.
Conduct a safety inspection of tower and all
rappelling equipment prior to training
exercise.
Conduct annual safety inspection of tower.
Monitor Heat Index, advise all to drink
sufficient volumes of water at frequent
intervals, carry canteen(s) and know
location of water points.
Brief cadets to avoid wildlife, insects and
plants. Use insect repellent.
Have bee stings kits available.
L
L
M
M
M
M
M
L
AR 385-55, Prevention of
Motor Vehicle Accidents
AR 600-55, Army Driver and
Operator Standardization
Program
TSP No.1, Basic Rappelling
TC 21-24, Rappelling
TC 21-24, Rappelling
AR 385-10, Safety Program
DA Pam 385-1, Unit Safety
TB MED 507
Water buffalo/jugs on site.
GTA 8-5-50
FM 21-10
GTAs based on area.
Driver – Self
Driver – Self
Driver – Self
Qualified Rappel
Master will supervise.
Rappel Master will
inspect.
Army Safety Officer,
CDSO, Univ. Safety.
Cadre monitor
weather.
Cadre monitor Heat
Index.
Use buddy system.
15. Determine Overall Mission/Task Risk Level After Countermeasures Are Implemented:
(Circle Highest Remaining Risk Level)
LOW (L) MODERATE (M) HIGH (H)EXTREMELY HIGH (E)
16. Medical Support: Advanced Trauma Life Support (ATLS) is required within 1 hour. On-site Medical Support provided (Circle one): Medic Combat Lifesaver ARC/NSC First-Aid Responder None
17. Prepared by: (Rank, Last Name, Duty Position)
18. Reviewed by Action Officer/Commander: (Rank, Last Name, Duty Position and Signature):
19. Risk Decision Authority (Signature Block and Signature):
Extremely High Risk: Not Applicable for Cadet Command
High Risk: CG or DCG
Moderate Risk: Brigade Cdr (0-6). At Advanced/Basic Camp – Region Cdr or CofS
Low Risk: Battalion Cdr. At Advanced/Basic Camp – Committee Chief or Regimental Cdr/TAC Officer
CDTCMD Form 385-1-R-E, Apr 01
Risk Assessment and Risk Management Countermeasure Worksheets in CC Reg 145-3 are OBSOLETE
Work Sheet Instructions
Blocks
1 8. Selfexplanatory
9.IdentifyHazards–Review METT-T factorsforthemission ortask. Additionalfactors include
historicallessons learned,experience, judgment,equipment characteristicsandwarnings, and
environmentalconsiderations.
10.Initial Risk Level– Assess hazardanddetermine initialriskfor eachhazard byapplyingrisk
assessment matrix.
11.DevelopControls – Develop oneormore controlsfor eachhazardthat will eithereliminatethe
hazard orreducetherisk(probability and/or severity).Specifywho, what, where, why,when,andhow
for eachcontrol.
12.ResidualRisk Level– Determinetheresidualriskfor eachhazard byapplyingthe risk
assessment matrix,assuming thecontrols areimplemented.
13.ImplementControls– Decidehoweach control will beputintoeffect orcommunicatedtothe
personnel whowill make it happen(written orverbalinstruction;tactical,safety, garrisonSOPs,
rehearsals).
14.Who/HowSupervised– Whoandhowwilleachcontrolbe monitored(continuous
supervision,spot-checks).Evaluate frequentlyandpass onlessons learned.
15.DetermineOverall Mission/Task Risk–Selectthehighestresidualrisklevel andcircle it.
Thisbecomes theoverallmissionortaskrisklevel.Thecommanderdecideswhether thecontrols
aresufficient toaccept thelevel ofresidualrisk. Iftheriskis toogreat tocontinuethemission or task,
the commanderdirects developmentof additionalcontrols ormodifies,changes,orrejects theCOA.
16.Medical Support– Selecttypeofon-site medical supportprovidedandcircle it.
17 & 18.Self explanatory
19.Risk Decision Authority–The decisionto acceptornotaccept therisk(s) associatedwith an
actionis made bytheappropriatecommander or leader responsiblefor performingthat action.
Need toRisk Manage a METT-T Hazard
Hazards not adequately controlled are likely to causeloss of combat power.Answer the
following questionsabout each hazardto determine ifitis adequately controlled.If not,
hazards needs to be risk managed.
Arethe ControlsAdequate?
Yes
No
Support– Is type/amount/capability/condition ofsupport adequate tocarry
out the mission?
Personnel
Supplies
Equipment/Material
Services/Facilities
Standards – Is guidance / procedure adequately clear/ practical /specific
to controlhazard?
Training – Is training adequately thorough and recent to control hazard?
Leader –Is leadership ready, willing, and able to enforce standards
required to control hazard?
Individual/Unit Self-Discipline – Is performance and conduct sufficiently
self-disciplined to control hazard?
If all “yes”, no furtheraction required (subject tocommander’s risk guidance).If one or more
“no ”, risk manage thishazard
Risk Assessment Matrix
PROBABILITY
SEVERITY
Frequent
Likely
Occasional
Seldom
Unlikely
Catastrophic
E
E
H
H
M
Critical
E
H
H
M
L
Marginal
H
M
M
L
L
Negligible
M
L
L
L
L
PROBABILITY– Thelikelihood that an event will occur.
FREQUENT – Occurs often,continuously experienced.
LIKELY –Occurs several times.
OCCASIONAL– Occurssporadically.
SELDOM– Unlikely,but could occur at sometime.
UNLIKELY – Canassume it will not occur.
SEVERITY
– The expected consequenceof an event in terms of degree of injury, property
damage, or othermission-impairing factors.
CATASTROPHIC – Death or permanent totaldisability, system loss,major damage,
significant property damage, mission failure.
CRITICAL – Permanent partial disability, temporary totaldisability inexcess of 3months,
majorsystem damage, significant property damage, significant mission degradation.
MARGINAL– Minor injury, lost workday accident, minor system damage, minor property
damage, some mission degradation.
NEGLIGIBLE – First aid or minormedical treatment, minor system impairment, little/no
impact on missionaccomplishment.
* FM 101-5, 31 May 1997
