Fillable Printable Army Risk Assessment Form Sample
Fillable Printable Army Risk Assessment Form Sample
Army Risk Assessment Form Sample
RISK MANAGEMENT WORKSHEET
(CDTCMD Reg 385-10; proponent agency is Cadet Command Safety)
1. Organization and Unit Location:
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 will be 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. 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
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. Tasks 9. 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. Self explanatory
9. Identify Hazards – Review METT-T factors for the mission or task. Additional factors include
historical lessons learned, experience, judgment, equipment characteristics and warnings, and
environmental considerations.
10. Initial Risk Level – Assess hazard and determine initial risk for each hazard by applying risk
assessment matrix.
11. Develop Controls – Develop one or more controls for each hazard that will either eliminate the
hazard or reduce the risk (probability and/or severity). Specify who, what, where, why, when, and how
for each control.
12. Residual Risk Level – Determine the residual risk for each hazard by applying the risk
assessment matrix, assuming the controls are implemented.
13. Implement Controls – Decide how each control will be put into effect or communicated to the
personnel who will make it happen (written or verbal instruction; tactical, safety, garrison SOPs,
rehearsals).
14. Who/How Supervised – Who and how will each control be monitored (continuous
supervision, spot-checks). Evaluate frequently and pass on lessons learned.
15. Determine Overall Mission/Task Risk – Select the highest residual risk level and circle it.
This becomes the overall mission or task risk level. The commander decides whether the controls
are sufficient to accept the level of residual risk. If the risk is too great to continue the mission or task,
the commander directs development of additional controls or modifies, changes, or rejects the COA.
16. Medical Support – Select type of on-site medical support provided and circle it.
17 & 18. Self explanatory
19. Risk Decision Authority – The decision to accept or not accept the risk(s) associated with an
action is made by the appropriate commander or leader responsible for performing that action.
Need to Risk Manage a METT-T Hazard
Hazards not adequately controlled are likely to cause loss of combat power. Answer the
following questions about each hazard to determine if it is adequately controlled. If not,
hazards needs to be risk managed.
Are the Controls Adequate?
Yes
No
Support – Is type/amount/capability/condition of support adequate to carry
out the mission?
Personnel
Supplies
Equipment/Material
Services/Facilities
Standards – Is guidance / procedure adequately clear / practical /specific
to control hazard?
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 further action required (subject to commander’s risk guidance). If one or more
“no ”, risk manage this hazard
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 – The likelihood that an event will occur.
FREQUENT – Occurs often, continuously experienced.
LIKELY – Occurs several times.
OCCASIONAL – Occurs sporadically.
SELDOM – Unlikely, but could occur at some time.
UNLIKELY – Can assume it will not occur.
SEVERITY
– The expected consequence of an event in terms of degree of injury, property
damage, or other mission-impairing factors.
CATASTROPHIC – Death or permanent total disability, system loss, major damage,
significant property damage, mission failure.
CRITICAL – Permanent partial disability, temporary total disability in excess of 3 months,
major system 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 minor medical treatment, minor system impairment, little/no
impact on mission accomplishment.
* FM 101-5, 31 May 1997
