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HANDOUT 5-2
Form 1112-5 UNITED STATES
(May 2001) DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
RISK MANAGEMENT WORKSHEET
1. Organization and Location
2. Page ____1____of______10_____
3. Operation / Task Serious Accident Investigation 4. Beginning Date: 5. Ending Date: 6. Date Prepared
7. Prepared by (Name / Duty Position)
8. Identified Hazards 9. Assess the 10. Control Measures Developed for 11. Assess 12. How to Implement 13. Supervisors and
Hazards: Identified Hazards: (Specific measures the Hazard’s the Controls: ( Include Evaluation by: (Continuous
Initial Risk taken to reduce the probability of a Residual Risk: SOP’s ,references, etc.) Leader Checks, Buddy
hazard) System, etc.)
(Be Specific) L M H E (Be Specific) L M H E (Be Specific) (Be Specific)
MOTOR VEHICLE OPERATIONS
X Team Leader will ascertain whether driver X The Team Leader or This will be included in initial
Driver physical limitations. is capable of operating a vehicle safely. If safety advisor will ensure team briefings by either the
there is doubt, a medical exam should be that team member have team leader or the team
conducted. completed DDC and are safety advisor.
properly licensed to
operate a vehicle for
official business – this
includes agency ID Cards
for anyone operating a
vehicle for official
business.
Refer to BLM Manual
H1112-1, Ch. 14, BLM
H1112-2, Topic 4.
X
14. Remaining Risk Level After Control Measures Are LOW MEDIUMX HIGH EXTREMELY HIGH
Implemented: (CIRCLE HIGHEST REMAINING RISK LEVEL) (Line Supervisor) (Branch Chief) (District Manager (Must be State Director/Associate)
15. RISK DECISION AUTHORITY: (Approval/Authority Signature Block) (If Initial Risk Level is Medium, High or Extremely High, Brief Risk Decision Authority at that
Supervisor will initially
only that if a new driver risk
level on Controls and Control Measures used to reduce risks) (Note: if the person preparing the form signs this block, the signature indicatesdetermine the appropriateis
capable the decision
decision authority was notified of the initial risk level, control measures taken and appropriate resources requested; and that the risk was accepted by of operating a
authority.) vehicle safely.
___________________________________________________________________________
(Signature)
DOI BLM JHA 1 of 10
HANDOUT 5-2
8. Identified Hazards 9. Assess 10. Control Measures Developed for 11. Assess 12. How to Implement 13. Supervisors and
the Identified Hazards: (Specific the Hazard’s the Controls: ( Include Evaluation by: (Continuous
Hazards: measures taken to reduce the Residual SOP’s, references, Leader Checks, Buddy
Initial Risk probability of a hazard) Risk: etc.) System, etc.)
(Be Specific) L M H E (Be Specific) L M H E (Be Specific) (Be Specific)
Driver proficiency. X -Driver must possess a valid state X -Supervisor will Supervisor checks of
driver’s license. physically view driver’s employee driving activities.
license, contact safety
office for training info.
Fatigue X -Adequate rest stops/stretch breaks, X -Refer to BLM Manual Supervisor check of time
driver rotation. H1112-1, Ch. 14, BLM recovery to ensure driving/rest
-Drivers will not exceed 8 hours driving H1112-2, Topic 4. schedules are being followed.
time within a 16 hour duty period. Pre-trip briefing.
-At least 8 consecutive hours of rest are
required before any duty period requiring
driving.
Vehicle malfunction. X -Thoroughly inspect vehicle monthly; X -Vehicle manager will Supervisor will spot check for
fluids, lights, wipers, washers, brakes, perform. performance.
belts, and tires.
- Daily pre-trip “walk-around” inspections - Driver will perform.
of tires, lights, glass, fluid leaks. Refer to BLM Manual
H1112-1, Ch. 14, BLM
H1112-2, Topic 4.
Collision. X -Seat belt worn at all times when vehicle X -Defensive Driver Supervisor will spot check for
is in motion. Training will be performance.
-3 second rule following distance, and provided
other defensive driving techniques.
-Reduce speed.
-Increase following distance/time to 4
seconds+.
-Insure proper tire inflation as per info on
tire.
-Vehicles will carry:
Warning flags or reflectors
Essential emergency repair
tools
First Aid kit, w/BBP barriers
DOI BLM JHA 2 of 10
HANDOUT 5-2
8. Identified Hazards 9. Assess 10. Control Measures Developed for 11. Assess 12. How to Implement 13. Supervisors and
the Identified Hazards: (Specific the Hazard’s the Controls: ( Include Evaluation by: (Continuous
Hazards: measures taken to reduce the Residual SOP’s, references, Leader Checks, Buddy
Initial Risk probability of a hazard) Risk: etc.) System, etc.)
(Be Specific) L M H E (Be Specific) L M H E (Be Specific) (Be Specific)
Wet, icy, or loose pavement X -Reduce speed X -Defensive Driver Supervisor will spot check for
-Increase following distance/time to 4 Training will be performance.
seconds provided.
-Insure proper tire inflations as per info
on tire
Vehicle Emergency X -Reduce speed, stay calm, maintain X -Vehicle manager or
attention and firm control, and pull off primary driver.
roadway slowly.
Backcountry driving, gravel and/or X -Reduce speed. X -Team new employees -Supervisor will spot check for
mountainous roads. Increase following distance/time to 4 with employees performance.
seconds. experienced with local -Supervisor will spot check for
conditions for initial compliance.
* Poor traction X -Insure proper tire inflations as per info X trips. -Crew chief, supervisor safety
on tire. -Safety meeting briefings.
reminders, briefings. -Buddy System with crew
members.
* Tire puncture X -Ensure that spare tire and necessary
tools are prepared prior to departure. X
* Dust/mud obscured visibility X -Utilize windshield cleaner, increase X
following distance to 4 seconds.
* Brake failure X -Avoid riding breaks on long or steep X
downhill grades: utilize low gears as
much as possible to reduce speed.
HELICOPTER OPERATIONS Get safety briefing as required prior to
assignment. X Team briefings Team Safety Advisor will
Flying objects, particulates, dust, X ensure PPE is available and
etc. Wear appropriate PPE. i.e. flight suits or worn and required briefings
fire nomex shirts and pants, helmets or X PPE will be worn IAW are performed.
Noise and other flight related X hardhats, leather or nomex flight gloves, flight safety
hazards and hearing protection. requirements
DOI BLM JHA 3 of 10
HANDOUT 5-2
8. Identified Hazards 9. Assess 10. Control Measures Developed for 11. Assess 12. How to Implement 13. Supervisors and
the Identified Hazards: (Specific the Hazard’s the Controls: ( Include Evaluation by: (Continuous
Hazards: measures taken to reduce the Residual SOP’s, references, Leader Checks, Buddy
Initial Risk probability of a hazard) Risk: etc.) System, etc.)
(Be Specific) L M H E (Be Specific) L M H E (Be Specific) (Be Specific)
WALKING AND HIKING
Falling objects X Approved hardhats will be worn when X Safety Advisor will Team Safety Advisor will
there are overhead hazards; including ensure that everyone ensure PPE is available and
walking in wooded areas. Hazard trees has a hardhat and worn and required briefings
will be identified and noted. wears it as required. are performed.
Unimproved walking surfaces. X Safety briefings will be performed and X The Safety briefing will
- tripping hazards appropriate boots will be worn by all be conducted on site
- snags personnel. Snags and other hazards will and general and
- steep rough terrain be identified to members walking to help specific safety issues
will be covered.
The Team Leader will ensure proper
Fatigue X work/rest cycles. Team members who X Work rest schedules will
are not accustomed to working at be developed and
arduous duties should be identified and adhered to by the team.
actions taken to ensure that they do not
overextend themselves.
The Team Safety Advisor will ensure that The Team Leader will
Weather X appropriate attire, sunscreen, raingear, X ensure that equipment
- sun etc., will be made available for the team is available and used.
- cold as appropriate. Any vehicle operations
- wind during inclement weather will require a
- raid formal Risk Assessment approved by the
- snow/ice Team Leader. The Safety Advisor will
coordinate with the local
Local safety personnel will provide the safety person to
Other hazards X team an overview of other hazards the X ascertain the hazards Entry into areas will not be
- poisonous plants team may be exposed to and offer the team may be made until routine and know
- inspects/animals remedies that routinely help ensure that exposed to. non-routine hazards are
- illegal drug activities local employees are not exposed to Involvement of the local identified and the risks
- hostile people these hazards. safety person may mitigated. Noted hazards will
Law enforcement will be used as include safety briefings be briefed to all team
appropriate and be provided by the local to the team as well as members.
unit. coordination for law
enforcement.
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HANDOUT 5-2
8. Identified Hazards 9. Assess 10. Control Measures Developed for 11. Assess 12. How to Implement 13. Supervisors and
the Identified Hazards: (Specific the Hazard’s the Controls: ( Include Evaluation by: (Continuous
Hazards: measures taken to reduce the Residual SOP’s, references, Leader Checks, Buddy
Initial Risk probability of a hazard) Risk: etc.) System, etc.)
(Be Specific) L M H E (Be Specific) L M H E (Be Specific) (Be Specific)
Security/Safety X Establish building evacuation procedures X The Team Safety Team Leader will ensure that
for work area being utilized; make sure Advisor will develop this is complete and briefed to
all employees are aware of exits and Emergency Plans as the team.
safety meeting area. necessary for the team
to include sign-in/out
Inform team members of the process to procedures.
report any accidents or injuries.
Provide all team members with incident
emergency phone numbers and the
process to follow for rapid notification in
the event of an emergency.
Check-out/check-in systems (such as a
sign out board) shall be located and
utilized for team use.
Advise the appropriate person(s) on the
accident investigation team of travel
plans with expected times of arrival and
return when traveling to and from the
investigation site or isolated locations.
Ensure vehicles are operating properly
and are equipped for the specific task.
Travel in pairs where warranted.
Ensure that communications equipment
is operating properly and replacement
batteries are available for hand-held
radios.
Bloodborne Pathogen Program X All employees shall receive HIV/AIDS X The Safety Advisor will Team Leader will ensure that
education training. For employees ensure this is this is complete and briefed to
whose jobs put them at risk for an completed. The team the team.
occupational exposure, training shall may use the local BBP
cover the major elements of the OSHA program to accomplish
bloodborne pathogens regulation. this.
Exposure to Diseases X To further minimize employee risk, all X The Safety Advisor will Team Leader will ensure that
DOI BLM JHA 5 of 10
HANDOUT 5-2
8. Identified Hazards 9. Assess 10. Control Measures Developed for 11. Assess 12. How to Implement 13. Supervisors and
the Identified Hazards: (Specific the Hazard’s the Controls: ( Include Evaluation by: (Continuous
Hazards: measures taken to reduce the Residual SOP’s, references, Leader Checks, Buddy
Initial Risk probability of a hazard) Risk: etc.) System, etc.)
(Be Specific) L M H E (Be Specific) L M H E (Be Specific) (Be Specific)
employees, regardless of job ensure this is this is complete and briefed to
classification or duties, shall observe completed. The team the team.
universal precautions at all times. may use the local BBP
Observing universal precautions is an program to accomplish
approach to infection control in which this.
human blood and human body fluids are
treated as if known to be infectious for
HIV, HBV, or other bloodborne
pathogens.
Working in Hot Conditions X Individual differences in heat tolerance X The Safety Advisor will All team members will use the
- Fatigue are related to fitness, hydration, illness, monitor heat indexes buddy system to ensure heat
- Weather drugs and medication, and fatigue. and ensure that injuries do not affect the
identified control teams work.
Heat stress occurs when the body's core measures are
temperature rises beyond safe limits. implemented. All team
Evaporation of sweat is the body's main members will monitor
line of defense against heat. As sweat not only their own
evaporates, it cools the body. When condition but that of
water lost by sweating is not replaced, their team mates.
the body's heat controls break down and
body temperature climbs dangerously.
Three factors that can contribute to heat The team leader will
stress are low or poor physical fitness, ensure that water is
excess weight, and hypertension. made available for all
team members, that
Schedule the hardest work during the rest breaks are
cooler hours of the day. Set a moderate scheduled, and that the
work pace. As the temperature team is aware of heat
increases, stop for frequent rest periods indexes and warnings.
of at least 15 minutes. Always have an
adequate supply of water available and
ensure that employees are getting
needed liquids.
Plan ahead for drinking water; don't allow
water supplies to run out.
To prevent dehydration:
DOI BLM JHA 6 of 10
HANDOUT 5-2
8. Identified Hazards 9. Assess 10. Control Measures Developed for 11. Assess 12. How to Implement 13. Supervisors and
the Identified Hazards: (Specific the Hazard’s the Controls: ( Include Evaluation by: (Continuous
Hazards: measures taken to reduce the Residual SOP’s, references, Leader Checks, Buddy
Initial Risk probability of a hazard) Risk: etc.) System, etc.)
(Be Specific) L M H E (Be Specific) L M H E (Be Specific) (Be Specific)
Drink 8 to 16 ounces of water before
work.
Take frequent drinks during each hour of
work (1 quart or 1 liter per hour).
Drink as much water as possible at lunch
and the evening meal.
Continue replacing fluids throughout the
evening.
Limit caffeine drinks, such as coffee or
cola.
Avoid alcoholic drinks.
Provide well-planned meals and healthy
snacks that are vital to maintain work
capacity and to avoid heat disorders
through adequate replacement of water,
salt, and potassium.
Carbohydrate/electrolyte beverages are
recommended.
Wear hardhats; they protect your head
and keep you cooler.
Prevent sunburn by wearing lightweight,
light-colored, loose clothing, which
allows air to circulate and sweat to
evaporate, and offers protection from
direct sun. Bare skin absorbs the sun's
radiant heat and raises body
temperature.
During periods of continued extreme
o
temperatures (90 F or above), ensure
that supervisors monitor employees and
DOI BLM JHA 7 of 10
HANDOUT 5-2
8. Identified Hazards 9. Assess 10. Control Measures Developed for 11. Assess 12. How to Implement 13. Supervisors and
the Identified Hazards: (Specific the Hazard’s the Controls: ( Include Evaluation by: (Continuous
Hazards: measures taken to reduce the Residual SOP’s, references, Leader Checks, Buddy
Initial Risk probability of a hazard) Risk: etc.) System, etc.)
(Be Specific) L M H E (Be Specific) L M H E (Be Specific) (Be Specific)
that employees watch each other for
signs of heat-stress disorders, including
heat cramps, heat exhaustion, and
heatstroke.
Heat cramps are identified by muscular
pains and cramps, with leg and
abdominal muscles usually affected first.
Remedies include stretching and gently
massaging cramped muscles and
applying a heating pad or hot water
bottle to help relieve muscle spasms.
Heat exhaustion is characterized by
fatigue, weakness, and collapse. The
skin becomes pale, cool, and clammy.
Individuals experience nausea,
dizziness, a throbbing headache,
breathing problems, and diarrhea.
Recommended actions include moving
to a cool, shady place, lying with the feet
raised 8 to 12 inches above the head,
loosening clothing, and applying cool
compresses to the skin. If there is no
improvement quickly, seek medical
attention at once.
Heatstroke is a medical emergency.
Unaclimatized employees are especially
prone to heatstroke. Symptoms are
confusion, high body temperature, hot
(often dry) skin, rapid pulse, convulsions,
loss of consciousness, and coma. Lack
of sweating is one sign of imminent
heatstroke. Do not delay treatment.
Cool the body down immediately.
Administer fluids and transport the victim
to a medical facility as quickly as
possible.
DOI BLM JHA 8 of 10
HANDOUT 5-2
8. Identified Hazards 9. Assess 10. Control Measures Developed for 11. Assess 12. How to Implement 13. Supervisors and
the Identified Hazards: (Specific the Hazard’s the Controls: ( Include Evaluation by: (Continuous
Hazards: measures taken to reduce the Residual SOP’s, references, Leader Checks, Buddy
Initial Risk probability of a hazard) Risk: etc.) System, etc.)
(Be Specific) L M H E (Be Specific) L M H E (Be Specific) (Be Specific)
Lightning and Thunderstorms X Heavy rain, hail, and lightning occur only X The team will avoid The Safety Advisor will ensure
in the mature stage of a thunderstorm. working in the field that the team is aware of
Keep informed; know what the storm is during periods of adverse weather conditions
doing. extreme weather. If and takes the appropriate
lightning is seen, the actions.
When there is no shelter, avoid tall team will seek
objects such as lone trees. If only appropriate shelter.
isolated trees are nearby or if you are in
open country, the best protection is to
make yourself as small a target as
possible. Drop to your knees, bend
forward with your hands resting on your
knees, and keep a distance of twice the
height of the nearest tree between you
and the tree. To minimize the flow of the
current, keep your feet together. Keep
away from wire fences, telephone lines,
electrically conductive objects, and
railroad tracks.
Advise team members that if they feel an
electrical charge, if their hair stands on
end, or their skin tingles, a lightning
strike may be imminent.
Solar Radiation X Keep exposed skin covered by wearing a X Team members should Safety Advisor will ensure that
hat, a bandanna, and a long-sleeved ensure they bring the team is properly outfitted
shirt (with sleeves rolled down and collar appropriate personal and equipped for all
turned up). items such as sun operations.
glasses with UV
Wear sunglasses that filter out 100 protection, sunscreen,
percent of the UV rays. The use of non- etc., are brought and
UV protected sunglasses or photo grey used as required.
glasses can increase the chance of UV
damage to the retina and are not
recommended.
DOI BLM JHA 9 of 10
HANDOUT 5-2
8. Identified Hazards 9. Assess 10. Control Measures Developed for 11. Assess 12. How to Implement 13. Supervisors and
the Identified Hazards: (Specific the Hazard’s the Controls: ( Include Evaluation by: (Continuous
Hazards: measures taken to reduce the Residual SOP’s, references, Leader Checks, Buddy
Initial Risk probability of a hazard) Risk: etc.) System, etc.)
(Be Specific) L M H E (Be Specific) L M H E (Be Specific) (Be Specific)
Provide and use protective sunscreen
lotion, cream, oil, and lip balm as
identified in the JHA.
When possible, stay indoors during the
peak exposure time in the summer or
find worksites that are shady.
Alter work schedules where appropriate
to avoid peak summer exposure.
DOI BLM JHA 10 of 10
