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BLM RISK MANAGEMENT WORKSHEET HANDOUT 5 2 Form 1112 5

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BLM RISK MANAGEMENT WORKSHEET HANDOUT 5 2 Form 1112 5 Powered By Docstoc
					                                                                            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.

DOI BLM JHA                                                                         4 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)
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

				
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