Activity Hazard Analysis (AHA)

Activity/Work Task: Repair Concrete Overall Risk Assessment Code (RAC) (Use highest code) M
Project Location: Risk Assessment Code (RAC) Matrix
Contract Number: Probability
Severity
Date Prepared: 5 February 2020 Frequent Likely Occasional Seldom Unlikely
Catastrophic E E H H M
Prepared by (Name/Title):
Critical E H H M L
Marginal H M M L L
Reviewed by (Name/Title):
Negligible M L L L L
Notes: (Field Notes, Review Comments, etc.)
Step 1: Review each “Hazard” with identified safety “Controls” and determine RAC (See above)
Fire Dept. Phone 911 for Emergency Response.
“Probability” is the likelihood to cause an incident, near miss, or accident and
For Government Vehicle accidents, contact supervisor immediately, identified as: Frequent, Likely, Occasional, Seldom or Unlikely. RAC Chart
if not available (Name)(Phone #) “Severity” is the outcome/degree if an incident, near miss, or accident did E = Extremely High Risk
If a dig permit is required, follow instructions of dig permit and occur and identified as: Catastrophic, Critical, Marginal, or Negligible H = High Risk
attach to AHA upon completion of job. M = Moderate Risk

Follow OSHA instructions, Table 1, on specified exposure Step 2: Identify the RAC (Probability/Severity) as E, H, M, or L for each
“Hazard” on AHA. Annotate the overall highest RAC at the top of AHA. L = Low Risk
control methods when working with silica.

Job Steps Hazards Controls RAC

Mobilization, stage materials, and
provide adequate barriers
throughout duration of
construction.
Perform lockout/tagout operations
before, during and after job.
Remove damaged sections of
concrete and replace with new.
Motor vehicle accidents.
Muscle strains while lifting material.
Struck by moving materials. Slips,
Trips, Cuts and Falls.
While driving on base maintain posted speed limits. Cell M
phone use is prohibited while driving on base. Obey all
traffic laws at all times. Use seatbelts properly.
Utilize proper lifting techniques. Materials shall not be M
staged/ stored in access ways /doorways. Safely ensure
footing and body position for awareness of slips, trips, or
falls. Get help when lifting material over 40 pounds.
Wear proper PPE (Hard hats, gloves, safety toed boots)
when handling materials with sharp objects.

Concrete design mix is to satisfy
#### psi, with minimum thickness
of eight inches.
Site Clean Up/Demobilization.
Falls. Personnel should note all areas where the potential for M
falls may occur and ensure fall protection is utilized.
Slipping and Tripping potential. Personnel should inspect areas where debris or slick M
surfaces are present to prevent tripping and slipping
accidents. Appropriate footwear is needed to provide
adequate traction. Safety shoes are required for all

Hearing Damage.
Struck by falling debris.
Eye Injury / Debris enter eyes.
Electrical Shock or Electrocution.
Respiratory illnesses.
Cuts/Abrasions, Puncture Wounds.
Slipping, Tripping, Falls, Muscle
strains and proper disposal of all trash
and debris.
Unstable ladders or unbalanced
scaffolding.
personnel to provide both adequate foot wear with
traction and to protect the feet.
Wear Approved Hearing Protection when exposed to M
louder than 85 Decibels.
Wear approved Hard Hat at all times. M
Use Approved Safety Glasses/eye protection at All M
Times.
When using any electrical tools ensure they are only M
plugged into GFCI outlets only. Make sure that any
extension cords being used is free from defect like nicks,
tears, cuts, rips, etc. If any defects are found tag them out
and remove from service.
Ensure areas are properly ventilated. Use the required M
filter mask or respirator when applying vaporous and/or
toxic propellants or liquids.
Use Approves Gloves to protect hands from sharp L
objects.
Maintain proper housekeeping practices keep work area M
clean and while walking the site be observant.
Use caution when removing debris and excess materials
from jobsite. Utilize the use of carts or dollies when
access is available. Safely ensure footing and body
position for awareness of slips, trips, or falls. Proper
lifting techniques utilized. Employees shall be trained in
and shall use safe lifting techniques.
Step ladders are in locked and stable position. Extension M
ladders are used correctly to Manufacturer’s
requirements. Scaffolding is erected correctly, balanced,
stable, and wheels locked during use. No personnel shall
ride and move scaffold to another area.
Supervisors ensure employees review AHA daily.
 Training Requirements/Competent or
Equipment to be Used Inspection Requirements
Qualified Personnel name(s)
Government Motor vehicles. Government and State Operators Licenses Daily vehicle inspection required.
required.
Power tools/Hand tools (electric, gas, Hand and power tools shall be used, inspected, and
hydraulic, pneumatic) maintained IAW manufacturer's instructions and
recommendations and shall only be used for the purpose
for which designed.

Personal Protective Equipment (PPE) will Daily PPE inspection required.

be used when the task(s) being
accomplished requires bodily protection.

Heavy equipment Employee shall be licensed to operate Utilize spotter when crossing lanes, during mobilization
(jlg and manlift) equipment. Employee shall wear fall of manlift.
protection when working from elevated
equipment.

UFGS 013526 11/15 1.9 Government reserves the right to require the Contractor to revise and resubmit the AHA if it fails to effectively identify the work sequences; specific anticipated hazards, site
conditions, equipment, materials, personnel and the control measures to be implemented. UFGS 013526 1.9.1 Review the AHA list periodically (at least monthly) at supervisory safety meetings,
update when procedures, scheduling or hazards change. UFGS 013526 1.9.2 - Each employee performing work must review the AHA and sign a signature log for that AHA prior to starting work.
The SSHO must maintain a signature log on site for every AHA.

Accepted By: ____________________________ Date: ________________