Sample AHA

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ACTIVITY HAZARD ANALYSISDate Submitted: August 18,2010

Contract No.: W912CN-10-C-0044 Name of Project: Tunnel Renovation, Bldg.1292, Fort Shafter, Oahu, Hawaii Activity Start Date: ___________________________ Date of Pre-Phase Meeting:______________________________________ Accepted by Govt. Rep.: ______________________________ (Signature)

Submitted by Contractor: _________________________________ (Signature)

__________Safety Officer______________ ____________________________________ (Title) (Title) (Date) Comments by Govt. Rep:____________________________________________________________________________________________ __________________________________________________________________________________________________________________ PHASE NO. ACTIVITY POTENTIAL HAZARDS PRECAUTIONARY ACTION & CONTROLS TO BE TAKEN Spec. Sec. 01 90 00 Mobilize on Site Set up Traffic & Pedestrian Controls Hit by automobiles Two person crew minimum, wear orange safety vests, stay alert to traffic; have flag person or use stop sign

Traffic congestion & accidents Strictly adhere to approved Traffic Control Plan diagrams Foreign Objects in Eyes and descriptions Foreign Objects in Eye Must wear safety glasses at all times while on jobsite Two person crew minimum, work out of back of truck, wear safety vests, stay alert

Place Traffic Barriers & Signs

Hit by automobiles

Barriers hit by on coming autos Two person crew minimum, work out of back of truck, wear safety vests or reflective clothing, stay alert EQUIPMENT TO BE USED Flashing Traffic Barriers & Approved Directional Signs Traffic confusion & accidents Use traffic barriers with flashing lights from safety INSPECTIONS REQUIREMENTS TRAINING REQUIREMENTS Daily, notify safety systems if any flashers are not working OJT/Surrounding environment awareness

POD Form 184-R (REV) 16 Oct 98

(Edition of 22 Apr 91 is obsolete)

(Sheet 1 of 2 Sheets)

ACTIVITY HAZARD ANALYSIS (Continuation) PHASE NO. ACTIVITY POTENTIAL HAZARDSHand pinch and cut injuries

PRECAUTIONARY ACTION & CONTROLS TO BE TAKENWear leather gloves and use both hands to lift and open barricades for placement when necessary

Eye Injury, Foot & Head Injury Sunburn

Must wear safety glasses, steel toe shoes, and hard hatat all times while on jobsite Wear Sunscreen on all exposed skin and face, Wear long pants and shirt with sleeves Make sure personnel stays hydrated Install temporary construction fence to enclose area of sidewalk work Stay within construction area Post signs stating construction area; hard hat area etc. Overhead lines will be flagged with (orange) marking ribbon. Upon completion DPW will be notified of where the circuit is located.

Temporary Control Fences

Dehydration Public Entry and tripping

Public Injury Temporary Electrical Power

Prevent Electrocution

All Potential Hazards

Assess work area prior to starting work on any task. Appropriate AHA's to be reviewed during Weekly Safety Meeting.

POD Form 184-R (Rev) 16 Oct 98

(Sheet 2 of 2 Sheets)

ACTIVITY HAZARD ANALYSISDate Submitted: August 18, 2010

Contract No.: Contract No.: W912CN-10-C-0044 Name of Project: Tunnel Renovation, Bldg.1292, Fort Shafter, Oahu, Hawaii Activity Start Date:______________________________________ Date of Pre-Phase Meeting:____________________________ Submitted by Contractor: _________________________________ Accepted by Govt. Rep.: ______________________________ (Signature) (Signature) __Safety Officer________________ (Title) _______________________________________ (Title) (Date)

Comments by Govt. Rep:____________________________________________________________________________________________ PHASE NO. Spec. Sec. 02 41 00 Tripping / falling General jobsite requires daily cleanup. Use proper ladder setup for correct working height. Height exceeds 6 feet must be fully harness and lanyard attached to anchor Must wear two banded dust mask whenever generating dust Use wet method, if possible Use half mask respirator when required. ACTIVITY Demolition POTENTIAL HAZARDS Foot and skin punctures PRECAUTIONARY ACTION & CONTROLS TO BE TAKEN Remove any protruding nails from debris

Inhalation of dust

Eye Injury, Foot & Head Injury Must wear safety glasses, steel toe shoes, and hard hat at all times while on jobsite EQUIPMENT TO BE USED Hand Tools Electric Saw PPE Wheel Barrow POD Form 184-R (REV) 16 Oct 98 INSPECTIONS REQUIREMENTS Daily Prior to each use Daily Daily (Edition of 22 Apr 91 is obsolete) TRAINING REQUIREMENTS OJT Tradesmen OJT OJT

ACTIVITY HAZARD ANALYSIS (Continuation) PHASE NO. ACTIVITY POTENTIAL HAZARDSDebris falling and Hitting people below

PRECAUTIONARY ACTION & CONTROLS TO BE TAKENImmediately pick up and bag all debris as it is created Tie trash bag down until ready to remove No throwing debris from different levels unless proper precautions are taken

Cuts

Wear leather gloves when handling debris

Loss of hearing

Use of ear plugs if noise exceeds DOD Noise exposure levels

All Potential Hazards

Appropriate AHA's to be reviewed during weekly safety meeting. Assess work area prior to starting work on any task.

POD Form 184-R (Rev) 16 Oct 98

(Sheet 2 of 2 Sheets)

ACTIVITY HAZARD ANALYSISDate Submitted: August 18, 2010

Contract No.: Contract No.: W912CN-10-C-0044 Name of Project: Tunnel Renovation, Bldg.1292, Fort Shafter, Oahu, Hawaii Activity Start Date:_______________________________________ Date of Pre-Phase Meeting:___________________________ Submitted by Contractor: _________________________________ Accepted by Govt. Rep.: ______________________________ (Signature) (Signature) ______Safety Officer_____________ (Title) _____________________________________ (Title) (Date)

Comments by Govt. Rep:____________________________________________________________________________________________ PHASE NO. ACTIVITY POTENTIAL HAZARDS PRECAUTIONARY ACTION & CONTROLS TO BE TAKEN Spec. Sec. 02 83 13.00 20 LEAD IN CONSTRUCTION Lead Paint Removal only by trained personnel from R&D Technology Following their approved Lead Plan and asbestos removal plan Remove any protruding nails form debris

Inhalation, Skin Exposure

Foot and skin punctures

Tripping / falling

General jobsite requires daily cleanup. Use proper ladder setup for correct working height. Height exceeds 6 feet must be fully harness and lanyard attached to anchor Must wear two banded dust mask whenever generating dust TRAINING REQUIREMENTS Tradesmen Tradesmen OJT

Inhalation of dust EQUIPMENT TO BE USED Hand Tools Respiratory PPE

INSPECTIONS REQUIREMENTS Daily Prior to each use Daily

POD Form 184-R (REV) 16 Oct 98

(Edition of 22 Apr 91 is obsolete)

ACTIVITY HAZARD ANALYSIS (Continuation) PHASE NO. ACTIVITY POTENTIAL HAZARDSEye Injury, Foot & Head Injury

PRECAUTIONARY ACTION & CONTROLS TO BE TAKENMust wear safety glasses, steel toe shoes, and hard hat at all times while on jobsite

Cuts

Wear leather gloves when handling debris

Debris falling and Hitting people below

Immediately pick up and bag all debris as it is created Tie trash bag down until ready to remove

All Potential Hazards

Appropriate AHA's to be reviewed during weekly safety meeting. Assess work area prior to starting work on any task.

POD Form 184-R (Rev) 16 Oct 98

(Sheet 2 of 2 Sheets)

ACTIVITY HAZARD ANALYSISDate Submitted: October 1, 2009

Contract No.: W9128A-09-C-0006 Name of Project: Restore Showers and Replace Water Heaters with Solar Heaters, Bldg. 520& 525, Fort Shafter, Oahu, Hawaii Activity Start Date:_______________________________________ Date of Pre-Phase Meeting:____________________________ Submitted by Contractor: _________________________________ (Signature) Accepted by Govt. Rep.: ______________________________ (Signature)

_______Safety Officer______________ ___________________________________ (Title) (Title) (Date) Comments by Govt. Rep:____________________________________________________________________________________________ PHASE NO. ACTIVITY POTENTIAL HAZARDS PRECAUTIONARY ACTION & CONTROLS TO BE TAKEN Spec. Sec. 13280A Asbestos Abatement Asbestos Dust exposure All workers must comply with approved asbestos Removal Plan Operation Requirements Must wear safety glasses, steel toe shoes, and hard hat at all times while on jobsite Use correct Lifting Procedures, 2 people if needed Wet Removal Methods to be used, Only R&D Personnel allowed in the containment area Use GFCI on all power tools Inspect power and extension cords.

Foot & Head Injury Back Injury Exposure to Public of LCP Shocks, Electrocution Falls

EQUIPMENT TO BE USED Hand Tools Respirators PPE Harness/Lanyard POD Form 184-R (REV) 16 Oct 98

Use proper ladder setup for correct working height. Height exceeds 6 feet must be fully harness and lanyard attached to anchor INSPECTIONS REQUIREMENTS TRAINING REQUIREMENTS Daily Tradesmen Prior to each use OJT; fitting Daily OJT Daily, Prior to each use Fall Protection Awareness (Edition of 22 Apr 91 is obsolete)

ACTIVITY HAZARD ANALYSIS (Continuation) PHASE NO. ACTIVITY POTENTIAL HAZARDSAll Potential Hazards

PRECAUTIONARY ACTION & CONTROLS TO BE TAKENAppropriate AHA's to be reviewed during weekly safety meeting. Assess work area prior to starting work on any task.

POD Form 184-R (Rev) 16 Oct 98

(Sheet 2 of 2 Sheets)

ACTIVITY HAZARD ANALYSISDate Submitted: August 18, 2010

Contract No.: W912CN-10-C-0044 Name of Project: Tunnel Renovation, Bldg.1292, Fort Shafter, Oahu, Hawaii Activity Start Date