EM385-1-1 (30NOV14) UFGS 103526 11/15

Activity Hazard Analysis (AHA)

Activity/Work Task TEMPORARY TELECOMMUNICATIONS Overall Risk Assessment Code (RAC) L
AHA Signature Log # (Use highest code )
Risk Assessment Code (RAC) Matrix

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Project Location San Diego
Contract Number N62473-13-D-7436 Probability
Date Prepared March 7, 2018 Severity Frequent Likely Occasional Seldom Unlikely
SSHO Signature Catastrophic E E H H M

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Superintendent Signature Critical E H H M L
QC Manager Signature Marginal H M M L L
Subcontractor Foreman Name: Mark Johnson Negligible M L L L L
Step 1: Review each Hazard with identified safety

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Signature:
QA Reviewed by (Name/Title) James Smith / SSHO "Controls". Determine RAC (see above). RAC CHART
Notes: (Field Notes, Review Comments, etc) Probability: Likelihood the activity will cause a
Mishap (Near Miss, Incident, or Accident).
Identify as Frequent, Likely, Occasional, Seldom E = Extremely High Risk
or Unlikely

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Severity: The outcome if a mishap occurred.
Identify as Catastrophic, Critical, Marginal, or H = High Risk
Negligible
Step 2: Identify the RAC (probability vs. severity)
as E, H, M, or L for each "Hazard" on AHA. M = Moderate Risk

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Annotate the overall highest RAC at the top of
the AHA L = Low Risk

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Job Steps (Work Sequences) Specific Anticipated Hazards Controls RAC
- Use this Activity Hazard Analysis and other
formal and informal training as a means to train
workers.
Employees not trained in the safe execution of their
Site-specific/Job-specific training for workers NOTE: If the scope of work detailed below L
tasks may harm themselves or others
changes in any way, contact the Safety
Department and complete an AHA amendment
detailing the new scope of work.
- Workers entering the job site must wear a hard
hat, safety glasses, Class II reflective vest and
safety-toed work boots AT ALL TIMES.
Head, foot, or eye injury - Wear gloves when handling sharp objects.
Put on your personal protective equipment. Personnel being struck by equipment/trucks - Do not wear clothing or jewelry that could L
Hearing damage easily get snagged or caught by equipment or
machinery.

EM 385-1-1, Sect. 5.A, 5.B, 5.C, 5.D, 5.E, 5.F

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.
 Job Steps (Work Sequences) Specific Anticipated Hazards Controls RAC
- When moving material, keep hands and feet
clear of pinch points. Stack material on stickers.
- Store material in such a manner that it will not
be blown or knocked over.
Crushing or pinching hands or feet - Stay clear of moving machinery, heed backup
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Receive deliveries and store material Excessive material handling alarms and get out of the way.
Strains and Sprains - Stage material as close to its final destination as
possible.
- Use safe lifting techniques.

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EM 385-1-1, Sect. 14.A
- Do not use electrical cords with cuts, worn
insulation, or visible conductors.
- Use cords rated for hard or extra-hard usage.
- Use factory-assembled cord sets as much as

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possible. Repairs must preserve the original
electrical and mechanical integrity of the cord.
- Electrical tape fixes are prohibited and
Electrical Shock
Check electrical cords (portable flexible cords) replacement plugs must be properly sized and L
Electrocution/Death
provided with strain relief clamps.
- Check that the ground prong is in tact.

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- GFCI protection shall be provided on all circuits
serving portable electric hand tools. Use only
GFCI protected circuits.

EM 385-1-1, Sect. 11.D.05, 11.A.06

- Remove defective tools from the job site.

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- Wooden handles for tools are secured tightly in
the tool and free of cracks and splinters.
- All saws are equipped with properly
functioning manufacture installed guards.
- Hand held power tools (saws, drills, grinders)

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are equipped only with a constant pressure
switch.
Injury due to defective or improperly functioning
- Pneumatic nailers have a functioning safety
power tools
device on the muzzle to prevent ejection unless
Inspect tools Electric shock from defective tools. L
muzzle in contact with work surface.
Impact injuries, splinters
- Only use tools for their intended use.
Impact injuries from spinning tool
- GFCI protection shall be provided on all circuits
serving portable electric hand tools. Use only
GFCI protected outlets.
- Tag defective tools and remove them from the
workplace.

EM 385-1-1, Sect. 11.D.05, 13.A, 13.B, 13.C, 13.D,

13.H

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.
 Job Steps (Work Sequences) Specific Anticipated Hazards Controls RAC
- Use only approved metal safety cans to store
and dispense fuel.
- Place oily or fuel soaked rags and other
Re-fuel gas powered tools Fires, explosions, burns combustibles in approved containers. L
- DO NOT SMOKE WHILE REFUELING.

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EM 385-1-1, Sect. 9.B, 26.D
- Never use compressed air to blow dirt from
hands, face, or clothing and pressure should not
exceed 30 psi.

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Airway irritation, silicosis - DO NOT HORSEPLAY WITH COMPRESSED AIR.
Cleaning surfaces with compressed air Injection of foreign material into the body through - Wear a dust mask and goggles in addition to L
the skin the standard PPE when cleaning with
compressed air.

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EM 385-1-1, Sect. 20.B.05
- Before beginning each phase of work the
foreman will explain to the workers what needs
to be done and how the work will proceed.
- All rebar which is below the level where work is
Lack of coordination between workers- Mistakes,
Layout, communication, and preparatory instructions ongoing onto which workers could fall must be L
Injuries
protected with square type rebar caps.

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- Be aware of your surroundings while moving
materials, watch where you are going.
- Never move materials over or above workers.
- Team lift heavy or awkward materials.
- Use safe lifting techniques.

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- Use material handling aids whenever possible.
- Be aware of your surroundings and watch
where you are going while carrying material.
- Never move materials above coworkers.
- When receiving/stocking material through a

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wall or floor opening, do not stand in front or
Strains from lifting
above the opening where you could fall.
Moving material Striking and injuring co-workers with materials L
- (See training and inspection requirements for
Crushed by
reach-lifts below.)
- When stocking material above ground level up
to 35-feet , a reach-lift will place the pallet as
close to the material's final destination as
possible, then hand stocking will occur.

EM 385-1-1, Sect. 14.A See Activity Hazard

Analysis on forklift operation

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.
 Job Steps (Work Sequences) Specific Anticipated Hazards Controls RAC
- Keep corridors and high traffic areas free of
cords, hoses, & other equipment.
- Completely unroll all hoses and cords, avoid
tangles.
- Arrange hoses and cords in an orderly fashion.

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- Clean up scrap materials and debris before and
Roll out tools and set up equipment Tripping - Hoses, Cords, Compressor after working in an area. L
- Maintain Good housekeeping.
- All trash and debris shall be put in appropriate
locations.

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- Do not leave tools and materials laying around
on the ground.
EM385-1-1, Sect. 14.C
- Assure that there is good communication
between workers and the lift operator.

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- Never walk under a raised load.
Unexpected movements - Use a tag line on all loads to help stabilize the
Materials striking and injuring workers load and maneuver it into position.
Hoist and Set Material/Components (Forklift) L
Crushed by falling material
Swinging loads striking and injuring workers EM 385-1-1, Sect. 13.D, 14.A, 21.A, B, C, H, 27.A, B,
C

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See Activity Hazard Analysis on Forklift Operation
- Ensure that a portable an ABC rated fire
extinguisher is always within 100 ft. of your
working area.
- Know how to operate the fire extinguisher.

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- Always heed “No Smoking or Open Flame”
warning signs. Remove combustible scrap and
Working with combustible materials Fires and explosions- burns debris from work areas daily. L
- Store combustibles in approved
locations/containers.

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- Use approved metal safety cans used for
handling and use of flammable liquids.

EM385-1-1, Sect. 6.A, 6.B, 9.A, 9.B

- Never enter a confined space such as man-
holes, vats, silos, vaults, tunnels, duct work, etc.
This hazard analysis does not cover painting in
Working in Confined Spaces Asphyxiation or carbon monoxide poisoning Confined Spaces. L
- Always heed warning signs for confined spaces.

EM 385-1-1, Sect. 34

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.
 Job Steps (Work Sequences) Specific Anticipated Hazards Controls RAC
- Wear personal protective gear including eye,
ear, and hand protection.
- Proper warning signs are required to be posted.
- Never use a powder actuated tool unless you
have been trained and certified the specific tool

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(brand/model) & its use.
Using Explosive-Actuated tools Injuries to eyes, hands and wrists, or ears L
- Hold the tool firmly (bend elbow slightly), and
perpendicular to the work surface.
- In the event of "mis-fire" hold in place for 30
seconds before removal.

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EM 385--1-1, Sect. 5.A, 5.B, 5.C, 5.D, 5.E, 5.F, 13.E
- Keep fingers at least 8 inches from the blade
- Cut short pieces from long stock and hold the
long end of the piece.

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- Don't try to cut too quickly
- Make sure the piece you are cutting is properly
supported and secured.
Cuts and scrapes
Cut uni-strut and/or conduit - Watch where you are throwing your sparks. Do L
Sharp edges, burrs
not cut where sparks will land on other workers
or on combustible materials

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- Wear safety glasses with side shields or goggles,
and foam ear plugs.

EM 385--1-1, Sect. 5.A, 5.B, 5.C, 5.D, 5.E, 5.F, 13.A

- Make sure you always have an adequate supply
of cold water available. If your water supply is

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running low talk to your supervisor.
- Take scheduled cool down breaks.
- Provide ventilation or air cooling equipment for
enclosed work areas.
- Use sunscreen.

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- Respond quickly and decisively in case of an
Working in hot weather Heat Stroke, Heat Exhaustion, Heat Cramps Sunburn L
accident. Call 911 immediately.
- Know where the emergency numbers are
posted, where the first aid kit is, and who is
trained in first aid.
- Only persons trained in first aid should be
allowed to administer first aid.

EM 385-1-1, Sect. 6.I

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.
 Job Steps (Work Sequences) Specific Anticipated Hazards Controls RAC
- Store equipment out of the way. Roll up hoses
and cords at end of day.
- Clean up work area at the end of each shift.
Stack materials in designated lay down areas.
- Never throw or drop scrap and debris to a lower
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Roll up Equipment & Clean-up Slipping, Tripping, or falling, and Delayed Egress level unless that drop area has been
cautioned/barricaded off to prevent workers from
entering the area.
- Place combustibles in approved containers.

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EM 385-1-1, Sect. 2.B
- Wear a dust mask or respirator when sweeping.
Sweep floor Dust inhalation L
EM 385-1-1, Sect. 5.G
- Respond quickly and decisively in case of an

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accident. Call 911 immediately
- Know where the emergency numbers are
posted, where the first aid kit is, and who is
Delayed emergency response- further injury or loss
Responding to an emergency trained in first aid L
of life
- Only persons trained in first aid should be
allowed to administer first aid

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EM 385-1-1, Sect. 3.A, 3.B
- Use appropriate PPE when administering first
aid such as gloves, masks, eye protection and/or
resuscitation equipment especially when blood is
present

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- Wash after contact with blood or other body
Administering First Aid Exposure to blood-borne pathogens L
fluids
- Dispose of soiled material in a labeled leak-
proof container

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EM 385-1-1, Sect. 3.A, 3.B, 3.D

Training Requirements & Competent or

Equipment to be Used Inspection Requirements
Qualified Personnel Names
- Conduct Daily Inspection prior to Use
Forklift Operator Training and Certification/License
- including Back-up Alarm and Maintenance Records.
Forklift Review of Manufacturer's Operating Manual
- Operators Manual shall be on ALL equipment.
Activity Hazard Analysis Review
- Forklift will be equipped with Fire Extinguisher.
- Inspected daily PRIOR TO LOADING for proper function, broken
Only Qualified Operators possessing a Qualified
parts, etc. Any equipment found defective will be tagged, taken out
Explosive-Actuated Tools Operators Card can use an explosive-actuated
of service and replaced immediately. Explosive-actuated tools must
device.
be inspected, thoroughly cleaned, and tested after 1,000 rounds.
- Inspected daily for broken parts, damaged cords etc. Any
Trained by site supervisor and authorized to use
Power Tools equipment found defective will be tagged, taken out of service and
power tools.
replaced immediately.

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.
 Training Requirements & Competent or
Equipment to be Used Inspection Requirements
Qualified Personnel Names
- Inspected daily for broken parts, loose handles or components etc.
Hand Tools Trained by site supervisor before use. Any equipment found defective will be tagged, taken out of service
and replaced immediately.
- Activity Hazard Analysis Review for each worker.
Valid Driver's License Required. Valid Insurance
- Vehicle must be properly maintained and in good working order.

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Field/Work Truck Certificate Required. Review Owner's Manual.
- Owner's Manual must be with vehicle.
Activity Hazard Analysis Review for each worker.
- Inspect daily prior to each shift.
All workers will be trained in the proper donning - Inspect ALL PPE prior to each use. Any damaged PPE will be
Personal Protective Equipment (PPE)
and use of PPE before beginning work. replaced immediately.

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A MINIMUM of 2 individuals trained in CPR/First - First Aid Kits will be inspected weekly for damage and/or missing
First Aid Kits Aid will be on-site and available to render aid at all items which shall be replaced immediately.
times.

Competent Person Signature

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S A
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.
Activity/Work Task: TEMPORARY TELECOMMUNICATIONS
Contract Name: MARKETING SAMPLE

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Contract Number: N62473-13-D-7436

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Competent Persons
Name: Signature: Date:

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Meeting Attendees
Name: Signature: Date: Name: Signature: Date: