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DD Form 2977, Deliberate Risk Assessment Worksheet, January 2014

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DELIBERATE RISK ASSESSMENT WORKSHEET
1. MISSION/TASK DESCRIPTION
2. DATE (DD/MM/YYYY)
HEAT / MRAP Egress Training Device
3. PREPARED BY
a. Name (Last, First, Middle Initial)
b. Rank/Grade
c. Duty Title/Position
f. Telephone (DSN/Commercial (Include Area Code))
d. Unit
e. Work Email
g. UIC/CIN (as required)
h. Training Support/Lesson Plan or OPORD (as required) i. Signature of Preparer
Five steps of Risk Management: (1) Identify the hazards
(2) Assess the hazards
(4) Implement controls
4. SUBTASK/SUBSTEP
OF MISSION/TASK
(5) Supervise and evaluate
6. INITIAL
RISK
LEVEL
5. HAZARD
Mounting or
dismounting of Egress
Training device
Slip, trip and falls during
entry/exit procedures
Rotation of trainer
Head/Neck injuries resulting from
unsecured personnel and
equipment.
(3) Develop controls & make decisions
(Step numbers not equal to numbered items on form)
H
H
9. RESIDUAL
8. HOW TO IMPLEMENT/
WHO WILL IMPLEMENT
7. CONTROL
1. All personnel will maintain 3
points of contact at all times.
2. All personnel will maintain
situational awareness.
How:
1. All training will be conducted
under the direct observation of a
trained safety.
2. All participants will wear PPE
How:
RISK LEVEL
Everyone will receive instructions
L
Who:
Egress Training Instructors
Certify safeties on SOPs
M
Who:
Site PM certifies all safeties
3.All occupants will remain belted How:
in seats until safeties instruct them Safety brief & PMCS
that it is safe to unfasten.4. Interior Who:
of vehicle trainer is padded
Safeties
5. No unsecured items are allowed How:
PMCS & NCOIC approve form
in trainer 6. All individuals must
complete a medical fitness
Who:
questionnaire prior to participation. Safeties and OIC
7. All individuals will understand
actions required during a vehicle
rollover.
How:
Classroom Instruction
Who:
Instructors & Senior Occupant
Additional entries for items 5 through 9 are provided on page 2.
10. OVERALL RESIDUAL RISK LEVEL (All controls implemented):
EXTREMELY HIGH
HIGH
MEDIUM
LOW
11. OVERALL SUPERVISION PLAN AND RECOMMENDED COURSE OF ACTION
12. APPROVAL OR DISAPPROVAL OF MISSION OR TASK
a. Name (Last, First, Middle Initial )
b. Rank/Grade
APPROVE
c. Duty Title/Position
DISAPPROVE
d. Signature of Approval Authority
e. Additional Guidance:
DD FORM 2977, JAN 2014
Page 1 of ____
3 Pages
Adobe Professional X
DELIBERATE RISK ASSESSMENT WORKSHEET
4. SUBTASK/SUBSTEP
OF MISSION/TASK
Rotation of trainer
5. HAZARD
Personal injuries resulting from
pinch point and loose doors/
hatches
Personnel being struck by loose
objects
6. INITIAL
RISK
LEVEL
H
M
7. CONTROL
8. HOW TO IMPLEMENT/
WHO WILL IMPLEMENT
1. Communication hazards to
occupants before and during
training. 2. Maintain constant
situational awareness
How:
3. Keep body parts away from
moving parts and hazardous
components.4. Ensure all doors and
hatches are secured while moving
How:
1.Restrict items that are allowed in
trainer. 2. Ensure all
personnel/objects are properly
secured prior to operation.
How:
9. RESIDUAL
RISK LEVEL
Certify Safeties & Training
Who:
M
Leaders & Safeties
Safeties on Control Panel & sides
Who:
Safeties
Only foam TNG aids & Breifs
Who:
L
Egress instructors & Safeties
3. All personnel are belted in during How:
operation
Incorporate into Breif
Who:
Leadership
Heat and Cold weather injuries
M
1. Ensure all personnel are aware of How:
how to detect and prevent heat and Incorporate into safety brief
cold injuries. 2. Ensure all
Who:
personnel have appropriate gear.
Egress Instructors
3. Limit exposure time whenever
possible.
L
How:
Identify staging areas
Who:
Safeties and Instructors
Injuries to operator resulting from
moving parts.
H
1. Establish a 6' exclusion zone
during OPN. 2. Identify hazardous
parts/areas. 3. Identify location of
emergency stop buttons.
How:
4. Teach operator how to safely
operate equip.
How:
Hazardous areas marked/ Briefs
M
Who:
Safeties
Safeties trained and certified
Who:
Ejection of gunner during rollover
drill.
Injuries resulting from 90 degrees
gunners hatch exit (falls)
H
H
PM representative
1. Will remain in harness until told How:
to release. 2. Occupants secure
Instructions from Safety/ Briefs
gunner during rollover and pull into Who:
vehicle once it exceeds 30 degrees. Egress instructors and Safeties
3. All occupants will communicate
hazards and fully understand roles
and responsibilities during rollover
drills.
How:
1. Training on all 4 egress battle
drills, to include order of exit.
2. Ensure personnel are aware of 3'
drop.
How:
3. Exiting personnel will push open
with their legs and back to the
hatch. 4. External assistance while
exiting vehicle.
How:
Practice before operation
Who:
M
M
Egress instructors and Safeties
Taught during class/ Briefs
M
Who:
Egress instructors and Safeties
Safety Brief/ safeties help
Who:
Egress instructors and Safeties
How:
5. Situational awareness of all
personnel involved in training at all Train Safeties
times.
Who:
Egress instructors and Safeties
How:
Who:
DD FORM 2977, JAN 2014
2 of ____
3 Pages
Page ____
DELIBERATE RISK ASSESSMENT WORKSHEET
Probability (expected frequency)
Frequent:
Risk Assessment Matrix
Continuous,
regular, or
inevitable
occurrences
Severity (expected consequence)
Catastrophic: Death, unacceptable
loss or damage, mission failure,
or unit readiness eliminated
Critical: Severe injury, illness, loss,
or damage; significantly degraded
unit readiness or mission capability
Moderate: Minor injury, illness, loss,
or damage; somewhat degraded
unit readiness or mission capability
Negligible: Minimal injury, loss,
or damage; little or no impact to
unit readiness or mission capability
Legend:
EH – extremely high risk
Likely:
Occasional:
Seldom:
Several or
numerous
occurrences
Sporadic or
intermittent
occurrences
Infrequent
occurrences
Unlikely:
Possible
occurrences but
improbable
A
B
C
D
E
I
EH
EH
H
H
M
II
EH
H
H
M
L
III
H
M
M
L
L
IV
M
L
L
L
L
H – high risk
M – medium risk
L – low risk
13. RISK ASSESSMENT REVIEW 5HTXLUHGZKHQDVVHVVPHQWDSSOLHVWRRQJRLQJRSHUDWLRQVRUDFWLYLWLHV
a. Date
b. Last Name
c. Rank/Grade
d. Duty Title/Position
e. Signature of Reviewer
14. FEEDBACK AND LESSONS LEARNED
15. ADDITIONAL COMMENTS OR REMARKS
DD FORM 2977, JAN 2014
3 of ____
3 Pages
Page ____
Instructions for Completing DD Form 2977, "Deliberate Risk Assessment Worksheet"
1. Mission/Task Description: Briefly describe the overall
10. Overall Risk After Controls are Implemented: Assign
Mission or Task for which the deliberate risk assessment
an overall residual risk level. This is the highest residual
is being conducted.
risk level (from block 9).
2. Date ''00<<<<: Self Explanatory.
3. Prepared By: Information provided by the individual
conducting the deliberate risk assessment for the operation
or training .
Legend: UIC = Unit Identification Code; CIN = Course ID
Number; OPORD = operation order; DSN = defense
switched network; COMM = commercial
11. Supervision Plan and Recommended Course of Action:
Completed by preparer. Identify specific tasks and levels
of responsibility for supervisory personnel and provide the
decision authority with a recommend course of action for
approval or disapproval based upon the overall risk
assessment.
12. Approval/Disapproval of Mission/Task: Risk approval
authority approves or disapproves the mission or task based
on the overall risk assessment, including controls, residual
4. Sub-task/Sub-Step of Mission/Task: Briefly describe all
subtasks or substeps that warrant risk management.
risk level, and supervision plan. Space provided for authority to
provide additional guidance; use continuation page if needed.
13. Risk Assessment Review: Should be conducted on a
5. Hazard: Specify hazards related to the subtask in block 4.
regular basis. Reviewers should have sufficient oversight of
the mission or activity and controls to provide valid input on
changes or adjustments needed. If the residual risk rises
6. Initial Risk Level: Determine probability and severity.
Using the risk assessment matrix (page 3), determine level
of risk for each hazard specified. probability, severity and
associated Risk Level; enter level into column.
above the level already approved, operations should cease
until the appropriate approval authority is contacted and
approves continued operations.
14. Feedback and Lessons Learned: Provide specific input
on the effectiveness of risk controls and their contribution to
7. Control: Enter risk mitigation resources/controls identified
to abate or reduce risk relevant to the hazard identified in
block 5.
mission success or failure. Include recommendations for
new or revised controls, practicable solutions, or alternate
actions. Submit and brief valid lessons learned as necessary
to persons affected.
8. How to Implement / Who Will Implement: Briefly
15. Additional Comments or Remarks: Preparer provides
describe the means of employment for each control
additional comments, remarks, or information to support
(i.e., OPORD, briefing, rehearsal) and the name of the
the risk assessment. If block 15 is used as a continuation
individual unit or office that has primary responsibility for
of block 14, strike through the block number and title.
control implementation.
Additional Guidance: Block 4-9 continuance page may be
9. Residual Risk Level: After controls are implemented,
determine resulting probability, severity, and residual risk
level.
DD FORM 2977 INSTRUCTIONS, JAN 2014
reproduced as necessary for processing of all subtasks/
substeps of the mission/task. If a complete page is not utilized,
write “NOTHING FOLLOWS” on the first unused row,
immediately after the final item assessed.
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