Incident Action Plan Safety Analysis Form (Ics 215a) Page 2
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2ICS 215A
Incident Action Plan Safety Analysis
Purpose. The purpose of the Incident Action Plan Safety Analysis (ICS 215A) is to aid the Safety Officer in completing
an operational risk assessment to prioritize hazards, safety, and health issues, and to develop appropriate controls.
This worksheet addresses communications challenges between planning and operations, and is best utilized in the
planning phase and for Operations Section briefings.
Preparation. The ICS 215A is typically prepared by the Safety Officer during the incident action planning cycle. When
the Operations Section Chief is preparing for the tactics meeting, the Safety Officer collaborates with the Operations
Section Chief to complete the Incident Action Plan Safety Analysis. This worksheet is closely linked to the Operational
Planning Worksheet (ICS 215). Incident areas or regions are listed along with associated hazards and risks. For those
assignments involving risks and hazards, mitigations or controls should be developed to safeguard responders, and
appropriate incident personnel should be briefed on the hazards, mitigations, and related measures. Use additional
sheets as needed.
Distribution. When the safety analysis is completed, the form is distributed to the Resources Unit to help prepare the
Operations Section briefing. All completed original forms must be given to the Documentation Unit.
Notes:
• This worksheet can be made into a wall mount, and can be part of the IAP.
• If additional pages are needed, use a blank ICS 215A and repaginate as needed.
Block
Block Title
Instructions
Number
1
Incident Name
Enter the name assigned to the incident.
2
Incident Number
Enter the number assigned to the incident.
3
Date/Time Prepared
Enter date (month/day/year) and time (using the 24-hour clock)
prepared.
4
Operational Period
Enter the start date (month/day/year) and time (24-hour clock) and end
• Date and Time From
date and time for the operational period to which the form applies.
• Date and Time To
5
Incident Area
Enter the incident areas where personnel or resources are likely to
encounter risks. This may be specified as a Branch, Division, or
Group.
Hazards/Risks
List the types of hazards and/or risks likely to be encountered by
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personnel or resources at the incident area relevant to the work
assignment.
7
Mitigations
List actions taken to reduce risk for each hazard indicated (e.g.,
specify personal protective equipment or use of a buddy system or
escape routes).
8
Prepared by (Safety Officer and
Enter the name of both the Safety Officer and the Operations Section
Operations Section Chief)
Chief, who should collaborate on form preparation. Enter date
• Name
(month/day/year) and time (24-hour clock) reviewed.
• Signature
• Date/Time
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