Activity Hazard Analysis Template
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1ACTIVITY HAZARDS ANALYSIS
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Overall Risk Assessment Code (RAC)
(Use highest code)
Date:
Project:
Risk Assessment Code Matrix
E = Extremely High Risk
Probability
Activity:
H = High Risk
M = Moderate Risk
Frequent
Likely
Occasional
Seldom
Unlikely
L = Low Risk
Activity Location:
E
E
H
H
M
Catastrophic
S
e
v
E
H
H
M
L
Critical
Prepared By:
e
r
H
M
M
L
L
Marginal
i
t
M
L
L
L
L
y
Negligible
Add Identified Hazards
JOB STEPS
HAZARDS
ACTIONS TO ELIMINATE OR MINIMIZE HAZARDS
RAC
X
X
X
Add Items
EQUIPMENT
TRAINING
INSPECTION
X
X
X
Involved Personnel:
Acceptance Authority (digital signature):
NCTD Work Plan Form July 2015
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Parent category: Business