Incident Action Plan Safety Analysis (Page 2 of 2) in pdf

Incident Action Plan Safety Analysis Page 2

INCIDENT ACTION PLAN SAFETY ANALYSIS (ICS FORM 215A-OS)

Purpose. This form communicates to the the Operations and Planning Section Chiefs safety and health issues

identified by the Safety Officer. The Worksheet is used by the Planning section Chief to complete Operations

briefings.

Preparation. This form is principally crafted by the Safety Officer.

Use additional sheets, as needed.

Distribution. When the safety analysis is completed, the form is distributed to the Planning Section Chief to

help prepare Operations briefing packages. All completed original forms MUST be given to the Documentation

Unit.

Item #

Item Title

Instructions

Incident Name

Enter the name assigned to the incident.

Operational Period

Enter the time interval for which the form applies. Record the start

and end date and time.

Date

Enter date (MMDDYYYY) prepared.

Time

Enter time prepared (24-hour clock).

Division/Group

Enter Division/Group indentifiers.

Blank Risk Header

Enter appropriate title for risk.

Blank Risk

Enter appropriate information for risk mitigation.

Mitigation Header

Blank Risk Cells

Enter an X to indicate a risk type of concern in a division/group.

Blank Risk

Enter an X to indicate mitigation for risk to division/group.

Mitigation Cells

Prepared By

Enter name and title of the person preparing the form.

Incident Action Plan Safety Analysis Page 2