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Incident/Event Safety, Risk and Health Analysis ICS 215-A: From (Date and Time) : To (Date and Time)

The ICS 215A aids the Safety Officer in conducting an operational risk assessment during incident planning. It is used to identify potential hazards, assess risks, and develop controls. The form includes sections to document the incident name, operational period, organizational divisions, potential hazards and threats, mitigating measures, and signatures of the Safety Officer and Operations Section Chief.

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PELIGRO RAMIE
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2K views2 pages

Incident/Event Safety, Risk and Health Analysis ICS 215-A: From (Date and Time) : To (Date and Time)

The ICS 215A aids the Safety Officer in conducting an operational risk assessment during incident planning. It is used to identify potential hazards, assess risks, and develop controls. The form includes sections to document the incident name, operational period, organizational divisions, potential hazards and threats, mitigating measures, and signatures of the Safety Officer and Operations Section Chief.

Uploaded by

PELIGRO RAMIE
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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April 29, 2018

INCIDENT/EVENT SAFETY, RISK AND HEALTH ANALYSIS


ICS 215-A
1. INCIDENT/EVENT NAME 2. OPERATIONAL PERIOD
From (Date and Time):
To (Date and Time):

4. POTENTIAL HAZARDS/ THREATS

3. DIVISION/ GROUP /
OTHERS

(Check box if the hazard applies)

Use additional sheets as necessary


6. Prepared by SOFR Name and Signature: Date Prepared: Time Prepared:

7. Prepared by OSC Name and Signature: Date Prepared: Time Prepared:

ICS 215A: INCIDENT/EVENT ACTION PLAN SAFETY, RISK AND HEALTH ANALYSIS
April 29, 2018
PURPOSE: The ICS 215A aids the Safety Officer (SOFR) in completing an operational risk assessment to prioritize hazards, safety and health
issues, and to develop appropriate controls.

PREPARATION: The ICS 215A is typically prepared by the SOFR during the incident action planning cycle. When the Operations Section Chief
(OSC) is preparing for the tactics meeting, the SOFR collaborates with the OSC to complete the ICS 215A. This worksheet is closely linked to
the ICS 215.

DISTRIBUTION: When ICS 215A 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.

HOW TO FILL-UP THE FORM:

BLOCK NO. BLOCK TITLE INSTRUCTIONS


1 Incident Name Enter the name assigned to the incident/event
2 Operational Period Enter the start date (month-dd-yyyy) and time (24 hour format) and end date and time for the
operational period to which the form applies.
3 Division / Group / Enter the Division, Group, or others that were organized based on ICS 215.
Others
4 Potential Hazards/ List the hazards or threats likely to be encountered by the personnel at the incident/event area
Threats relevant to the work assignment. Should the hazard or threat apply to the Branch, Division or Group,
put a check mark under the corresponding block.
5 Mitigating Measures List the actions to be taken to reduce the risk for the hazard or threat indicated.
6 Prepared by SOFR Enter complete name of the SOFR, signature, date (month-dd-yyyy), and time (24 hour format) the
form was prepared and completed.
7 Prepared by OSC Enter complete name of the OSC, signature, date (month-dd-yyyy), and time (24 hour format) the form
was prepared and completed.

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