Download Introduction to ORM Worksheet - University of Florida Navy ROTC

Risk Management Worksheet
1. Organization and Unit Location:
2. Page
1
University of Florida NROTC
3. Mission/Task:
4. Begin Date:
DDMMMYYYY
Navy Physical Training Program
5. End Date:
DDMMMYYYY
of
2
6. Date Prepared:
DDMMMYYYY
7. Operational Phase in which Mission/Task will be conducted:
Sustainment Phase/Swim
8. Tasks:
9. Identify Hazards:
Swimming
-Drowning
-Head Injury
-Fatigue
10. Initial
Risk
Level
M
M
M
11. Develop Controls:
12. Residual
Risk Level:
-Warm-up properly
-Tailor the workout to the abilities of
the individuals
-Have water and cups on hand
-Have designated nonparticipating
person observe the training and
watch for injured persons
-Use RSC lifeguards and safety
equipment
M
M
M
M
13. Implement Controls:
14. Who/How
Supervised:
-Ensure all equipment and
training is conducted IAW the
pre mishap safety plan dated 13
May 2005
-Ensure that the swim PT
officer understands his billet
and responsibilities
-Staff Swim PT
officer will be on
hand for interval
training workouts
M
15. Determine Overall Mission/Task Level After Countermeasures are Implemented:
(Check Highest Remaining Risk Level)
LOW(L)
16. Medical Support: On site Support Provided: Medic
17. Prepared By: (Rank, Last Name, Duty Position)
19. Risk Decision Authority
Combat Lifesaver
MODERATE(M)
HIGH(H)
EXTREMELY HIGH(E)
First Aid Responder
None
18. Reviewed by Action Officer Commander: (Rank, Last Name, Duty Position)
Extremely High Risk: N/A for NROTC Commands
High Risk:
Moderate Risk:
Low Risk:
Work Sheet Instructions
1-8. Self Explanatory.
9. Identify Hazards-Review risk factors for the mission or task. Additional
factors include historical lessons learned, experienced, judgment, equipment
characteristics, warnings, and environmental considerations.
10. Initial Risk Level-Assess hazard and determine initial risk for each hazard by
applying risk assessment matrix.
11. Develop Controls-Develop one or more controls for each hazard that will
either eliminate the hazard or reduce the risk.
12. Residual Risk Level-Determine the residual risk for each hazard by applying
the risk assessment matrix, assuming controls are implemented.
13. Implement Controls-Decide how each control will be put into effect or
communicated to the personnel who will make it happen.
14. Who/How supervised-Who and how will each control be monitored
(continuous, spot-checks)
15. Determine Overall Mission/Task Risks-Select the highest residual risk level
and check it. This becomes the overall mission risk level.
16. Medical Support-Select type of on site medical support provided.
17&18. Self Explanatory.
19. Risk Decision Authority- The decision to accept or not accept risk associated
with an action is made by the appropriate commander or leader responsible for
performing that action.
Hazards not adequately controlled are likely to cause loss. Answer the following questions
about each hazard to determine if it is adequately controlled. If not, hazards need to be risk
managed.
Are the Controls Adequate
Yes
No
Support-Is type/amount/capability/condition or support
adequate to carry out mission
-Personnel
-Supplies
-Equipment/Materials
-Services/Facilities
Standards-Is guidance/procedure adequately
clear/practical/specific to control hazard?
Training-Is training adequately thorough and recent to
control hazard?
Leader-Is leadership ready, willing, and able to enforce
standards required to control hazard?
Individual/Unit Self Discipline- Is performance and
conduct sufficiently self-disciplined to control hazard.
Risk Assessment Matrix
SEVERITY
Catastrophic
Critical
Marginal
Negligible
Frequently
E
E
H
M
PROBABILITY
Likely
Occasional
E
H
H
H
M
M
L
L
Seldom
H
M
L
L
Unlikely
M
L
L
L
PROBABILITY
FREQUENT-Occurs often
LIKELY-Occurs several times
OCCASIONAL-Occurs sporadically
SELDOM-Unlikely, but could occur at some time
UNLIKELY-Can assume it will not occur
SEVERITY
CATASTROPHIC-Death or permanent total disability, system loss, major damage,
significant property damage, or other mission-impairing factors
CRITICAL-Permanent partial disability, temporary total disability in excess of 3 months,
major system damage, significant property damage, significant mission degradation.
MARGINAL-Minor injury, lost workday, accident, minor system damage, minor
property damage, some mission degradation.
NEGLIGIBLE-First aid or minor medical treatment, minor system impairment, little/no
impact on mission accomplishment.