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SGT Layton, Luke DD - 2977 - Deliberate Risk Assesment Form

This document outlines safety procedures for a training on first aid for burns. It lists the name, rank, unit, and contact information for the participant. The training will include an instructor brief, hazards will be identified, and safety protocols will be followed. A risk assessment was conducted and approved for the training.

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Luke Layton
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180 views5 pages

SGT Layton, Luke DD - 2977 - Deliberate Risk Assesment Form

This document outlines safety procedures for a training on first aid for burns. It lists the name, rank, unit, and contact information for the participant. The training will include an instructor brief, hazards will be identified, and safety protocols will be followed. A risk assessment was conducted and approved for the training.

Uploaded by

Luke Layton
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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081-831-1007 (SL1) - Perform First Aid for Burns

081-831-1007 20200727

Burns

Layton, Luke, S. SPC E4 35P AE

A Co, 24th MI BN luke.s.layton.mil@mail.mil

W6TDAA 081-831-1007

Brief

Make SM aware
Tripping Hazards L L
of hazards
Instructor briefs
all attended

DD FORM 2977, SEP 2014 Page 1 of 5


DD FORM 2977, SEP 2014 Page 2 of 5
081-831-1007 (SL1) - Perform First Aid for Burns 20200727

Layton, Luke, S. SPC E4 35P AE

A Co, 24th MI BN luke.s.layton.mil@mail.mil

W6TDAA 081-831-1007

Take all direction


from AIs
Fire Evacuate in
L designated L
protocol All personnel

DD FORM 2977, SEP 2014 Page 3 of 5


Probability (expected frequency)

Frequent: Likely: Occasional: Seldom: Unlikely:


Continuous, Several or Sporadic or Infrequent Possible
Risk Assessment Matrix regular, or numerous intermittent occurrences occurrences
inevitable occurrences occurrences but improbable
occurrences

Severity (expected consequence) A B C D E

Catastrophic: Mission failure, unit readiness eliminated;


death, unacceptable loss or damage I EH EH H H M

Critical: Significantly degraded unit readiness or mission


capability; severe injury, illness, loss or damage II EH H H M L

Moderate: Somewhat degraded unit readiness or mission


capability; minor injury, illness, loss, or damage III H M M L L

Negligible: Little or no impact to unit readiness or mission


capability; minimal injury, loss, or damage IV M L L L L

Legend: EH - Extremely High Risk H - High Risk M - Medium Risk L - Low Risk

13. RISK ASSESSMENT REVIEW (Required when assessment applies to ongoing operations or activities)

a. Date b. Last Name c. Rank/Grade d. Duty Title/Position e. Signature of Reviewer

X
14. FEEDBACK AND LESSONS LEARNED

15. ADDITIONAL COMMENTS OR REMARKS

DD FORM 2977, SEP 2014 Page 4 of 5


Instructions for Completing DD Form 2977, "Deliberate Risk Assessment Worksheet"

1. Mission/Task Description: Briefly describe 11. Supervision Plan and Recommended


the overall Mission or Task for which the Course of Action: Completed by preparer.
deliberate risk assessment is being conducted. Identify specific tasks and levels of responsibility
for supervisory personnel and provide the
2. Date (DD/MM/YYY): Self Explanatory. decision authority with a recommend course of
action for approval or disapproval based upon the
3. Prepared By: Information provided by the overall risk assessment.
individual conducting the deliberate risk
assessment for the operation or training. Legend: 12. Approval/Disapproval of Mission/Task:
UIC = Unit Identification Code; CIN = Risk approval authority approves or disapproves
Course ID Number; OPORD = operation order; the mission or task based on the overall risk
DSN = defense switched network; COMM = assessment, including controls, residual risk level,
commercial and supervision plan.

4. Sub-task/Sub-Step of Mission/Task: Briefly 13. Risk Assessment Review: Should be


describe all subtasks or substeps that warrant risk conducted on a regular basis. Reviewers should
management. have sufficient oversight of the mission or activity
and controls to provide valid input on changes or
5. Hazard: Specify hazards related to the adjustments needed. If the residual risk rises
subtask in block 4. above the level already approved, operations
should cease until the appropriate approval
6. Initial Risk Level: Determine probability authority is contacted and approves continued
and severity. Using the risk assessment matrix operations.
(page 3), determine level of risk for each hazard
specified. probability, severity and associated 14. Feedback and Lessons Learned: Provide
Risk Level; enter level into column. specific input on the effectiveness of risk controls
and their contribution to mission success or
7. Control: Enter risk mitigation resources/ failure. Include recommendations for new or
controls identified to abate or reduce risk relevant revised controls, practicable solutions, or
to the hazard identified in block 5. alternate actions. Submit and brief valid lessons
learned as necessary to persons affected.
8. How to Implement / Who Will Implement:
Briefly describe the means of employment for 15. Additional Comments or Remarks:
each control (i.e., OPORD, briefing, rehearsal) Preparer or approval authority provides any
and the name of the individual unit or office that additional comments, remarks, or information to
has primary responsibility for control support the integration of risk management.
implementation.
Additional Guidance: Blocks 4-9 may be
9. Residual Risk Level: After controls are reproduced as necessary for processing of all
implemented, determine resulting probability, subtasks/ substeps of the mission/task. The
severity, and residual risk level. addition and subtraction buttons are designed to
enable users to accomplish this task.
10. Overall Risk After Controls are
Implemented: Assign an overall residual risk
level. This is equal to or greater than the highest
residual risk level (from block 9).

DD FORM 2977, SEP 2014 Page 5 of 5

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