Incident Risk Assessment Worksheet 1. Incident/Activity Name 2. Location Work Capacity Test

Identification of Hazards and 3. Name and Title of Analyst 4. Date Risk Assessment

6. Mitigation or Abatement Action 5. Pre-Mitigation (Engineering, Administrative, PPE, Avoidance, 7. Post-Mitigation Education, etc)

9. Hazard P r 10. o 11. 12. 13. Severity 14. 8. Hazard Severity b RAC Hazard Probability Code Code a bi lit y

Physical Overexertion  Provide prospe ctive particip ants informa tion about the test and describ e how to prepar e for it 6-8 weeks prior to WCT particip ation

 Applica nts comple te the approp riate Health Screen docum ents ie HSQ, or Medica l Standa rds Progra m exam prior to WCT particip ation.

 Brief WCT particip ants on admini stration , rules, and safety require ments prior to the test -- WCT Admini strator will answer questio ns concer ning the test.

 Make them underst and they are to quit and get help from one of the Test Admini strators on the course if they begin to feel ill during the test.

 Test Admini strators and Emerg ency Service s Person nel (EMT) monitor person nel for illness, injury, or duress during WCT.

 Test Admini strator is to termina te test if indicat ed by level of subject distres s.

 Provide prospe ctive particip ants official time for fitness training where policy permits .

 Schedu le tests when environ mental conditi ons are most favorab le.

 Have a person currentl y qualifie d as an EMT (advan ced life support and other EMS equipm ent) on site when testing is done.

Hazard P Mitigation or r Abatement Action

o (Engineering, Hazard Severity Severity b RAC Administrative, Hazard Probability RAC Code Code a PPE, Avoidance, bi Education, etc) lit y Physical Overexertion  Have unit Emerg ency Medica l Plan (ICS- 206) and make sure Test Admini strators , EMT’s, and local unit dispatc hers know how to activat e plan.

 Ensure particip ants do not exceed a walking pace as require d by WCT.

 Ensure test subject s are properl y hydrate d, and provide water to particip ants during WCT.

Strains and Sprains  Provide informa tion to prospe ctive subject s describ ing how to get into shape for the tests.

 Provide prospe ctive subject s official time for fitness training where policy permits .

 Brief subject s about the test just prior to beginni ng.

 Monitor subject s for indicati ons of distres s and termina te the test for them.  Ensure test subject s have comfort able footwe ar that provide s adequa te support and protecti on to feet and ankles.

 Give subject s time to adjust packs for comfort prior to beginni ng the test.

 Provide time prior to starting the test for subject s to warm up and stretch.

 Have subject s cool down and stretch after the test.

Heat Stress  Make sure Test Admini strators underst and the effects of exercisi ng in heat, ran recogni ze the sympto ms of heat stress, and how to treat it.

Hazard P Mitigation or r Abatement Action

o (Engineering, Hazard Severity Severity b RAC Administrative, Hazard Probability RAC Code Code a PPE, Avoidance, bi Education, etc) lit y Heat Stress  Where possibl e, schedu le tests for the most favorab le environ mental conditi ons. Use the Heat Stress chart, Fitness and Work Capaci ty, 2nd Edition, (p. 29). Avoid the "High" range.

 Inform prospe ctive test subject s on how to dress for the conditi ons and include the informa tion in the pre-test briefing .

 Make sure test subject s are aware of the need for acclima tization . Provide time for employ ees to becom e acclima tized if conditi ons of their employ ment permit.

 Test Admini strators include heat stress informa tion in the test briefing if approp riate.

 Provide water at key points along the test course if conditi ons dictate.

 Test Admini strators monitor all test subject s for signs of heat stress, termina te test if is stress is indicat ed, and are prepar ed to provide treatme nt needed .

Cold Temperature  Make & sure Adverse Weather Test Admini strators knows sympto ms of cold- related physica l effects and are prepar ed to treat them.

 Inform prospe ctive test subject s on how to dress for the conditi ons and include informa tion in the pre-test briefing .

 Locate an indoor facility suitabl e for testing if conditi ons warrant .

 Postpo ne testing if conditi ons warrant .

 Locate a suitabl e test surface . Consid er indoor facility, plowed airport, plowed road or other safe area.  Postpo ne testing if conditi ons warrant .

Hazard Mitigation or Hazard Severity RAC Abatement Action Hazard Probability Severity RAC P Code (Engineering, Code r Administrative, o PPE, Avoidance, b a bi Education, etc) lit y  Select test course without traffic.

 Arrang e for traffic control to elimina te traffic hazard.

Traffic  Make sure test subject s are briefed about traffic hazard and control s implem ented prior to the test.

Pack Rubbing,  Make Chafing, or Straining sure Subjects test subject s have practic ed with a pack and have becom e work harden ed to carry a pack.

 Recom mend upper body clothin g that protect s from pack rubbing .

 Makes sure subject s have an opportu nity prior to testing to adjust  and try out the pack.

 Termin ate testing for subject s struggli ng to carry the pack or maintai n a pace adequa te to comple te the test succes sfully.

 Permit subject s to use a self- provide d pack that meets the applica ble weight require ment.

Agency Administrators Signature and Date Preparers Signature and Date Proj Date Prepared Name of Preparer ect MEDICAL PLAN Na me

Transportation Ambulance Services

Add Paramedics Name Phone ress Yes No

Hospitals

Loc Travel Time Name atio Air Phone n Ground

Medical Emergency Procedures

Provide detailed Emergency Medical Procedure for project (Refer to instructions to complete) Instructions for Completion of Emergency Medical Procedures As appropriate the following information should be included in the emergency medical procedures for any staffed project or incident location. The plan must be reviewed and approved by the Agency Administrator.  Include timeframes (ETEs and ETAs) from and to specific locations  Include GPS coordinates for key locations such as remote camps, project areas, helispots, etc.  List all potential evacuation resources and/or equipment that could be used for medical emergency  Identify other resources and/or equipment (types, capabilities, availability) not assigned to Unit/Agency but possibly available if requested  Identify contingencies (alternate plan or procedure if the preferred option becomes unavailable or identified resources cannot perform the mission)  Identify specific concerns by location  Identify environmental influences or factors and resource status changes that might keep the preferred option from working  Use the Risk Assessment Worksheet to mitigate lengthy travel times to access Advanced Life Support  If the primary evacuation plan is to use aviation, then a secondary plan should be identified including time frames for patient extraction The emergency medical procedures must be communicated to all personnel assigned to the project.

RA and Emergency Medical Procedures Acknowledgment We, the undersigned work leader and crew members, acknowledge participation in the discussion of this RA and accompanying emergency medical procedures. We have thoroughly discussed and understand the provisions of each of these documents:

Date:

Signature Signature