AHA Template for Contractors - NCI at Frederick: NCI at ...
PROJECT/ACTIVITY INFORMATIONContractor Name: Activity:HAZARDS#JOB STEPHAZARDSACTIONS TO ELIMINATE OR MINIMIZEEACH HAZARD123456789101112PPEMINIMUM PPE REQUIRMENTS FOR ALL JOB STEPSSPECIAL PPE REQUIREMENTSIdentify steps requiring special PPE:EQUIPMENTTOOLS AND EQUIPMENTINSPECTION CRITERIAOSHA-RELATED TRAINING APPLICABLE TO THIS ACTIVITYPreparerName and signature of person who filled out this AHA:Date:By signing this AHA, the preparer is certifying that the information provided is true, and that any change in the conditions described in this AHA or inadequacies found for protecting employees during the activity may require a revision to this AHA. Acceptance by Leidos personnelName and signature of Project Administrator:Date:Name and signature of EHS POC:Date: ................
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