Hics 215a-Incident Action Plan Iap Safety Analysis
Hics 215a-Incident Action Plan Iap Safety Analysis
Hics 215a-Incident Action Plan Iap Safety Analysis
1. Incident Name
2. Operational Period (#
DATE:
TIME:
3. Hazard Mitigation
3a. Potential / Actual Hazards
4. Prepared by
Safety Officer
5. Approved by
Incident Commander
3c. Mitigations
SIGNATURE: _________________________________________________________________
DATE/TIME:
____________________________________________________________________
FACILITY: ____________________________________________________________________
PRINT
NAME: __________________________________________________________________
_________________________________________________________________
Purpose:
Operational risk assessment to prioritize hazards, safety, and health issues, and toSIGNATURE:
assign mitigation
actions
Origination: Safety Officer
Copies to:
Planning Section Chief for Incident Action Plan (IAP) and Documentation Unit Leader
DATE/TIME:
FACILITY: ____________________________________________________________________
____________________________________________________________________
The purpose of the HICS 215A - Incident Action Plan (IAP) Safety Analysis is to record the
findings of the Safety Officer after completing an operational risk assessment and to
identify and resolve hazard, safety, and health issues. When the safety analysis is completed, the
form is used to help prepare the Operations Briefing.
ORIGINATION:
Prepared by the Safety Officer during the IAP cycle. For those assignments involving risks
and hazards, mitigation actions should be developed to safeguard responders. Appropriate
incident personnel should be briefed on the hazards, mitigations, and related measures.
COPIES TO:
Duplicate and attach as part of the IAP. All completed original forms must be given to the
Documentation Unit Leader.
NOTES:
Issues identified in the HICS 215A should be reviewed and updated each operational period.
If additional pages are needed, use a blank HICS 215A and repaginate as needed.
Additions may be made to the form to meet the organizations needs.
NUMBER
TITLE
INSTRUCTIONS
Incident Name
Operational Period
Hazard Mitigation
3a. Potential / Actual
Hazards
3c. Mitigations
Prepared by
Safety Officer
Approved by
Incident Commander
HICS 2014