ABIA - Safety Risk Management Decision Report (SRMDR)

Enhancing our Safety Culture through Safety Management System Processing 

1. Report Date: 

2. Current System, Procedure, or Activity: 

3. Proposed Change: 

4. Project, Re-configuration, Operation, Equipment, Task or Activity: 

5. Hazard Identification (real or perceived): 

6. Risk Analysis: 

6.1. Trigger mechanisms - 

6.2. Existing controls - 

7. Human Factors: 

8. Risk Assessment: 

8.1. Severity - 

8.2. Likelihood ‐ 

9. Mitigation and/or Treatment of Risks: 

10. Communications and Training Requirements: 

11. Monitoring and Tracking Responsibility: 

12. Safety Risk Management Decision Report Approval 

_____________________________ _______________ 

ABIA SMS Coordinator Approval Date 

Is Director Level Approval Required? Y / N

________________________________ _________________ 

ABIA Director___________________ Approval Date 
ABIA - Safety Risk Management Decision Report (SRMDR)

Enhancing our Safety Culture through Safety Management System Processing 

Appendix 

• Preliminary Hazard List Worksheet 

• Predictive Risk Matrix 

• Preliminary Hazard Analysis Worksheet 

• Airport Diagram 

• Airport Aerial – Overall 

• Airport Aerials – Sections
ABIA - Safety Risk Management Decision Report (SRMDR)

Enhancing our Safety Culture through Safety Management System Processing 

SRMDR Supplemental Hazard Analysis Worksheet 

(To be completed for each identified hazard)

Date: 

Hazard Tracking Number: Hazard Element Number:

Hazard Description: 

Cause of Hazard: 

System State: 

Possible Effect: 

Existing Controls or Requirements: 

Severity: 

Severity Rational: 

Likelihood: 

Likelihood Rational: 

Current/Initial Risk: 

Recommended Mitigation: 

Predicted Residual Risk: 
ABIA - Safety Risk Management Decision Report (SRMDR)

Enhancing our Safety Culture through Safety Management System Processing 

Preliminary Hazard List Worksheet 

SRMDR Hazard Tracking Number: 

ID Description Cause 
ABIA - Safety Risk Management Decision Report (SRMDR)

Enhancing our Safety Culture through Safety Management System Processing 

Preliminary Hazard List Worksheet 

SRMDR Hazard Tracking Number: 

ID Description Cause 
ABIA - Safety Risk Management Decision Report (SRMDR)

Enhancing our Safety Culture through Safety Management System Processing 

SRMDR Hazard Tracking Number: 

Hazard Element Number: Hazard Description: 
ABIA - Safety Risk Management Decision Report (SRMDR

Preliminary Hazard Analysis Worksheet 

SRMDR Hazard Tracking Number: 

ID Description Cause System 

State 

Potential 

Effect 

Severity Existing 

Control(s)

Likelihood Current 

Risk 

Recommende

Safety 

Mitigation 

Enhancing our Safety Culture through Safety Management System Processin
ABIA - Safety Risk Management Decision Report (SRMDR

Preliminary Hazard Analysis Worksheet Definitions 

Tracking Number - A unique number assigned each hazard for the purpose of referencing 

the analysis. 

Description – A word depiction of the real or perceived hazard. 

Cause – A reason, condition, task, or activity that brings about a hazardous act or state. 

System State – The current configuration, policy, procedure, or process from within which 

Potential Effect – The effect(s) the hazard would have on the system state if not mitigated 

Severity – The level or extent to which property damage, injury or loss of life is contributab

(Catastrophic, Major, Minor, Minimal) 

Existing Control – System, process, procedure, or policy currently in place to counter the h

Likelihood – The frequency or regularity in which the hazard can occur. (Frequent, Probab

Improbable) 

Current Risk – Level of risk attributed to the hazard. (High, Moderately High, Medium, Low

Recommended Safety Mitigation – Additional procedures, actions, activities or processes 

system state to lessen the likelihood and/or seriousness of the hazard. 

Residual Risk – A re-measuring of the risk level once recommended safety mitigations are 

Comments – Notes, implementation or timeline requirements or other pertinent information

Enhancing our Safety Culture through Safety Management System Processin
ABIA - Safety Risk Management Decision Report (SRMDR

Enhancing our Safety Culture through Safety Management System Processin

Preliminary Hazard Analysis Worksheet 

SRMDR Hazard Tracking Number: 

ID Description Cause System 

State 

Potential 

Effect 

Severity Existing 

Control(s)

Likelihood Current 

Risk 

Recommende

Safety 

Mitigation 
ABIA - Safety Risk Management Decision Report (SRMDR)

Enhancing our Safety Culture through Safety Management System Processing 

ABIA Airport Diagram 
ABIA - Safety Risk Management Decision Report (SRMDR)

Enhancing our Safety Culture through Safety Management System Processing 

ABIA Airport Aerial 
ABIA - Safety Risk Management Decision Report (SRMDR

ABIA Aerial – Area 1 

Enhancing our Safety Culture through Safety Management System Processin
ABIA - Safety Risk Management Decision Report (SRMDR

Enhancing our Safety Culture through Safety Management System Processin

ABIA Aerial – Area 2 
ABIA - Safety Risk Management Decision Report (SRMDR

ABIA Aerial – Area 3 

Enhancing our Safety Culture through Safety Management System Processin
ABIA - Safety Risk Management Decision Report (SRMDR

ABIA Aerial – Area 4 

Enhancing our Safety Culture through Safety Management System Processin
ABIA - Safety Risk Management Decision Report (SRMDR

ABIA Aerial – Area 5 

Enhancing our Safety Culture through Safety Management System Processin