# ABIA - Safety Risk Management Decision Report (SRMDR)

Enhancing our Safety Culture through Sa fety 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 Sa fety 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 Sa fety 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 Sa fety 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 Sa fety 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 Sa fety Management System Processing SRMDR Hazard Tracking Number:

Hazard Element Number: Hazard Description:ABIA - Safety Risk Management Decision Report (SRMDR)Preliminary Hazard Analysis WorksheetSRMDR Hazard Tracking Number:IDDescriptionCauseSystemStatePotentialEffectSeverityExistingControl(s)LikelihoodCurrentRiskRecommendedSafetyMitigationResidualRiskCommentsEnhancing our Safety Culture throughSafety Management System ProcessingABIA - Safety Risk Management Decision Report (SRMDR)Preliminary Hazard Analysis Worksheet DefinitionsTracking Number- A unique number assigned eachhazard for the purpose of referencing the hazard duringthe 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 the hazard exists.Potential Effect– The effect(s) the hazard would have on the system state if not mitigatedSeverity– The level or extent to which property damage, injury or loss of life is contributable to a hazard.(Catastrophic, Major, Minor, Minimal)Existing Control– System, process, procedure,or policy currently in place to counter the hazard.Likelihood– The frequency or regularity in which the hazard can occur. (Frequent, Probable, Remote,Improbable)Current Risk– Level of risk attributed to the hazard. (High, Moderately High, Medium, Low)Recommended Safety Mitigation– Additional procedures, actions, activitiesor processes imposed on thesystem 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 implemented.Comments– Notes, implementation or timeline requirements or other pertinent information.Enhancing our Safety Culture throughSafety Management System ProcessingABIA - Safety Risk Management Decision Report (SRMDR)Enhancing our Safety Culture throughSafety Management System ProcessingPreliminary Hazard Analysis WorksheetSRMDR Hazard Tracking Number:IDDescriptionCauseSystemStatePotentialEffectSeverityExistingControl(s)LikelihoodCurrentRiskRecommendedSafetyMitigationResidualRiskComments

# 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 AerialABIA - Safety Risk Management Decision Report (SRMDR)ABIA Aerial – Area 1Enhancing our Safety Culture throughSafety Management System ProcessingABIA - Safety Risk Management Decision Report (SRMDR)Enhancing our Safety Culture throughSafety Management System ProcessingABIA Aerial – Area 2ABIA - Safety Risk Management Decision Report (SRMDR)ABIA Aerial – Area 3Enhancing our Safety Culture throughSafety Management System ProcessingABIA - Safety Risk Management Decision Report (SRMDR)ABIA Aerial – Area 4Enhancing our Safety Culture throughSafety Management System ProcessingABIA - Safety Risk Management Decision Report (SRMDR)ABIA Aerial – Area 5Enhancing our Safety Culture throughSafety Management System Processing