Form 1112-5 

(May 2001) 

UNITED STATES 

DEPARTMENT OF THE INTERIOR 

BUREAU OF LAND MANAGEMENT 

RISK MANAGEMENT WORKSHEET 

1. Organization and Location 

 Basic Risk Management Worksheet for the SEAT Program. 2. Pag

3. Operation / Task 

SEAT MANAGER POSITION 

4. Beginning Date: Open 

5. Ending Date: Open 

6. Da

4/200

7. Prepared by (Name / Duty Position) 

8. Identified Hazards: 9. Assess the Hazards 

Initial 

10. Control Measures Developed for Identified Hazards: (Specific measures taken to reduce the probability of a hazard.) 

11. Assess the Hazard’s Residual’s Risk 

12. How to ImplemeControls: (Include SOreferences, etc.) 

(Be Specific) L M H E (Be Specific) L M H E (Be Specifi

DEHYDRATION: Skin damage and 

exhaustion from direct sun exposure and 

high temperatures. 

X Drink plenty of fluids, wear appropriate 

clothing like full brim hats and long sleeve shirts, provide shade for all crew members and use sun screen for exposed skin. 

X Ensure adequate le

fluids and equipme

available at the basIncorporate dehydrwarning signs into briefings. 

FATIGUE: Extended duty hours in an 

uncontrolled environment. 

X Monitor and document duty hours and environmental conditions. 

Assess the conditions at each base for improving the general working environment, and relay the suggestions to the using agency. 

X Ensure the using 

advised of current work conditions. Rduty time daily on time sheet and adh

agency work/rest guidelines 

14. Remaining Risk Level After Control Measures Are Implemented: 

(CIRCLE HIGHEST REMAINING RISK LEVEL) 

LOW 

(Line Supervisor) 

MEDIUM 

(Branch Chief) 

HIGH 

(District Manager) 

(Mu

15. RISK DECISION AUTHORITY: (Approval/Authority Signature Block) (If Initial Risk Level is Medium, High or Extremely High, Brief Risk Decision Au

Measures used to reduce risks. NOTE: if the person preparing the form signs this block, the signature indicates only that the appropriate risk decision authority was notified of the int

appropriate resources requested; and that the risk was accepted by the decision authority.) 

MARK BICKHAM, BLM NATIONAL SEAT PROGRAM MANAGER 

(Signature) 
CONTINUED 

8. Identified Hazards 9. Assess the Hazards 

Initial 

10. Control Measures Developed for Identified Hazards: (Specific measures taken to reduce the 

probability of a hazard.) 

11. Assess the Hazard’s Residual’s Risk 

12. How to ImplemControls: (Include Sreferences, etc.) 

(Be Specific) L M H E (Be Specific) L M H E (Be Specifi

Driving cars and light trucks 

X 

Become familiar with vehicles that you may be asked to drive. Always drive 

defensively, obey traffic laws, use seatbelts, 

and maintain speed within safe and legal 

limits. 

X Hol tailgd ate safe

sessions on defen

driving technique

employee demons

their proficiency itype of vehicle thedrive. 

Lifting heavy objects X Ensure the weight of the object has been determined prior to lifting. Use proper 

lifting techniques or identify and order the proper tool for lifting the object safely 

X Include a demons

proper lifting techa safety briefing aequipment on the weighing objects. 

Working in proximity of running aircraft 

engines and pumps. 

X Use hearing protection when in the vicinity 

of running engines or pumps. Use eye protection to mitigate blowing dust and debris. 

X 

The SEAT Manag

ensure that they hhearing and eye pfor each assignme

Working in proximity of running aircraft propellers and engine exhaust.

X Maintain a safe distance from the aircraft at all times. 

Approach and depart from the aircraft in full view of the pilot and with their consent. 

Stay away from exhaust stacks of all aircraft 

during operations and for a time after the 

engine has been shut down. 

X Make sure each p

crew member revapproach and depprocedures and si

the initial pilot bri

Get a briefing from 

pilot on the exhausystems and surfa
CONTINUED 

8. Identified Hazards 9. Assess the Hazards 

Initial 

10. Control Measures Developed for Identified Hazards: (Specific measures taken to reduce the 

probability of a hazard.) 

11. Assess the Hazard’s Residual’s Risk 

12. How to ImplemControls: (Include Sreferences, etc.) 

(Be Specific) L M H E (Be Specific) L M H E (Be Specifi

Working around possible hazardous materials. 

X 

Have Dataterial Ma Safety Sheets (MSDS) 

for all materials used on the base readily 

available for all persons on base. 

Review the local using agency’s Hazardous 

Communication Plan and who to contact if 

needed. 

X Fo mitillow gation 

procedures outline

MSDS for materia

Follow procedure

in the Hazardous 

Communication Pneeded. 

Falling from working around areas that 

may be wet or slippery from retardant residue. 

X 

Maintain a clean reloading area. Pick-up or

wash down and dilute any spills on surfacesof the reloading area. Flag or sign areas that may become wet or slippery during operations. Wear appropriate foot gear with closed toesand compatible with walking on wet or 

potentially slick surfaces. . 

X Ensure the contra

following the spil

guidelines in the cBrief all personnethat may have potproblems when w

Monitor the foot gpersonnel working around a wet or sl

NOTE: THIS IS A BASIC HAZARD LIST FOR RAMP AND SEAT OPERATIONS. THE SEAT MANADDITIONAL HAZARDS THAT MAY BE SPECFIC TO THEIR OPERATION.