Appendix 2-2 PHA Worksheets

Appendix 2-2 PHA Worksheets - APPENDIX 2 A POT POURRI OF...

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Unformatted text preview: APPENDIX 2 A POT POURRI OF PHA WORKSHEETS 59 APPENDIX 2 AFWL Worksheet MATRIX - PRELIMINARY HAZARD ANALYSIS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. EVENT CAUSING SUBSYSTEM EVENT CAUSING HAZARDOUS HAZARDOUS MODE POTENTIAL OR HAZARDOUS ELEMENT CONDITION ACCIDENT FUNCTION CONDITION HAZ. POTENTIAL EFFECT CLASS ACCIDENT ACCIDENT PREVENTION MEASURES a. HARDWARE b. PROCEDURES c. PERSONNEL Source: Air Force Weapons Laboratory AFWL FORM 2 AFSC - KAFB NM 60 APPENDIX 2 AFOTEC Worksheet PAGE OF PAGES PRELIMINARY SYSTEM SAFETY HAZARD ANALYSIS AND RISK ASSESSMENT TITLE (Specify and Identify) JON/TITLE START DATE G IN HOUSE G CONTRACT LOCATION OFFICE SYMBOL/PHONE NO. ANALYSIS (Specify) G DESCRIPTION (Portion of Project Operation System covered by this analysis) INITIAL G REVISION G ADDENDUM DEADLINE FOR COMPLETION OF FURTHER ANALYSIS POTENTIAL CONSEQUENCES (As applicable) REMARKS RISK ASSESSMENT (Key on reverse) FURTHER ANALYSIS REQUIRED SYSTEM HAZARDS (Use additional forms as required) EXISTING COUNTERMEASURES (Safety Manual Stds, Operating Procedures, Prior Safety Analysis, Etc.) Source: Air Force Weapons Laboratory PREPARER DATE DSSO CERTIFICATION DATE AFWL/SE OR TSC COORDINATION DATE AFSC FORM JUN 85 1152 REPLACES AFWL 2, JUN 84, WHICH IS OBSOLETE. 61 APPENDIX 2 AFSC Worksheet SYSTEM_______________ SUBSYSTEM___________ 1 ITEM/FUNCTION 2 SYSTEM EVENT PHASE PRELIMINARY HAZARD ANALYSIS 3 HAZARD DESCRIPTION 4 HAZARD CLASSIFICATION PREPARED BY_____PG__OF___ ISSUE DATE:_______REV______ 5 SAFETY PROVISIONS 6 CORRECTIVE ACTION PRIORITY Source: AFSC System Safety Design Handbook 62 APPENDIX 2 LaRC Worksheet/1 PRELIMINARY HAZARD ANALYSIS SYSTEM/PROJECT_______________ CONTRACT NO._________________ SUBSYSTEM/FUNCTION_____________ OPERATING MODE___________________ HAZARD SEVERITY CATEGORY SHEET____OF_____ ANALYST:_________ DATE:_____________ HAZARDOUS ELEMENT HAZARDOU S CONDITION HAZARD CAUSE HAZARD EFFECT CORRECTIV E ACTION REMARKS Source: NASA/Langley Research Center 63 APPENDIX 2 LaRC Worksheet/2 UNDESIRED EVENT CAUSE EFFECT HAZARD LEVEL ASSESSMENTS RECOMMENDATION Source: NASA/Langley Research Center 64 APPENDIX 2 LeRC Worksheet PRELIMINARY HAZARD ANALYSIS WORKSHEET Lewis Research Center Project Name____________________________________ ITEM NO. HAZARDOUS CONDITION HAZARD CAUSE(S) HAZARD EFFECTS HAZARD SEVERITY DATE_______________ PAGE____of_________ Part Analyzed____________________________ HAZARD RISK INDEX HAZARD CONTROLS HAZARD FREQUENCY Source: NASA/Lewis Research Center NASA-C-10052 (6'92) (PAM 221) 65 APPENDIX 2 Sverdrup PHA Worksheet/1 Sverdrup Technology, Inc. Probability Interval: _____ Date: System Number: __________ Analysis: Revision Initial Addition Risk Befor e Preliminary Hazard Analysis Description of Countermeasures Identify countermeasures by appropriate code letter(s): D = Design Alteration E = Engineered Safety Feature S = Safety Device W = Warning Device P = Procedures/Training Risk Afte r Brief Descriptive Title (Portion of System/Sub-system/Operational Phases covered by this analysis): Hazard No. / Description Prepared by/Date: *Target Codes: P--PersonnelE--Equipment T--Downtime R--Product V--Environment Approved by/Date: 66 APPENDIX 2 Sverdrup PHA Worksheet/2 67 APPENDIX 2 Sverdrup PHA Worksheet/3 Hazard Analysis & Risk Assessm ent !" H ZA DD S RIP N A R E C TIO !&%&*# RV E: E IS D # 3(4#%"&#$* A IV /P O E SP A E CT ITY R C S H S : A D IO A C U E M AS R S D IT N L O NT R E U E * %+,(# . IN IALRIS A S S M N IT K SES ET (w ex go plan d ign d-inc nterm asu s) ith istin r ne /des e ou e re #$#%&' ())%*%&' !&-#& . / 1 2 #0/ # / P S -C U TE M AS ER KAS E S E O T O N R E UR IS S S M NT (w ad ith dition co te easu inp al un rm res lace) !&-#& #$#%&' ())%*%&' . / 1 2 #0/ # P uct: rod a dto i k oes , n s r i d a e r o nl u o x oe i o r az s *Mn a ryforRs Cd 1&2ulespemtte byWiv r.Pes n emstntbeep sdtoRskCde1o2h ard. %+,(# . C deE chC nte ea re: (D =De nA ation/ (E = E ine dS fetyF tur o a ou rm su ) sig lter ) ng ere a ea es (S = S D s/ (W =W gD vic / (P =P ce res/T ing ) afety evice ) arnin e es ) ro du rain C M E TS O MN 68 APPENDIX 2 ...
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