1.  Organization and Unit Location:

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3.  Mission/Task:

4.  DTG Begin:

5.  DTG End:

6.  Date Prepared:

7.  Operational Phase in which the Mission/Task will be conducted:

8.  Prepared by: (Name/Rank/Duty Position)

9.  Identified Hazards:

10. Assess the Hazards:  Initial Risk: (Must Be Filled In By Hand)

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

12. Make Risk Decisions:  Remaining Risk: (Must Be Filled In By Hand)

13. How to Implement the Controls:

(Include SOPs and References, PCI, etc.)

14.  Supervision and Evaluation by:

(Continuous, Leader Checks, Buddy System, SITREP, etc.)

(Be Specific)

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