Appendix 2 APPENDIX 2. SAFETY RISK MANAGEMENT (SRM) WORKSHEETS The worksheets in this appendix are provided to illustrate the SRM process and a possible way to develop and document the SRM processes required under Title 14 of the Code of Federal Regulations (14 CFR) part 5, subpart C. These worksheets are provided for illustrative purposes only. Carriers may develop their own record keeping systems and should determine the amount and depth of documentation and recordkeeping that are needed to show compliance. Not all situations will require the same degree of detail.
FIGURE A2-1. SAFETY RISK MANAGEMENT TRIGGERING CONDITIONS AND
SUMMARY NOTE: Refer to part 5, § 5.51 Title:
Reason for Risk Assessment New System Design Change to Existing System Design New Operational Procedure Modification to an Existing Operation or Procedure Operational Environment Change Ineffective Risk Control
Brief Summary
Where signed below, the authorized manager has determined that no new hazards have been introduced by this change:
Name:
Signature:
Appendix 2 FIGURE A2-2. SYSTEM ANALYSIS NOTE: Refer to § 5.53(a) and (b).
Responsible Manager:
Authority for Implementation and Risk Acceptance:
Function and Purpose of the System or Change:
Description of Operating Environment Related Hazards
Personnel
Equipment
Facilities
Appendix 2 FIGURE A2-3. HAZARD LIST NOTE: Refer to §§ 5.53(c) and 5.23 (a)(1).
System/Project: __________________________ Responsible Manager: __________________________ Hazard Potential Consequence(s) H1 H2 H3 H4 H5 H6 H7 H8 H9 H10
Appendix 2 FIGURE A2-4. RISK ANALYSIS NOTE: Refer to § 5.55(a).
Pre-Control Post-Control Hazard Potential Consequences Severity Likelihood Substitute Risk?
Severity Likelihood H1 H2 H3 H4 H5 H6 H7 H8 H9 H10
Appendix 2 FIGURE A2-5. RISK ANALYSIS AND ASSESSMENT SUMMARY NOTE: Refer to §§ 5.55(b) and 5.23(b).
Acceptance Authority (Sign here and Initial Appropriate Columns): ___________________ Pre-Control Accept? Post-Control Accept?
Hazard Potential Consequences Severity Likelihood Severity Likelihood H1 H2 H3 H4 H5 H6 H7 H8 H9 H10
Appendix 2 FIGURE A2-6. RISK CONTROL NOTE: Refer to § 5.55(c) and (d).
System/Project: ___________________________________________________________ Responsible Manager: ___________________________________________________________ Hazard Control Substitute Risk Residual Risk H1 H2 H3 H4 H5 H6 H7 H8 H9 H10
Appendix 2 Page 7 (and 8) FIGURE A2-7. RISK CONTROL DOCUMENTATION NOTE: Refer to 14 CFR part 5, subpart F.
System/Project: ___________________________________________________________
Hazard Procedure Documentation H1 H2 H3 H4 H5 H6 H7 H8 H9 H10
Appendix 3 Page 1 (and 2) APPENDIX 3. SAMPLE SAFETY POLICY STATEMENT The Executive Management of [Certificate Holder’s name] recognizes that an effective Safety Management System (SMS) is vital to the success and longevity of the Company. Therefore the Executive Management is committed to implementing and maintaining a fully functional SMS and to the continuous improvement of the level of safety throughout [Certificate Holder’s name].
• Executive Management of [Certificate Holder’s name] will establish specific safety-related objectives and will periodically publish and distribute to all employees those objectives and plans.
• These safety objectives will be monitored, measured, and tracked to ensure overall corporate safety objectives are met. All employees and individuals in the company have the responsibility to perform their duties and activities in the safest practical manner.
• [Certificate Holder’s name] Executive Management is committed to providing the necessary financial, personnel, and other resources to establish and maintain a fully functional SMS.
• [Certificate Holder’s name] Executive Management is dedicated to establishing a confidential employee reporting system to report all hazards, accidents, incidents, and safety issues without fear of reprisal.
• Activities involving intentional disregard for FAA regulations, company policies and procedures, illegal activities, and/or drugs or alcohol may be subject to disciplinary action.
• As a component of the SMS, [Certificate Holder’s name] Executive Management is committed to establishing, maintaining, and periodically exercising an emergency response procedure and plan that provides for the safe transition from normal to emergency operations.
Executive Management will convey this expectation to all employees through postings, intranet site, company newsletter, and any other means to ensure all employees are aware of the company’s SMS, their duties and responsibilities, and our safety policy.
This safety policy will be periodically reviewed by Executive Management to ensure it remains relevant and appropriate to the company.
[Signed], Accountable Executive [Additional management personnel optional]
Appendix 4 APPENDIX 4. IDENTIFYING THE ACCOUNTABLE EXECUTIVE To assist the organization with the selection of their accountable executive, Figures A4-1 and 2 provide flowcharts with a series of questions. Figure A4-1 identifies different organizational structures and how those structures may determine the accountable executive.
FIGURE A4-1. ACCOUNTABLE EXECUTIVE DECISION PROCESS Accountable Executive Decision Process Confirm selection Is the organization Proprietor is by answering the Accountable a sole proprietor Accountable Executive questions on Executive ship? Yes page 2 No Proprietor is Accountable Executive Is the Nominate a Confirm selection organization a partnership partner as by answering the between Accountable questions on individuals? Yes Executive page 2 Nominated partner is No Accountable Executive Is the Has the Board Confirm selection controlled by a organization appointed a CEO or by answering the Directors? Board of Yes equivalent to manage the organization? questions on page 2 No No CEO is Accountable Executive Chairman of Board is Accountable Executive Who in the What is the most organization senior position in holds this the company? position?
If a clear selection cannot be made, NO yes re-evaluate Confirm selection Identified person is organization and by answering the Accountable Executive begin process questions on page again Page 1
Appendix 4 FIGURE A4-2. VERIFYING THE ACCOUNTABLE EXECUTIVE Once the accountable executive is identified (Figure A4-1), the questions in Figure 9 will assist in verifying that the selected person is the correct choice. In Figure A4-2, all questions must receive a "yes" answer. Should any of the questions result in a "no" answer, you should start the selection process again with a new candidate.
Start Identity person by name Select another candidate Does the person have final $5.25 (a) (1) authority over the service provider's operations?
No Yes Does the person control the financial resources required for §5.25 (a) (2) → the service provider's operation?
No Yes Does the person control the §5.25 (a) (3) human resources required to → conduct the service provider's operations? No Does the person retain the ultimate responsibility for the safety §5.25 (a) (4) performance of the service provider's operations? No Yes This person is the Accountable Executive