Appendix F Risk Assessment Instructions and Forms
This worksheet provides a starting point to logically track the process of hazards and risks. It can be used to
document risk management steps taken during the planning, preparation, execution of test missions and tasks.
All flyers must address the hazards listed in the attached risk assessment as a minimum. Operators may reference
the Range Safety Questionnaire if appropriate.
1 and 3: Self-explanatory.
2. Date is the date the form is prepared.
4: Subtask relating to the mission or task in block1.
5: Hazards – Identify hazards by reviewing factors for the mission or task. Additional factors include historical
lessons learned, experience, judgment, equipment characteristics and warnings, and environmental considerations.
UAV Flyers must address all hazards listed in the attached forms, but are not limited to just these hazards. Those
that are unique to that UAV must also be addressed.
6: Initial Risk Level– Includes historical lessons learned; intuitive analyses, experience, judgment, equipment
characteristics and warnings; and environmental considerations. Determine initial risk for each hazard by applying
risk assessment matrix on Page 6. Enter the risk level for each hazard-L, M, H, EH.
7: Controls – Develop one or more controls for each hazard that will either eliminate the hazard or reduce the risk
(probability and/or severity) of a hazardous incident. Specify who, what, where, why, when, and how for each
control. Enter controls. References to the range safety review questionnaire are appropriate.
8. How to Implement and Who will Implement: Example of how: SOP, Rehearsal, UAS Operating Instructions.
Example of who: Supervisor, AVO, Mission Commander
9.: Residual Risk Level– Determine the residual risk for each hazard by applying the risk assessment matrix on Page
6-4). Enter the risk level for each hazard-L, M, H, EH.
10., 11., 12.: Self-explanatory.
13: Risk Assessment Review. Required when assessment applies to ongoing operations or activities.
See the following page for more instructions on completing your RA.
F-1
Formatted Table
Instructions for Completing DD Form 2977, "Deliberate Risk Assessment Worksheet"
1. Mission/Task Description: Briefly describe the overall 10. Overall Risk After Controls are Implemented: Assign
Mission or Task for which the deliberate risk assessment an overall residual risk level. This is the highest residual
is being conducted. risk level (from block 9).
2. Date DD/MM/YYYY: Self Explanatory. 11. Supervision Plan and Recommended Course of Action:
Completed by preparer. Identify specific tasks and levels
of responsibility for supervisory personnel and provide the
3. Prepared By: Information provided by the individual
decision authority with a recommend course of action for
conducting the deliberate risk assessment for the operation
approval or disapproval based upon the overall risk
or training .
assessment.
Legend: UIC = Unit Identification Code; CIN = Course ID
Number; OPORD = operation order; DSN = defense 12. Approval/Disapproval of Mission/Task: Risk approval
switched network; COMM = commercial authority approves or disapproves the mission or task based
on the overall risk assessment, including controls, residual
risk level, and supervision plan. Space provided for authority to
4. Sub-task/Sub-Step of Mission/Task: Briefly describe all
provide additional guidance; use continuation page if needed.
subtasks or substeps that warrant risk management.
13. Risk Assessment Review: Should be conducted on a
regular basis. Reviewers should have sufficient oversight of
5. Hazard: Specify hazards related to the subtask in block 4.
the mission or activity and controls to provide valid input on
changes or adjustments needed. If the residual risk rises
above the level already approved, operations should cease
6. Initial Risk Level: Determine probability and severity.
until the appropriate approval authority is contacted and
Using the risk assessment matrix (page 7), determine level
approves continued operations.
of risk for each hazard specified, probability, severity and
associated Risk Level; enter level into column.
14. Feedback and Lessons Learned: Provide specific input
on the effectiveness of risk controls and their contribution to
mission success or failure. Include recommendations for
7. Control: Enter risk mitigation resources/controls identified
new or revised controls, practicable solutions, or alternate
to abate or reduce risk relevant to the hazard identified in
actions. Submit and brief valid lessons learned as necessary
block 5.
to persons affected.
8. How to Implement / Who Will Implement: Briefly 15. Additional Comments or Remarks: Preparer provides
describe the means of employment for each control additional comments, remarks, or information to support
(i.e., OPORD, briefing, rehearsal) and the name of the the risk assessment. If block 15 is used as a continuation
individual unit or office that has primary responsibility for of block 14, strike through the block number and title.
control implementation.
Additional Guidance: Block 4-9 continuance page may be
9. Residual Risk Level: After controls are implemented, reproduced as necessary for processing of all subtasks/
determine resulting probability, severity, and residual risk substeps of the mission/task. If a complete page is not utilized,
level. write “NOTHING FOLLOWS” on the first unused row,
immediately after the final item assessed.
DD FORM 2977 INSTRUCTIONS, JAN 2014
DELIBERATE RISK ASSESSMENT WORKSHEET
1. MISSION/TASK DESCRIPTION (INCLUDE DATES OF EVENT) 2. DATE (DD/MM/YYYY)
3. PREPARED BY
a. Name (Last, First, Middle Initial) b. Rank/Grade c. Duty Title/Position
d. Unit e. Work Email f. Telephone (DSN/Commercial (Include Area Code))
g. UIC/CIN (as required) h. Training Support/Lesson Plan or OPORD (as required) i. Signature of Preparer
Five steps of Risk Management: (1) Identify the hazards (2) Assess the hazards (3) Develop controls & make decisions
(4) Implement controls (5) Supervise and evaluate (Step numbers not equal to numbered items on form)
6. INITIAL 9. RESIDUAL
4. SUBTASK/SUBSTEP 8. HOW TO IMPLEMENT/
5. HAZARD RISK 7. CONTROL
OF MISSION/TASK WHO WILL IMPLEMENT RISK LEVEL
LEVEL
Loss of control Loss of propulsion How:
Who:
Loss of lift How:
Who:
Loss of heading, attitude and How:
position
Who:
Loss of Control Surface How:
performance
Who:
Loss of UAV electrical power
How:
Who:
Additional entries for items 5 through 9 are provided on page 2.
10. OVERALL RESIDUAL RISK LEVEL (All controls implemented):
EXTREMELY HIGH HIGH MEDIUM LOW
11. OVERALL SUPERVISION PLAN AND RECOMMENDED COURSE OF ACTION
12. APPROVAL OR DISAPPROVAL OF MISSION OR TASK APPROVE DISAPPROVE
a. Name (Last, First, Middle Initial) b. Rank/Grade c. Duty Title/Position d. Signature of Approval Authority
e. Additional Guidance:
DD FORM 2977, JAN 2014 Page 1 of Pages
Adobe Professional X
DELIBERATE RISK ASSESSMENT WORKSHEET
6. INITIAL
4. SUBTASK/SUBSTEP 5. HAZARD 7. CONTROL 8. HOW TO IMPLEMENT/ 9. RESIDUAL
RISK
OF MISSION/TASK WHO WILL IMPLEMENT RISK LEVEL
LEVEL
Loss of control (cont) Loss of GCS How:
Who:
How:
Controlled flight into Mission planning error or
ground operator error
Who:
Altitude error How:
Who:
Navigation error How:
Who:
Failure to see and avoid How:
terraain
Who:
Loss of link "fly-home" mode How:
Who:
How:
Mid-air collision Navigation error
Who:
How:
Altitude error
Who:
Unable to "see and avoid" How:
Who:
How:
Mission planning error
Who:
How:
Not seen by other aircraft
Who:
Take off and/or Pilot induced oscillation How:
landing mishaps
Who:
Automatic landing system How:
failure
Who:
How:
Operator error
Who:
DD FORM 2977, JAN 2014 Page of Pages
DELIBERATE RISK ASSESSMENT WORKSHEET
6. INITIAL
4. SUBTASK/SUBSTEP 5. HAZARD 7. CONTROL 8. HOW TO IMPLEMENT/ 9. RESIDUAL
RISK
OF MISSION/TASK WHO WILL IMPLEMENT RISK LEVEL
LEVEL
Vehicle loss Inadequate operator How:
response
Who:
How:
Incorrect inputs of critical
parameters
Who:
Operator information How:
overload
Who:
Critical information How:
unavailable, inadquate,
blocked Who:
Latency of flight control How:
commands
Who:
Operator fatigue How:
Who:
How:
Control of multiple UAVs
Who:
How:
Software paths to unsafe
state
Who:
Injury on ground to Range hazards How:
crew
Who:
How:
Flight line hazards
Who:
How:
Injury to others on Aircraft unintentional landing
ground or damage to
property Who:
Aircraft unintentional How:
departure from runway while
taking off or landing Who:
How:
Who:
How:
Who:
DD FORM 2977, JAN 2014 Page of Pages
DELIBERATE RISK ASSESSMENT WORKSHEET
6. INITIAL
4. SUBTASK/SUBSTEP 5. HAZARD 7. CONTROL 8. HOW TO IMPLEMENT/ 9. RESIDUAL
RISK
OF MISSION/TASK WHO WILL IMPLEMENT RISK LEVEL
LEVEL
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
DD FORM 2977, JAN 2014 Page of Pages
Formatted Table
DELIBERATE RISK ASSESSMENT WORKSHEET
Probability (expected frequency)
Frequent: Likely: Occasional: Seldom: Unlikely:
Risk Assessment Matrix Continuous, Several or Sporadic or Infrequent Possible
regular, or numerous intermittent occurrences but
inevitable occurrences
occurrences occurrences improbable
occurrences
Severity (expected consequence) A B C D E
Catastrophic: Death, unacceptable
loss or damage, mission failure, I EH EH H H M
or unit readiness eliminated
Critical: Severe injury, illness, loss,
or damage; significantly degraded II EH
EH H H M L
unit readiness or mission capability
Moderate: Minor injury, illness, loss,
or damage; somewhat degraded III H M M L L
unit readiness or mission capability
Negligible: Minimal injury, loss,
or damage; little or no impact to IV M L L L L
unit readiness or mission capability
Legend:
EH – extremely high risk H – high risk M – medium risk L – low risk
13. RISK ASSESSMENT REVIEW (Required when assessment applies to on going operation of activities)
a. Date b. Last Name c. Rank/Grade d. Duty Title/Position e. Signature of Reviewer
14. FEEDBACK AND LESSONS LEARNED
15. ADDITIONAL COMMENTS OR REMARKS
DD FORM 2977, JAN 2014 Page of Pages
