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INCIDENT ACTION SAFETY ANALYSIS (ICS 215A)
{var Title}  

1. Incident Name:  
{var IncidentName}

2. Incident Number:
{var IncidentNumber}

3. Date/ Time Prepared:

Date: {var PreparedDate}     Time: {var PreparedTime}

4. Operational Period: Date From: {var DateFrom}  Date To: {var DateTo}
  Time From: {var TimeFrom}  Time To: {var TimeTo}
5. Incident Area 6. Hazards/Risks 7. Mitigations
{var area1} {var hazard1} {var Mitigtion1}
{var area2} {var hazard2} {var Mitigtion2}
{var area3} {var hazard3} {var Mitigtion3}
{var area4} {var hazard4} {var Mitigtion4}
{var area5} {var hazard5} {var Mitigtion5}
{var area6} {var hazard6} {var Mitigtion6}
{var area7} {var hazard7} {var Mitigtion7}
{var area8} {var hazard8} {var Mitigtion8}
{var area9} {var hazard9} {var Mitigtion9}
{var area10} {var hazard10} {var Mitigtion10}
{var area11} {var hazard11} {var Mitigtion11}
{var area12} {var hazard12} {var Mitigtion12}
{var area13} {var hazard13} {var Mitigtion13}
{var area14} {var hazard14} {var Mitigtion14}
{var area15} {var hazard15} {var Mitigtion15}

8. Prepared by (Safety Officer): Name {var Prepedby}       Signature: {var Prepsig}

    Prepared b: (Operations Section Chief): Name {var Prepedbychief}       Signature: {var OpsChiefpsig}

ICS 215A
  Date/Time: {var Formdatetime}  
                                                                Ver 1.0.1