DELIBERATE RISK ASSESSMENT WORKSHEET
1. MISSION/TASK DESCRIPTION 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)
4. SUBTASK/SUBSTEP
OF MISSION/TASK
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
Additional entries for items 5 through 9 are provided on page 2.
10. OVERALL RESIDUAL RISK LEVEL (All controls implemented):
11. OVERALL SUPERVISION PLAN AND RECOMMENDED COURSE OF ACTION
a. Name (Last, First, Middle Initial)
b. Rank/Grade
c. Duty Title/Position d. Signature of Approval Authority
12. APPROVAL OR DISAPPROVAL OF MISSION OR TASK
e. Additional Guidance:
DD FORM 2977, JAN 2014
APPROVE DISAPPROVE
EXTREMELY HIGH HIGH MEDIUM LOW
Page 1 of ____ Pages
5. HAZARD
6. INITIAL
RISK
7. CONTROL
9. RESIDUAL
RISK LEVEL
8. HOW TO IMPLEMENT/
WHO WILL IMPLEMENT
Adobe Professional X
LEVEL
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4. SUBTASK/SUBSTEP
OF MISSION/TASK
5. HAZARD
6. INITIAL
RISK
LEVEL
7. CONTROL
9. RESIDUAL
RISK LEVEL
8. HOW TO IMPLEMENT/
WHO WILL IMPLEMENT
DELIBERATE RISK ASSESSMENT WORKSHEET
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
How:
Who:
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Who:
How:
Who:
DD FORM 2977, JAN 2014
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How:
Who:
13. RISK ASSESSMENT REVIEW 5HTXLUHGZKHQDVVHVVPHQWDSSOLHVWRRQJRLQJRSHUDWLRQVRUDFWLYLWLHV
b. Last Name c. Rank/Grade d. Duty Title/Position e. Signature of Reviewer a. Date
14. FEEDBACK AND LESSONS LEARNED
15. ADDITIONAL COMMENTS OR REMARKS
Risk Assessment Matrix
Probability (expected frequency)
Frequent:
Continuous,
regular, or
inevitable
occurrences
Likely:
Several or
numerous
occurrences
Occasional:
Sporadic or
intermittent
occurrences
Seldom:
Infrequent
occurrences
Unlikely:
Possible
occurrences but
improbable
Severity (expected consequence)
Catastrophic: Death, unacceptable
loss or damage, mission failure,
or unit readiness eliminated
I
Critical: Severe injury, illness, loss,
or damage; significantly degraded
unit readiness or mission capability
II
EH L
Moderate: Minor injury, illness, loss,
or damage; somewhat degraded
unit readiness or mission capability
III
L L
Negligible: Minimal injury, loss,
or damage; little or no impact to
unit readiness or mission capability
IV
L L L L
Legend:
EH – extremely high risk H – high risk M – medium risk L – low risk
DELIBERATE RISK ASSESSMENT WORKSHEET
A B C D E
DD FORM 2977, JAN 2014
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EH
EH
H
H H
H H
M
M
EH
M M
M
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1. Mission/Task Description: Briefly describe the overall
Mission or Task for which the deliberate risk assessment
is being conducted.
9. Residual Risk Level: After controls are implemented,
determine resulting probability, severity, and residual risk
level.
2. Date ''00<<<<: Self Explanatory.
10. Overall Risk After Controls are Implemented: Assign
an overall residual risk level. This is the highest residual
risk level (from block 9).
3.
Prepared By: Information provided by the individual
conducting the deliberate risk assessment for the operation
or training .
Legend: UIC = Unit Identification Code; CIN = Course ID
Nu
mber; OPORD = operation order; DSN = defense
switched network; COMM = commercial
11
. Supervision Plan and Recommended Course of Action:
Completed by preparer. Identify specific tasks and levels
of responsibility for supervisory personnel and provide the
decision authority with a recommend course of action for
approval or disapproval based upon the overall risk
assessment.
4.
Sub-task/Sub-Step of Mission/Task: Briefly describe all
subtasks or substeps that warrant risk management.
12. Approval/Disapproval of Mission/Task: Risk approval
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
provide additional guidance; use continuation page if needed.
5. Hazard: Specify hazards related to the subtask in block 4.
13
. Risk Assessment Review: Should be conducted on a
regular basis. Reviewers should have sufficient oversight of
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
until the appropriate approval authority is contacted and
approves continued operations.
6.
Initial Risk Level: Determine probability and severity.
Using the risk assessment matrix (page 3), determine level
of risk for each hazard specified. probability, severity and
associated Risk Level; enter level into column.
14
. Feedback and Le
ssons Learned: Provide specific input
on the effectiveness of risk controls and their contribution to
mission success or failure. Include recommendations for
new or revised controls, practicable solutions, or alternate
actions. Submit and brief valid lessons learned as necessary
to persons affected.
7. Co
ntrol: Enter risk mitigation resources/controls identified
to abate or reduce risk relevant to the hazard identified in
block 5.
15. Additional Comments or Remarks: Preparer provides
additional comments, remarks, or information to support
the risk assessment. If block 15 is used as a continuation
of block 14, strike through the block number and title.
8.
How to Implement / Who Will Implement: Briefly
describe the means of employment for each control
(i.e., OPORD, briefing, rehearsal) and the name of the
individual unit or office that has primary responsibility for
control implementation.
Additional Guidance: Block 4-9 continuance page may be
reproduced as necessary for processing of all subtasks/
substeps of the mission/task. If a complete page is not utilized,
write “NOTHING FOLLOWS” on the first unused row,
immediately after the final item assessed.
Instructions for Completing DD Form 2977, "Deliberate Risk Assessment Worksheet"
DD FORM 2977 INSTRUCTIONS, JAN 2014