121 ARW ANNUAL SAFETY FACILITY INSPECTION (FY23)

121 ARW FY22 Annual Safety Inspection Report

• Organization Inspected:

  Select ARW Headquarters Medical Group Mission Support Group Maintenance Group Operations Group 220th Electrical Installation Squadron 164 Weather Flight Other

  • ARW Headquarters
  • Medical Group
  • Mission Support Group
  • Maintenance Group
  • Operations Group
  • 220th Electrical Installation Squadron
  • 164 Weather Flight
  • Other

• Area:

• Unit:

  Select AMXS MXS

  • AMXS
  • MXS

• Unit:

  CES

  CF

  FSS

  LRS

  SFS

• Conducted on:

  Date

• Inspection & Assessment Conducted by:

Findings

• Building(s):

  Select 2006 (Main Gate) 2000 917 911 909 903 888 887 885 883 876 875 872 849 846 820 220 Unlisted

  • 2006 (Main Gate)
  • 2000
  • 917
  • 911
  • 909
  • 903
  • 888
  • 887
  • 885
  • 883
  • 876
  • 875
  • 872
  • 849
  • 846
  • 820
  • 220
  • Unlisted

• Describe:

• Unit Activity/Work Area (Room):

• Date of Inspection:

  Date

• Deficiency, Hazard, or Observation:

  Hazard

  Deficiency

• 

• Probability:

  A

  B

  C

  D

• Severity:

  I

  II

  III

  IV

• Risk Assessment Code:

  5 (Negligible)

  4 (Minor)

  3 (Moderate)

  2 (Serious)

  1 (Imminent)

• Description of Hazard:

• Reference:

• Description of Deficiency:

• Reference:

• Cause of Deficiency or Hazard:

  Select Training Equipment Technical Data Human Error Misconduct Process Inadequate or Faulty Leadership/Supervision Other

  • Training
  • Equipment
  • Technical Data
  • Human Error
  • Misconduct
  • Process Inadequate or Faulty
  • Leadership/Supervision
  • Other

• Describe:

• Recommendations for Improvement/Compliance:

• Follow-Up Date:

  Date

• Supervisor or POC: (Rank and Name)

• Phone Number: (x0000)

FORMAL OUT-BRIEF

• Was the commander available for a formal out brief within 3 days after completion of inspection? (AFI 91-202_ANGSUP)

  Yes

  No

  N/A

• Date of Out-brief:

  Date

• Commander's Rank, Name, and Title

• Signature:

  Sign

• Reason for Commander not out-briefed?

• Appointee's Rank, Name, Title:

• Date of Out-brief:

  Date

• Signature:

  Sign

FORMAL REPORT

• Date of Formal Report Submission:

  Date

• Safety office representative rank and name:

• Signature:

  Sign

• TR- TRAINING: Inadequate training in: guidance/policy/procedure, training oversight, initial qualification training, hands-on training , controls/metrics of training process/progress, training evaluation, training documentation, individual(s) not qualified, not experienced enough to perform task.
  
  EQ- EQUIPMENT: Correct tools/equipment not available, unserviceable or not used, incorrect tool selection. Equipment defect or design flaw, inadequate equipment maintenance.
  
  TD- TECHNICAL DATA: Tech data, operating instruction, or checklist incorrect, conflicting, misleading, unavailable, overly complex , outdated. (If tech data is incorrect/conflicting, misleading or too complex, individual must generate AFTO 22 and submit copy to MXS supervision)
  
  HE- HUMAN ERROR: Used as last resort. When all equipment, technical data, training, and other factors are adequate. When another qualified technician would not have made the same error.
  
  MC- MISCONDUCT: When all equipment, technical data, training, and other factors are adequate. The technician is fully aware of all requirements, demonstrates task competency, and the process is correct as written. Another qualified technician would not have made the same error and there is clear evidence the technician consciously disregarded technical data and/or regulations.
  
  PI- PROCESS INADEQUATE OR FAULTY: Used when root cause analysis indicates all other root cause codes are not applicable. Established shop process for accomplishing the task is faulty and will be changed as a result of the root cause analysis.
  
  LS- LEADERSHIP/SUPERVISION: Ineffective communication, decision making process ineffective, involvement insufficient, physical work environment issue, failure to adequately program resources.
  
  OT- OTHER: Enter specific issues that cannot be linked to ROOT CAUSES above.

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