Individual Off-Duty Risk Assessment Form |
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Effective risk management requires the elimination of risk-taking behaviors. These behaviors result in human error, the largest single component of mishaps. First-line supervisors are in the best position to help eliminate human error. They are aware of day to day events and stressors that affect the way people perform and can intervene by counseling individuals. The IRA Off-Duty Self Assessment Form helps quantify off-duty risk potential and focus on intervention and prevention strategies. We recommend using the attached form to identify and counsel people before a major holiday. Not all questions apply to every situation. Select those that are applicable and discard the others. Use the form as a catalyst for honest, frank discussion and counsel individuals at risk. To ensure questions are correctly answered, look them over and discuss inconsistencies. Assurance of privacy is a must. Questions are designed to assess behavioral factors and indicators that are related to human error mishaps. They range from biographical factors and work performance to risk-taking behaviors. One point is given for a "yes" answer. A maximum of 26 points can be scored. The higher the points, the greater the risk. Options:
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DIRECTIONS FOR USE OF FORM Score ranges: Low risk (0-5 points), Medium risk (6-14), and High risk (15-26). Supervisor will discuss results with interviewee and may discuss results with the chain of command for the purpose of the individual's welfare. A record may be made of counseling, however, form is property of interviewee only and will not be retained by the command or supervisor. Information or statements made to the supervisor concerning items on this form CANNOT be used in any adverse proceeding, administrative or criminal. |
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