Incident Action Plan Safety Analysis (ICS 215A)

1. Incident Name:	2. Incident Number:
3. Date/Time Prepared: Date: Time:	4. Operational Period: Date From: Date To: Time From: Time To:
5. Incident Area	6. Hazards/Risks	7. Mitigations
8. Prepared by (Safety Officer): Name: Signature:
Prepared by (Operations Section Chief): Name: Signature:
ICS 215A	Date/Time: