GI-STAR - Safety Inspection Database (Beta)
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Date of Inspection:
Facility Inspected:
Higher HQ Responsible for Facility (level 1):
Higher HQ Responsible for Facility (level 2):
Higher HQ Responsible for Facility (level 3):
Inspector:
Facility Personnel Accompanying Inspector:
Number of Deficiencies identified during inspection
RAC1:
RAC2:
RAC3:
RAC4:
RAC5:
REPEAT:
Overide
:
  • a.
  • b.
  • c.
  • d.
  • e.
  • f.
  • g.
  • h.
  • i.
  • j.
Comments:
Corrective Action:
RAC:
:
Risk Assessment Code Matrix and Terms
Accident Probability
Hazard Severity A B C D E
I 1 1 2 3 5
II 1 2 3 4 5
III 2 3 4 5 5
IV 3 4 5 5 5
Hazard Severity
Category Description Definition
I Catastrophic Death or permanent total disability, system loss, major property damage.
II Critical Permanent partial disability or temporary total disability in excess of 3 months, major system damage, significant property damage.
III Marginal minor injury, lost workday accident or compensable injury or illness, minor system/property damage.
IV Negligible First Aid or minor supportive medical treatment
Accident Probability
Level Description Definition
A Frequent Liekly to occur frequently in the life of the system, facility, etc.
B Probable Will occur several times in the life of item.
C Occasional Likely to occur some time in the life of item
D Remote Unlikely, but possible to occur in the life of item.
E Improbable So unlikely it can be assumed occurrence may not be experienced.

Reports

RAC Stats

RAC1 RAC2 RAC3 RAC4 RAC5
RACs 1-2 Total
RACs 3-5 Total
RAC 1
:
Repeat
Comment
Corrective Action
 

RAC 2
Repeat
Comment
Corrective Action
 


Brigade Statistics

Brigade Overall Brigade Compliance

Input Rollup

Location Date Inspected Unit Overall Compliance REPEATS
COMPLIANCE BY QUESTION
REPEATS BY QUESTION

Date of Inspection:
Facility Inspected:
Higher HQ Responsible for Facility (level 1):
Higher HQ Responsible for Facility (level 2):
Higher HQ Responsible for Facility (level 3):
Inspector:
Facility Personnel Accompanying Inspector:

Inspected Areas:
Section
Number of Deficiencies identified during inspection
RAC1:
RAC2:
RAC3:
RAC4:
RAC5:
REPEAT:
Risk Assessment Code Matrix and Terms
Accident Probability
Hazard Severity A B C D E
I 1 1 2 3 5
II 1 2 3 4 5
III 2 3 4 5 5
IV 3 4 5 5 5
Hazard Severity
Category Description Definition
I Catastrophic Death or permanent total disability, system loss, major property damage.
II Critical Permanent partial disability or temporary total disability in excess of 3 months, major system damage, significant property damage.
III Marginal minor injury, lost workday accident or compensable injury or illness, minor system/property damage.
IV Negligible First Aid or minor supportive medical treatment
Accident Probability
Level Description Definition
A Frequent Liekly to occur frequently in the life of the system, facility, etc.
B Probable Will occur several times in the life of item.
C Occasional Likely to occur some time in the life of item
D Remote Unlikely, but possible to occur in the life of item.
E Improbable So unlikely it can be assumed occurrence may not be experienced.

Overide
:
  • a.
  • b.
  • c.
  • d.
  • e.
  • f.
  • g.
  • h.
Comments:
Corrective Action:
RAC:
:
Facility Inspection Follow-Up Procedures
A copy of this inspection will be located on the Safety GKO site. You can access this inspection and all others conducted by the Safety Office at the links below:
https://gko.portal.ng.mil/states/SC/CMDGRP/SpecialStaff/Safety/Shared%20Documents/Forms/AllItems.aspx?RootFolder=%2Fstates%2FSC%2FCMDGRP%2FSpecialStaff%2FSafety%2FShared%20Documents%2FFY%2019%20Safety%20Inspection%20Results&FolderCTID=0x012000222657D952343747BA8B80AC210F8171&View=%7BD0E28655%2D591C%2D47B6%2D8D57%2D4063ED3C4D50%7D

All violations of standards detected during the facility inspection will be entered on DA Form 4754 (Violation Inventory Log) or the equivalent Spreadsheet (\\NGSCA7-120-01\NETWORK\TAG-AV\PUBLIC\SAFETY\FORMS\DA FORM 4754 SPREADSHEET.xlsx). This log will be used to monitor compliance. It will show all violations in order of discovery and prescribe an abatement date. This should be a continuous log that captures past facility deficiencies, so please update the log that was completed last year. The excel spreadsheet is the preferred form, as it allows for expansion, additional notes, and alteration. Please ensure that work orders are submitted for any deficiencies that require a work order. Indicate the identified Risk Assessment Code (RAC) on the work order request. Please note that completion of a Commander's Acknowledgement Memorandum is also a requirement. A sample memorandum and blank response documents are located on the Safety Office GKO site at the link provided below:
https://gko.portal.ng.mil/states/SC/CMDGRP/SpecialStaff/Safety/Shared%20Documents/Facility%20Safety%20Inspection%20Response%20Documents

Additional information is also included in the memorandum that serves as the cover for the inspection checklist.

Send the response to the Safety Office group email at: ng.sc.scarng.list.ngscarng-safety-office@mail.mil.


Contact the Safety Office if there are any questions or concerns. Thanks.