Downloaded from https://www.everyspec.com Legend for Figure 4-2; Instructions for completion of DA Form 4756 Block 1. Obtain from Directorate of Engineering and Housing (DEH). Block 2. Self-explanatory. Block 3. Enter date when plan is amended. Block 4. Enter name of unit, and installation which hazard was found. Block 5. Enter building number and room number location. Block 6. Enter risk Assessment Code (RAC) (chap 3). Block 7. State specific OSHA, Army, or other recognized safety and occupational standards violated. Block 8. Describe project details necessary to abate the hazard to an acceptable level. Block 9. Self-explanatory. Block 10. Self-explanatory. Block 11.
Explain interim measures supervisors and employees maintain until hazard is abated to an acceptable level. Block 12. Include points of contact in DEH, Safety Office, and others as appropriate. Block 13. Enter initial estimate of final abatement date; update as required. Figure 4-2. Sample DA Form 4756 18 AR 385–10 • 29 February 2000