BY ORDER OF THE AIR FORCE PAMPHLET 91-215 SECRETARY ...

improvement and reengineering projects. These materials are excellent definitions of the baseline against
which change can be evaluated.
A2.A.8.7. COMMENTS. The change analysis is one of the most important hazard analysis tools. In
organizations with mature ORM processes, most, if not all, higher risk activities will have been subjected
to thorough ORM applications and the resulting risk controls will have been incorporated into operational
guidance. In this situation, the vast majority of day-to-day ORM activity is the application of change
analysis to determine if this particular operation has any unique aspects that have not been previously
analyzed. Only if specific changes are detected will it be necessary to apply any ORM procedures. If there
is no change, optimum procedures will already have been fully integrated in the established operational
guidance.
A2.A.8.8. EXAMPLES. An example of a change analyses is illustrated at Figures A2.17 and A2.18.
Figure A2.17. Example of Change Analysis.
Situation: The DO of an Air Force Reserve flying organization has observed
evidence of what he considers “loose” flying over the last several days. He decides
to use a change analysis to assess changes in the unit that may have led to this
deterioration in flying performance He uses the change analysis worksheet
illustrated earlier (Figure A2.16) to make this assessment.
Result: Notice how the change analysis (Figure A2.18) reveals both planned and
unplanned changes. Notice also how the worksheet brings all the changes into focus
in context with each other. Any one of these changes are significant but not
particularly unusual. When all of them are viewed in the context of the worksheet,
the cumulative impact of all of the changes becomes apparent. The very probable
cause of the “loose” flying is the optempo and resulting mental and physical stress
on pilots. It is likely that a DO would intuitively be aware of many, if not all, of
these factors. The role of the change analysis is to assemble the changes in a format
where their cumulative impact is readily apparent. This situation is a good example
where the impact of the individual changes is considerably greater than the sum of
their individual impacts and only by considering all of the changes at one time can
the real risk issue be understood.
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