Job Safety Analysis Form

University: Team Name: Author Name: Author Email: Faculty Supervisor: Supervisor Email: Revision #: Revision Date:

Purpose of Experiment / Equipment: Briefly describe your Chem-E-Car’s design, intended mode for operation (source of power), intended mode for control (stopping), and major and their control.

Description of the car’s design:

Power source:

Stopping mechanism:

Hazards inherent in design and safety controls:

Expected Operating Conditions: : : Normal: Normal: Minimum: Minimum: Maximum: Maximum:

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Job Safety Analysis Form

1. Activity / Task (e.g. Chem-E-Car test)

Qualification/Training Required 1. Reading of MSDS sheets, 2. Chemical handling training

Hazardous Substances: 1. 2. 3.

Plant/Equip Required: 1. Beaker 100ml 2. Measuring cylinder 50ml 3. Model car etc.

Equipment Checks: 1. Car wheels are free moving 2. Stopping mechanism

2. Potential Hazards and/or High Work associated with the Activity/Task – Identify the safety equipment needed with the Activity/Task by placing a () next to it, and list the location of the safety equipment at your testing site. Safety Equipment Location Spill Response Supplies Location Fire Extinguisher: Spill Kit: Eyewash: Floor-Dri: Safety Shower: Spill Dikes: Telephone: Sodium Bicarbonate: Kit: Drain Plugs: Spill Containment Spill Pillows: Mercury Spill Kit:

Lab Coat Footwear Hard Hat Eyewear Gloves Hearing Face Shield Long Pants Long Sleeves 3. PPE to be Utilised:

        

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Job Safety Analysis Form

4. – Complete the risk assessment matrix for the operation of your Chem-E-Car. Consider each step required in operation starting from transferring your chemicals to the vehicle through to the disposal of the chemicals at the end of the test.

For details on how to determine the risk rating see Section Risk Matrix

Sequential Steps Hazards and Impacts Risk Rating Controls Risk Rating Owner List the basic task steps in a Identify the health and safety or environmental Rate the risk prior to Determine what actions are required to eliminate or minimise all Re-rate the sequential order. Hazards and Impacts associated with each step, controls being in hazards that could lead to an accident or environmental incident. with controls in action and examine each to determine the Risk Rating. place. Controls in this SWMS shall be monitored by our supervisors on site place. owner (Consequence and through our auditing and inspection program. (Consequence x x Likelihood)

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2 • •

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Job Safety Analysis Form

Sequential Steps Hazards and Impacts Risk Rating Controls Risk Rating Owner List the basic task steps in a Identify the health and safety or environmental Rate the risk prior to Determine what actions are required to eliminate or minimise all Re-rate the risk Control sequential order. Hazards and Impacts associated with each step, controls being in hazards that could lead to an accident or environmental incident. with controls in action and examine each to determine the Risk Rating. place. Controls in this SWMS shall be monitored by our supervisors on site place. owner (Consequence and through our auditing and inspection program. (Consequence x x Likelihood)

9 • •

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NOTE: Potential hazards you may want to think about:

Pressure, temperature, toxicity, flammability, reactivity/instability, hot and cold surfaces, electrical, arc welding, gas welding, lathe, milling machines, handheld power tools, drill press, other mechanical hazards, ionizing radiation, laser radiation, asphyxiates, open flame, biohazards etc.

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Job Safety Analysis Form

Chemical Information Page Chemical Reactions: For each chemical reaction that occur in your process provide; the chemical equation, species, stoichiometry and heat of reaction (if applicable).

Chemical Quantities: List chemical names, , and total quantity of chemical required for operation of vehicle.

Chemical State Chemical Name Total Quantity Solid, Liquid, Gas

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Job Safety Analysis Form

Chemical Properties: Provide information on all chemicals; including reactants, intermediates and products. Physical Incompatible Chemicals Flash Flammability Chemical Name State GHS Ratings List chemicals present within the laboratory, and Point Limits

S, L, G H F S Sp. any others that may come in contact. Temp. LFL UFL

GHS Ratings: H – Health, F – Flammability, S – Stability, Sp. – Special

Chemical Toxicology, Regulation and Disposal: List the same chemicals that appear above, in the same order. Toxicology Hazardous OSHA Personal Protective Equipment Chemical Name Waste Regulated Specific to this Chemical TWA PEL Other Number

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Job Safety Analysis Form

Biohazards: Provide details below on biological hazards that may occur during the design, development, preparation or competition phases of your car. Please list the biological hazards, the biohazard level, and a description of how these agents will be safety handled.

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Job Safety Analysis Form

Vehicle Primary Hazards : Then check the applicable means of control for each .

Hazard Criteria Control Pressure Pressure >7 kPa Must meet all requirements below: 1. Pressure gauge (to measure 2x MAOP) 2. Emergency relief device designed at < 1.1x MAOP. Relief sizing calculations and location must be provided. 3. Pressure certification – see Pressure Vessel Testing Protocol 4. Proper management system to prevent over or mis- charging. 5. All car components exposed to pressure must be certified to operate at pressure. Provide manufacturer’s pressure specifications. 6. No PVC, cPVC or polyethylene terephthalate (PETE or PET) plastics in pressure service 7. 7. Measurements or calculations of MAOP. See Chem- E-Car rules for more details on these requirements.

Note: MAOP means Maximum Achievable Operating Pressure

Toxic GHS toxicity rating ≥ 2 Doubly contained and handled properly.

Flammable GHS flammability rating ≥ 2 Doubly contained and handled properly

Reactive GHS instability / reactivity Doubly contained and handled properly. rating of 2 or 3. Rating of 4 is not allowed.

Temperature Exposed surface greater than Insulation or barrier to prevent contact. 65˚C or under 0˚C

Electrical Exposed wiring and Proper electrical insulation and connections provided. electrically energized components Alligator clips and twisted wire connections are not allowed – use binding posts or banana plugs for a more secure connection.

Mechanical Fast moving parts (meshing Guards present and adequate. gears, belts or chains)

Oxygen Components exposed to Certified for service. oxygen Thoroughly cleaned of contaminants as per instructions in rules – not used previously for other types of service.

Biohazards No biohazards greater than This is not allowed during the design, development, biohazard level 1 preparation or competition phases of your car.

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Job Safety Analysis Form

Restricted activities and vehicles Activity restrictions: All activities listed below are not allowed and will result in a disqualification from the Chem-E-Car competition.

Item (a) No transportation of chemicals to or from the competition. Chemicals will be provided by the organisers (b) Competitors must not store chemicals at the competition site

(c) No vehicle testing in hotel or dorm hallways, warehouses, or other facilities that are not designed for chemical handling. This includes your university and the competition site.

(d) All chemicals must be disposed of as stated by the MSDS. Chemical disposal will be provided by the host site.

Vehicles Restrictions: All of the items listed below are not allowed. Item Explanation (a) Flames and/or smoke Both inside and outside the vehicle, except for commercial internal combustion engines. See Chem-E-Car rules for using commercial internal combustion engines. (b) Liquid Discharge Liquid may not be discharged under normal operating conditions. (c) Open and/or improperly Containing chemicals a Globally Harmonized System of secured containers Classification and Labelling of Chemicals (GHS) rating of 2 or greater. No open containers allowed at the starting line or during the operation of your vehicle. All containers with these chemicals must have secure lids and must be secured to the vehicle. All containers brought to the starting line must have lids, be properly labelled, and proper personal protective equipment must be used.

(d) Chemical pouring at Chemicals with an NFPA rating of 2 or greater. Use a holding starting line vessel on vehicle, with valve, to load starting chemicals. (e) Regulated Chemicals A number of chemicals are listed by OSHA as a special hazard. See list below. OSHA has a special regulation for each chemical. See www.osha.gov for details. (f) Highly Reactive Any chemical, raw material, intermediate or product with an /Unstable Chemicals NFPA reactivity / instability rating of 4. (g) Hydrogen peroxide Hydrogen peroxide concentrations of greater than 30% are not allowed.

Regulated chemicals: , coal tar pitch volatiles, 4-nitrobiphenyl, alpha-napthylamine, methyl chloromethyl ether, 3,3'-dichlorobenzidine, bis-chloromethyl ether, beta-naphthylamine, benzidine, 4-aminodiphenyl, ethyleneimine, beta-propiolactone, 2-acetylaminofluorene, 4-dimethylaminoazo-benezene, n-nitrosodimethylamine, vinyl chloride, inorganic arsenic, benzene, 1,2-dibromo-3-chloropropane, acrylonitrile, ethylene oxide, formaldehyde, 4,4'- Methylenedianiline, 1,3-butadiene, methylene chloride.

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Job Safety Analysis Form

Risk Matrix To determine the risk rating use the table below by picking a likelihood and consequence rating. Direction on how to classify the consequence and likelihood ratings are provided in the tables further below.

Rating and descriptions Guide

5 Almost Certain Event is • Expected to occur once (or more) within 1 year, or expected to • > 75% probability of occurrence, or occur in most • Has occurred recently and likely to occur again. circumstances 4 Likely Event will • Will probably occur at sometime within the next 2 years, or probably occur • 51% - 75% probability of occurrence, or in most • Has a history of occurrence or could be difficult to control circumstances due to some external influences. 3 Possible Event should • Might occur at sometime within the next 5 years, or occur • 26% - 50% probability of occurrence at some time 2 Unlikely Event could • Could occur at sometime within the next 10 years, or occur at • 5% - 25% probability of occurrence. some time 1 Rare Event may • Improbable occurrence only in exceptional circumstances (i.e. occur only may only occur in more than 10 years), or in exceptional • < 5% probability of occurrence. circumstances

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Job Safety Analysis Form

Rating and descriptions Guide

5 Catastrophic Potential 1 or more fatalities (staff, contractors or member(s) of the public) disastrous impact on Significant destruction of key internal asset or third party operational property. Harm to the and/or cultural activities heritage that cannot be remediated 4 Major Significant Total permanent disability (staff or contractors). Multiple impact on hospitalisations, permanent disability and/or life operational threatening injuries affecting member(s) of the public. activities Significant damage to internal assets or third party property. Harm to the natural environment and/or cultural heritage with remediation difficult (multi-year management) 3 Severe Moderate impact Single permanent partial disability (staff or contractors). on operational activities Medical aid required for member(s) of the public. Some loss of or damage to third party property. Harm to the natural environment and/or cultural heritage that can be remediated (<1 year management). 2 Serious No material Medical treatment injury or lost time injury (staff or contractors). impact on operational On-site first aid to a small number of member(s) of the public, activities lost time. Harm to the natural environment and/or cultural heritage requiring minimal remediation (at the time of impact). 1 Minor Negligible Minimal impact on health & safety (staff, contractors impact on or member(s) of the public). operational activities Harm to the natural environment and/or cultural heritage requiring no active remediation and/or able to self-remediate.

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Job Safety Analysis Form

Consultation and Sign-off Record This form is to be used to verify that awareness in the relevant Job Safety Assessment (JSA) has been completed. Supervisors must have signed off on the assessment.

I confirm by my signature below, that I have attended a briefing on the requirements of the attached JSA and agree to perform the work in the manner detailed on it. I understand that when there is non-compliance with the attached JSA, work is stopped immediately, or when it is safe to do so, and not resumed until the JSA is complied with. I confirm that copies of the relevant MSDS's etc. have been reviewed.

NAME (Please print) SIGNATURE DATE

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