<p> ATAP Hazards, Equipment, and Authorizations Review Form</p><p>1. Location Information: Building: ______Room: ______Date Reviewed: ______</p><p>Reviewers______</p><p>2. Project Information ATAP Program ______</p><p>WPC Project______WPC Project Lead ______</p><p>WPC Activity______WPC Activity Lead ______</p><p>Area Safety Lead ______</p><p>Other Assigned Personnel______</p><p>Description/ Notes: ______</p><p>3. Summary: This experiment/operation requires:</p><p>__ Authorization through WPC Activities. __ Other Formal authorizations as listed below. __ Inclusion of chemicals in Chemical Management System __ Inclusion of hazards in Hazards Management System. __ Inclusion of lasers in Laser Inventory. </p><p>__ Inform Area Safety Lead for inclusion of hazards and controls on door placards. </p><p>November 2014 4. Hazard Information</p><p>Hazard Formal Authorization Comments</p><p>__Biohazards – Contact EHS for further guidance. pathogenic/opportunistic organisms, recombinant DNA, cell cultures, human blood or body fluids; human or animal subjects __Chemicals __Hazard Evaluation required for May require Hazard – Health Hazard toxic, reactive; pyrophoric; chemicals Evaluation by Industrial carcinogenic, reproductive toxin, possessing lethal or incapacitating Hygiene. sensitizer, corrosive toxicity, whenever glovebox is required for safety, or whenever Notify EHS Environmental __Physical Hazard reactive (e.g. alkali metals, peroxide formers, failure of other primary engineering Services of any equipment explosives), pyrophoric controls would result in a significant containing > 42 gallons of oil; __Oil Spill any equipment exposure or safety hazard secondary containment is containing > 42 gallons of oil __Risk Assessment for quantities required. that could pose a human health or environmental risk if released. Increase in quantity or hazard __ SPCC Plan inclusion in LBNL may impact categorization of SPCC Plan for equipment building and emergency containing > 55 gal. oil planning. __Compressed Gas __Engineering Safety Note and/or May require Hazard __ Inert pressure and/or oxygen __Hazard Evaluation required for: Evaluation by Industrial displacement  Any pressure system with Hygiene. __ Physical Hazard flammable, >75,000 lb-feet stored energy, pyrophoric, reactive (not including cylinders); Increase in quantity or hazard __Health Hazard toxic,  Flammable >2 full size may impact categorization of carcinogenic, reproductive toxin, cylinders (400 cu. ft.) per room; building and emergency sensitizer, corrosive  any pyrophoric, reactive or planning. health hazard gases; or  any potential oxygen deficiency</p><p>__Confined Space __Confined Space Permit See also Working Alone required for Administrative or below. Permit-Required Confined Space</p><p>__Cryogens __Hazard Evaluation required for May require Oxygen __ Mobile usage stored energy greater than 75,000 Deficiency Hazard evaluation __Installed system ft-lb or where there is a possibility by Industrial Hygiene. of asphyxiation (e.g., confined or unventilated space) Increase in quantity or hazard may impact categorization of building and emergency planning.</p><p>November 2014 Hazard Formal Authorization Comments</p><p>__ Digging or Surface __Penetration Permit required for See HMS for legacy radiation Penetration any penetration of concrete, or information. other surfaces > 1 1/2” __Electrical To be determined in consultation Evaluation required for non- __exposure to >50V and >5mA with EHS Liaison and Electrical NRTL equipment. Electrical Safety Subject Matter Expert. work requires authorization __ high voltage / high energy -- >100V or 10kW from the employee’s __repair, assembly, testing __Approved LOTO procedure is supervisor (see Health & __ work requiring LOTO required for LOTO of 2 or more Safety Manual, Section __non-NRTL equipment sources of energy. 8.8.2). See also Working Alone below. __Environmental Depends upon specific permit; Notify EHS Environmental contact EHS Environmental Services of all equipment releases– – __air emissions Services group for assessment. containing > 42 gallons of oil. __wastewater treatment or discharge __spill capable of causing damage or permit violation __Ergonomic issues – Recommend contacting EHS __lab/industrial Ergonomist for evaluation. __ computer workstation __Lasers __LSO Evaluation required for Laser eye exam and training __ Class 1,2, 3a Class 3b or 4 required. __ Class 3b or 4 __Lead See Ionizing Radiation below. __Shielding __>5 Bricks __Machine Tools Authorization from Shop __ machine shop Manager and PI/Work Lead. __ lab equipment See also Working Alone below. __Material Handling __Critical Lift Procedure required Training/certification required __manual lift > 50 lbs or for high value/consequence lifts for crane or industrial truck repetitive __Engineering Safety Note operation __ forklift/industrial truck required for custom-built or modified __ crane/hoist lifting fixtures __Non-Ionizing Radiation Contact Subject Matter > background outside Expert for evaluation. enclosure __ infrared __ ultraviolet __ RF & Sub-RF __ microwaves</p><p>November 2014 Hazard Formal Authorization Comments</p><p>__Non-Ionizing Radiation Contact Subject Matter -- Magnetic Fields > 5 Gauss Expert for evaluation. 5 outside enclosure Gauss field area must be marked. __Pressure >150 psi (not __Engineering Safety Note and Radioactive contents: see including gas cylinders) or 1500 ___EHS Evaluation required for Ionizing Radiation below. psig (liquid) or large volume  Non-commercial or __non-commercial or modified modified pressure vessel; pressure vessel  Stored energy greater than 75,000 ft-lb (not including gas cylinders);  Pressure >150 psig (gas) or 1500 psig (liquid);</p><p>__Radiation – Prompt __Radiological Work Contact EHS Radiation Ionizing Authorization or __X-Ray Safety for evaluation of all Authorization or __Low Dose radiation-producing Machine Authorization may be equipment and required (contact Health Physicist). documentation of __Safety Analysis Document and accelerator / non-accelerator Accelerator Readiness Review status determination. may be required for Accelerators (contact DOE representative) __Radiation – Ionizing __Radiological Work Increase in quantity or hazard Isotope Authorization or __Radiological may impact categorization of Work Permit required for any building and emergency amount planning. __Radiation – Ionizing __Sealed Source Authorization Increase in quantity or hazard Sealed Source required for all amounts may impact categorization of building and emergency planning. __Subcontractors __Subcontractor JHA performing hands-on work __Thermal joining or __ Hot Work/Open Flame Permit cutting – welding, soldering, (Fire Department) required for open silver soldering, brazing flame or arc __Thermal - e.g., oven, furnace, heat tape __Vacuum—stored energy > __ Engineering Safety Note 75,000 ft.-lb. __ EHS Hazard Evaluation</p><p>November 2014 Hazard Formal Authorization Comments</p><p>__Waste – hazardous, mixed __Satellite Accumulation Area or radioactive; medical/bio required for <55 gallons; __Waste hazard waste Accumulation Area required for >55 gallons __Working alone – hazards Document restrictions in WPC that remain after controls could Activity work authorization incapacitate a person so that he/she cannot self-rescue or activate emergency services __Other Hazards Contact EHS Liaison</p><p>5. Equipment Information</p><p>Equipment Comments __Autoclave __Approved Storage Cabinet (flammables, toxic gas, biohazard) __Clean Room (portable) __Crane, Hoist (not maintained by Facilities) __Ultracentrifuge Other</p><p>6. Environmental Performance</p><p>Environmental Comments Performance Waste Reduction Emissions Reduction Resource Conservation</p><p>November 2014 </p>