Appendix

APPENDIX A

HOISTING EQUIPMENT DATA SHEET

EQUIPMENT TYPE: __________________________________________

MANUFACTURER: __________________________________________

MODEL#_____________ SERIAL#__________

LOAD RATING: __________________________________________

EQUIPMENT I.D.: __________________________________________

INTENDED USE: __________________________________________

LOCATION OF EQUIPMENT

CERTIFICATION/TESTING

DATA: __________________________________________

APPENDIX B

HOISTING EQUIPMENT

IDENTIFICATION TAG

TYPE: ___________________________________________

I.D. # ___________________________________________

DATE OF ARRIVAL AT

THE APS: ___________________________________________

SAFETY Coordinator:

(SIGNATURE AND DATE) ___________________________________________

APS FLOOR COORDINATOR:

(SIGNATURE AND DATE) ___________________________________________

DATE IN SERVICE: ___________________________________________

NEXT INSPECTION DATE: ___________________________________________

APPENDIX C

CRANE OPERATOR QUESTIONNAIRE

Date ____________________

Operator _______________________________________ CAT __________________

Telephone __________________________

Supervisor _________________________________________

Briefly describe the type/s of lifting device/s to be used and the expected weightloads.

Lifting Device Weight Load

_________________________________________________________________

Operator training/experience operating a crane or other lifting device:

Date/Description of Training:

__________________________________________________________________________

___________________________________________________________________________

I certify that, to the best of my knowledge, I have normal depth perception, field of vision, reaction time, manual dexterity, and coordination, and do not have a detectable or known disease or physical malfunction that would render me incapable of safe operation or rigging duties.

__________________________________

Candidate's signature

LOM Laboratory Inspection Checklist for 432/A020 and 432/A030

Date: ____ / ____ / ____

General
Status	Criterion	Comment
	General housekeeping
	Required hazard warnings are posted at entrance(s)
	MSDS binder is in place at the main entrance to laboratory
	LOM Laboratory Information Binder is in place at the main entrance to laboratory
	The contact information on the cover sheet of the LOM Laboratory Information Binder is current
	List of authorized laboratory users is posted at entrances
	Paths of egress are free of obstructions
Electrical Safety
Status	Criterion	Comment
	Lights in hoods are protected from vapors
	Circuits and circuit breakers are labeled
	Extension cord usage is minimized
	Extension cords are not connected in series
	Circuits are not overloaded with extension cords or multiple connections
	Heating apparatus is equipped with redundant temperature controls

Fire Safety
Status	Criterion	Comment
	All flammable liquids not in use are stored in flammable-liquids storage cabinets
	Excessive quantities of flammable material stocks are not present
	Oxidizers and other incompatible materials are not present in flammable-liquid storage cabinets
	There are at least two well-marked means of egress from laboratory, each clear of obstructions
	Class ABC fire extinguisher is located along path of egress, and not obscured or obstructed
	Flammable materials are not stored along paths of egress from laboratory
	Refrigerators used for flammables are flammable material storage units or are explosion-proof
	UL-approved electrical equipment is used in locations/operations involving flammable liquids
Chemical Handling
Status	Criterion	Comment
	Chemicals are stored according to compatibility in appropriate storage cabinets
	All chemicals are stored at safe levels in cabinets or on stable shelving
	Stored quantities of chemicals are not excessive
	All containers are appropriately labeled (contents, warnings, bar codes)

Chemical Handling (cont)
Status	Criterion	Comment
	Containers holding ethers and other compounds with safe shelf life are labeled with latest date for disposal
	Gas cylinders are strapped firmly in place
	Gas cylinders are not in use are capped
	Gas cylinders of oxidizing and reducing agents are properly segregated
	Glass vacuum is vessel taped
	All work generating toxic and hazardous fumes done in hoods
	Apparatus susceptible to damage is marked with warning signs or protected by barriers
	Chemical waste log is current, bearing notations indicating inspections have been performed on each waste container
	Chemical waste is labeled and stored in designated Satellite Accumulation Areas according to compatibility and class
Ventilation
Status	Criterion	Comment
	Laboratory at negative pressure with respect to corridors
	Fume-generating apparatus at least 20 cm (8 inches) back from face of hood
	Fans and other equipment capable of creating cross-drafts are kept at a sufficient distance from hood operations
	Local exhaust units are used where hoods are not suitable or available
	Air-flow indicator on chemical fume hood appears to be functioning properly

Ventilation (cont)
Status	Criterion	Comment
	Label on chemical fume hood indicates that hood performance has been checked within the last twelve months
	VAV chemical fume hood/room supply (make-up) air interface appears to be functioning properly
Safety Equipment
Status	Criterion	Comment
	Eye wash station is available and inspections are current
	Deluge shower is available and inspections are current
	Supply of personal protective equipment is adequate
Program Administration
Status	Criterion	Comment
	Deficiencies noted during last inspection communicated to persons responsible for correction.
	All activities posing significant safety or health risks are covered by written procedures that have been reviewed with the intent to ensure that they incorporate adequate warnings and specify adequate protective measures.

Listing of Hazardous Chemicals and Wastes

HAZARDOUS CHEMICALS (AS DEFINED UNDER 29 CFR 1910.1200)

Name of Substance(s) (As identified on container label and MSDS.)	CAS No(s).	Common Synonyms

HAZARDOUS WASTES (AS DEFINED UNDER RCRA)

Name of Substance(s) (As identified on container label and MSDS.)	CAS No(s).	Location of Waste Containers

DND-CAT Safety Committee Annual ES&H Inspection Criteria

SECTOR NO. - BEAMLINE NO.- LOM LAB NO.- DATE -

SAFETY INSPECTION COMMITTEE CHAIR OR DESIGNEE -

Mark each item below as follows:

S (or checkmark) for Satisfactory

R for Requires follow-up (within 10 days)

U for Urgent response needed (within 1 day)

If all items in a category are satisfactory, circle “Satisfactory” in the category heading.

Satisfactory GENERAL

____________Are all exits and aisles unobstructed?

____________Are work areas clear and lab benches not overcrowded?

____________Do any potential tripping hazards exist?

____________Are equipment and materials stored safely?

____________Are containers for disposal of broken glass available?

____________Are waste containers labeled and in good condition?

____________Is glassware stored safely?

____________Are file cabinets/shelves secured to wall or tagged as unsecured?

____________Are gas cylinders secured properly?

____________Are any unusual noises or odors present?

____________Is overall housekeeping good?

____________Do waste logbooks document monthly inspections of Satellite Accumulation Areas?

____________Other:

Satisfactory SAFEGUARDS AND SAFE PRACTICES

____________Are off-hours instructions for unattended operation posted?

____________Is the safety handbook available?

____________Are protective shields in place if needed?

____________Are emergency shutdown procedures posted?

____________Are emergency shutoffs for house utilities and compressed gases

unobstructed?

____________Have you observed any unsafe acts or noncompliance with safety rules?

____________Are lab doors to corridors closed?

____________Does any equipment extend over the boundary lines marked on the floor? (Aisles must be unobstructed.)

____________Do any potential overhead hazards exist?

____________Is medical look-alike (lab ware) waste can available?

____________Is "sharps" disposal container available?

____________Do any illumination problems exist?

____________Is general ventilation acceptable?

____________Are vent purges set properly?

____________Is emergency door unobstructed?

____________Is emergency door unlocked?

____________Other:

Satisfactory PROTECTIVE EQUIPMENT

____________Is the safety cabinet stocked appropriately with applicable items from the following list?

________________Safety glasses

________________Gloves

________________Splash goggles

________________Face shields

________________Thermal gloves

________________Other:_____________________

Satisfactory EMERGENCY EQUIPMENT

____________Is access to fire extinguisher unobstructed?

____________Is fire extinguisher seal intact?

____________Are eye wash stations and safety shower inspected and unobstructed?

____________Other:

Satisfactory GENERAL LABELING

____________Are chemicals properly labeled and tagged?

____________Are cylinders properly labeled (tags on nonstock cylinders)?

____________If required, are "Hot" signs properly worded and clearly visible?

____________If required, are "Radioactive" signs properly worded and clearly visible?

____________If required, are "HIGH VOLTAGE" signs properly worded and clearly visible?

____________If required, are other signs properly worded and clearly visible?

____________If required, are over-temperature alarms installed?

On which units?

____________If required, are other alarms installed?

On which units?

____________Are electrical panels and other electrical shut-off switches properly labeled?

____________ Other:

Satisfactory MECHANICAL

____________Are all devices mechanically stable (suitable base for height and weight and anchored to floor, if appropriate)?

____________Are there any stored energy hazards?

________________Gravity

________________Spring

________________Vacuum

________________Pressure

________________Other : ____________________________________

____________If required, are overpressure alarms installed?

On which units?

____________Are equipment/shelves/cabinets secured properly?

____________Are cabinet tops free of stored items, as required by APS?

____________Are any sharp edges present?

____________Are there any unmarked or unprotected protruding objects?

_______________ Hazard removed

_______________ Safety guard recommended

_______________ Other recommendations: ________________________

Satisfactory ELECTRICAL

____________Are power strips secured?

____________Are any faulty or frayed wires present?

____________Are any electrical boxes open?

____________Are any electrical terminals exposed on instrumentation?

____________Is electrical equipment properly grounded?

____________Are any electrical circuits overloaded?

____________Are any ignition sources present?

____________Are GFCIs installed at appropriate locations?

____________Are posted signs adequate?

____________Are all the instruments/circuits adequately labeled?

____________Is access to electrical panels and other electrical shut-off switches unobstructed?

____________Do any lighting problems exist?

Satisfactory PIPING PRACTICES

____________Are any inspections of regulators or relief valves out of date?

____________Are rotameters and sight glasses properly shielded?

____________Are the proper size catch pans in use?

____________Are house utility systems protected?

Satisfactory VENTILATION

____________Are inspections and tests of toxic gas monitors up to date?

____________Are hood doors closed when not in use?

____________Is local exhaust used, if needed?

____________Has hood or vent been inspected and labeled within the last year by the Industrial Hygiene Section of ANL ESH or by Building Maintenance?

____________If required, are hood failure alarms installed?

On which units?

____________Are hoods being used in accordance with their classification?

Type 1 - Moderately to highly toxic materials

Type 2 - Low toxic materials and fumes

____________Other:

Satisfactory HAZARDOUS MATERIALS

(Acids, Bases, Oxidizers, Toxics, Carcinogens, etc.)

____________Are chemicals properly stored and labeled?

____________Are incompatible chemicals properly segregated?

____________Are peroxide formers and other compounds subject to hazardous decomposition labeled to show date received?

____________Are peroxide formers no more than 6 months old?

____________Is chemical tag system properly used?

____________Is chemical inventory list available and up to date?

____________Other:

Satisfactory FLAMMABLE AND COMBUSTIBLE LIQUIDS

____________Are all aerosol sprays with flammable propellants stored in flammable-liquid storage cabinets?

____________Is the storage cabinet inventory up to date?

____________Are glass bottles stored in catch pans?

____________Are electrically conductive containers that are used for transferring flammable liquids grounded and bonded?

____________Other:

Satisfactory RADIATION PROTECTION SAFEGUARDS

____________Is beamline shielding in place? (Use separate checklist.)

____________Are beamline padlocks secured?

____________Is FOE and Experimental Station shielding in place? (Use separate checklist.)

____________Are FOE and Experimental Station interlocks undisturbed, per visual inspection?

____________Are FOE and Experimental Station emergency beam dump buttons unobstructed?

____________Has a beamline radiation survey been done within the past month?

____________Other:

ADDITIONAL COMMENTS:

DND-CAT Safety Coordinator Monthly ES&H Inspection Criteria

SECTOR NO. _______BEAMLINE NO.-________ LOM LAB NO.-_________DATE -

SAFETY INSPECTION COMMITTEE CHAIR OR DESIGNEE - ___

Mark each item below as follows:

S (or checkmark) for Satisfactory

R for Requires follow-up (within 10 days)

U for Urgent response needed (within 1 day)

If all items in a category are satisfactory, circle “Satisfactory” in the category heading.

Satisfactory GENERAL

____________Are all exits and aisles unobstructed?

____________Do any potential tripping hazards exist?

____________Are containers for disposal of broken glass available?

____________Are waste containers labeled and in good condition?

____________Are file cabinets/shelves secured to wall or tagged as unsecured?

____________Are gas cylinders secured properly?

____________Do waste logbooks document monthly inspections of Satellite Accumulation Areas?

____________Other:

Satisfactory SAFEGUARDS AND SAFE PRACTICES

____________Are off-hours instructions for unattended operation posted?

____________Is the safety handbook available?

____________Are protective shields in place if needed?

____________Are emergency shutdown procedures posted?

____________Are emergency shutoffs for house utilities and compressed gases

unobstructed?

____________Are lab doors to corridors closed?

____________Does any equipment extend over the boundary lines marked on the floor? (Aisles must be unobstructed.)

____________Is medical look-alike (lab ware) waste can available?

____________Is "sharps" disposal container available?

____________Are vent purges set properly?

____________Is emergency door unobstructed?

____________Is emergency door unlocked?

____________Other:

Satisfactory PROTECTIVE EQUIPMENT

____________Is the safety cabinet stocked appropriately with applicable items from the following list?

________________Safety glasses

________________Gloves

________________Splash goggles

________________Face shields

________________Thermal gloves

________________Other:_____________________

Satisfactory EMERGENCY EQUIPMENT

____________Is access to fire extinguisher unobstructed?

____________Is fire extinguisher seal intact?

____________Are eye wash stations and safety shower inspected and unobstructed?

____________Other:

Satisfactory GENERAL LABELING

____________Are chemicals properly labeled and tagged?

____________Are cylinders properly labeled (tags on nonstock cylinders)?

____________If required, are "Hot" signs properly worded and clearly visible?

____________If required, are "Radioactive" signs properly worded and clearly visible?

____________If required, are "HIGH VOLTAGE" signs properly worded and clearly visible?

____________If required, are other signs properly worded and clearly visible?

____________Are electrical panels and other electrical shut-off switches properly labeled?

____________ Other:

Satisfactory MECHANICAL

____________Are all devices mechanically stable (suitable base for height and weight and anchored to floor, if appropriate)?

____________Are there any stored energy hazards?

________________Gravity

________________Spring

________________Vacuum

________________Pressure

________________Other : ____________________________________

____________If required, are overpressure alarms installed?

On which units?

____________Are equipment/shelves/cabinets secured properly?

____________Are cabinet tops free of stored items, as required by APS?

____________Are any sharp edges present?

____________Are there any unmarked or unprotected protruding objects?

_______________ Hazard removed

_______________ Safety guard recommended

_______________ Other recommendations: ________________________

Satisfactory ELECTRICAL

____________Are power strips secured?

____________Are any faulty or frayed wires present?

____________Are any electrical boxes open?

____________Are any electrical terminals exposed on instrumentation?

____________Is electrical equipment properly grounded?

____________Are all the instruments/circuits adequately labeled?

____________Is access to electrical panels and other electrical shut-off switches unobstructed?

Satisfactory PIPING PRACTICES

____________Are any inspections of regulators or relief valves out of date?

____________Are rotameters and sight glasses properly shielded?

Satisfactory VENTILATION

____________Are inspections and tests of toxic gas monitors up to date?

____________Are hood doors closed when not in use?

____________Are hoods being used in accordance with their classification?

Type 1 - Moderately to highly toxic materials

Type 2 - Low toxic materials and fumes

____________Other:

Satisfactory HAZARDOUS MATERIALS

(Acids, Bases, Oxidizers, Toxics, Carcinogens, etc.)

____________Are chemicals properly stored and labeled?

____________Are incompatible chemicals properly segregated?

____________Are peroxide formers and other compounds subject to hazardous decomposition labeled to show date received?

____________Is chemical inventory list available and up to date?

____________Other:

Satisfactory FLAMMABLE AND COMBUSTIBLE LIQUIDS

____________Are all aerosol sprays with flammable propellants stored in flammable-liquid storage cabinets?

____________Is the storage cabinet inventory up to date?

____________Are glass bottles stored in catch pans?

____________Are electrically conductive containers that are used for transferring flammable liquids grounded and bonded?

____________Other:

Satisfactory RADIATION PROTECTION SAFEGUARDS

____________Is beamline shielding in place? (Use separate checklist.)

____________Are beamline padlocks secured?

____________Is FOE and Experimental Station shielding in place? (Use separate checklist.)

____________Are FOE and Experimental Station interlocks undisturbed, per visual inspection?

____________Are FOE and Experimental Station emergency beam dump buttons unobstructed?

____________Has a beamline radiation survey been done within the past month?

____________Other:

ADDITIONAL COMMENTS:

SHOP INSPECTION CHECKLIST

The following items will be checked each month by the Shop Coordinator, who will ensure that all observed deficiencies are corrected and will file this checklist with the secretaries of the CATs that occupy LOM____ (insert building number).

S (or checkmark) for Satisfactory
R for Requires follow-up (within 10 days)
U for Urgent response needed (within 1 day)

	“Safety Glasses Required” signs are posted at all entrances
	Supply of visitors’ safety glasses is adequate
	List of approved machine operators is displayed
	Machine guards are in place
	Belts are in good condition
	Safety shields are in place
	Safety shield windows are clean and clear
	Machines are free of debris
	Power switches are unobstructed
	Unobstructed access to emergency power disconnects
	Machines have adequate working area and room to allow operator to step back in an emergency
	Clamping mechanisms are in good operating condition
	All special tools for machine operation are properly stored at machine
	Machines are operating within manufacturers’ safety specifications
	Aisles to exit doors are unobstructed
	No tripping hazards are present
	Power cords are properly secured
	Intact insulation on power cords
	Lighting is adequate
	Machines are anchored to floor
	Neat and orderly shop (general housekeeping)