Rev 10/16/06

IH60500 Content of Attachment 9.2 for editing:

+---------------+------------------------------------------------------+
| **Item Name** | **Description / Example of appropriate level of      |
|               | documentation**                                      |
+===============+======================================================+
| **1. Assign   |                                                      |
| the Project   |                                                      |
| Number        |                                                      |
| (completed by |                                                      |
| Sampler)**    |                                                      |
+---------------+------------------------------------------------------+
| Survey Title  | One line description of the survey event that        |
|               | identities the hazard and location. Example: *Lead   |
|               | surface wipe sampling in Building 120*               |
+---------------+------------------------------------------------------+
| Survey \#     | Unique identifier number used by sampling            |
|               | organization to track field sampling work.           |
+---------------+------------------------------------------------------+
| **2. Describe |                                                      |
| the Event     |                                                      |
| (completed by |                                                      |
| Sampler)**    |                                                      |
+---------------+------------------------------------------------------+
| First & Last  | Identify person sampled [and]{.underline} other      |
| Name of       | potentially exposed personnel or personnel           |
| Employee(s) & | represented by sampling data (i.e. similar exposure  |
| Life Numbers  | group). Example: *This sampling was done on plumber  |
|               | John Doe (BNL 9999). Also represented on this day by |
|               | the results was his companion plumber on the task    |
|               | Mary Smith (BNL 8888). Also represented by this type |
|               | monitoring are other plumbers of Plant Engineering   |
|               | who are assigned to periodic maintenance of the XYZ  |
|               | unit boiler.*                                        |
+---------------+------------------------------------------------------+
| Supervisor    | Name of management/supervisory personnel responsible |
|               | for the operation. Example: *John Doe of EENS is the |
|               | owner of the equipment. Mary Smith is the supervisor |
|               | of work group assigned to perform the episodic       |
|               | replacement of the unit's window.*                   |
+---------------+------------------------------------------------------+
| Task Done     | Describe the operation and associated work           |
|               | activities/tasks Example: *The work consisted of wet |
|               | rag wiping of 124 lead brick to remove oxidation,    |
|               | wrapping them with plastic tape, and stacking the    |
|               | bricks on a pallet for shipment.*                    |
+---------------+------------------------------------------------------+
| Hazard        | List the types and sources of potential health       |
|               | hazards (e.g., chemical, physical, or biological     |
|               | agents and ergonomic stressors). Provide the exact   |
|               | name of chemicals/hazards sampled and other hazards  |
|               | represented by the sampling.                         |
+---------------+------------------------------------------------------+
| Date of       | Mm/dd/yyyy                                           |
| sampling      |                                                      |
+---------------+------------------------------------------------------+
| Time of Day   | Military Time that the work occurred.                |
+---------------+------------------------------------------------------+
| Task          | State whether the sampling captures an everyday      |
| frequency     | occurrence, routine event, periodic event, or        |
|               | one-time event. State the frequency of occurrence.   |
|               | Example: *This was a one time event during the       |
|               | preparation for demolition of the building.*         |
+---------------+------------------------------------------------------+
| Task Normalcy | State whether the sampling captures the route of     |
|               | exposure on a typical day or an emergency, spill,    |
|               | accident, unplanned event, etc. Example: *This       |
|               | operation represents a frequent event in the         |
|               | maintenance cycle of the pump. It is performed       |
|               | typically every 40 to 60 days in a similar manner to |
|               | the work done during sampling.*                      |
+---------------+------------------------------------------------------+
| Exposure      | State whether the exposure represents typical        |
| Pattern       | exposure patterns, in terms of frequency, duration,  |
| Normalcy      | intensity, etc. Example: *This operation was         |
|               | conducted in a similar manner to the way the work is |
|               | typically done. However, only two workers were used  |
|               | on this day and usually three workers participate.   |
|               | Exposure potential may be higher than typical.*      |
+---------------+------------------------------------------------------+
| Building      | BNL Building \#                                      |
+---------------+------------------------------------------------------+
| Location      | Location within the building such as room number.    |
|               | Provide additional detail on area within a room as   |
|               | appropriate.                                         |
+---------------+------------------------------------------------------+
| Organization  | 2-digit abbreviation                                 |
| Name          |                                                      |
+---------------+------------------------------------------------------+
| Ind           | Does exposure occur in a closed in area or outdoors. |
| oors/outdoors | If outdoors, state the weather during sampling,      |
|               | including temperature and wind speed and direction). |
|               | Example: *This operation was conducted outdoors on a |
|               | very windy day. The workers were upwind of the       |
|               | source so exposure potential may be lower than       |
|               | typical.*                                            |
+---------------+------------------------------------------------------+
| Worker        | State if the worker(s) were sampled at the location  |
| location      | of typical operation. Example: *The operator was     |
|               | stationed at her typical position throughout the     |
|               | monitoring period. Exposure potential is expected to |
|               | represent typical work conditions.*                  |
+---------------+------------------------------------------------------+
| By-stander    | State if the monitoring represents by-stander        |
| R             | exposure                                             |
| epresentation |                                                      |
+---------------+------------------------------------------------------+
| Compounding   | Describe significant environmental                   |
| Environmental | conditions/factors that could affect worker exposure |
| Factors       | potential, and/or exposure sampling or measurements. |
|               | Example: *This operation was conducted on a very hot |
|               | day. A fan was used to cool the worker, and the wind |
|               | from it may cause excessive dust so that exposure    |
|               | potential may be higher than typical.*               |
+---------------+------------------------------------------------------+
| Sample        | List the specific location of the sample. Example:   |
| Location      | *Sample number 2 was taken four inches from the      |
|               | source and is not representative of worker exposure. |
|               | Sample 4 and 5 were worn by worker on their lapel    |
|               | and represent their exposure and those of other      |
|               | worker on other days doing this job.*                |
+---------------+------------------------------------------------------+
| Sketch or     | A hand drawn sketch, floor plan with sampling        |
| photo         | locations, or digital photo of the sampling area is  |
|               | to be included.                                      |
+---------------+------------------------------------------------------+
| Exposure      | Describe if the full exposure event was sampled (all |
| Sampling      | the time of exposure) or which portion was sampled.  |
| Period        | Describe if the sampling includes time when no       |
|               | exposure would be expected to occur (such as set-up  |
|               | or break-down of controls). Example: *The sample     |
|               | pumps were worn during the containment set-up and    |
|               | during the sand blasting. Pumps were worn during the |
|               | entire blasting period and were removed prior to     |
|               | worker decontamination.*                             |
+---------------+------------------------------------------------------+
| Sample        | Time of day to the nearest minute that the sampling  |
| Duration-     | pump was turned on and off. Multiple times should be |
| Time On/      | recorded if the pump was turned off during breaks,   |
| Sample        | lunch, or other periods.                             |
| Duration-     |                                                      |
| Time Off      |                                                      |
+---------------+------------------------------------------------------+
| **3. Describe |                                                      |
| the Sampling  |                                                      |
| Parameters    |                                                      |
| and Analysis  |                                                      |
| Technique (on |                                                      |
| media         |                                                      |
| sampling):    |                                                      |
| (Completed by |                                                      |
| SHSD IH       |                                                      |
| Lab)**        |                                                      |
+---------------+------------------------------------------------------+
| Calibration   | State the sampling instrument calibration data.      |
+---------------+------------------------------------------------------+
| Method        | State the sampling and analytical methods and        |
|               | protocols used (e.g., those specified by OSHA or     |
|               | NIOSH or other equivalent methods)                   |
+---------------+------------------------------------------------------+
| Laboratory    | State the analytical laboratory used.                |
+---------------+------------------------------------------------------+
| Results       | Provide the results of exposure monitoring/ sampling |
|               | measurements to the IH Professional or Sampler       |
+---------------+------------------------------------------------------+
| **4. Analysis |                                                      |
| of            |                                                      |
| Compliance:   |                                                      |
| (Completed by |                                                      |
| IH            |                                                      |
| Pr            |                                                      |
| ofessional)** |                                                      |
+---------------+------------------------------------------------------+
| Worker        | Provide supporting data and assumptions (e.g.,       |
| Protection    | consideration of respiratory protection or other PPE |
| status &      | attenuation factors). Example: *The workers wore     |
| future needs  | full Level C suits, with gloves and boots. Skin      |
|               | route of exposure would be minimal. A full face APR  |
|               | with OVC was worn during the spraying operation.     |
|               | Based on the sampling results, this level of PPE     |
|               | should continue to be used on future operations.*    |
+---------------+------------------------------------------------------+
| OEL           | Identify the applicable occupational exposure        |
|               | limits/industrial hygiene standards, including       |
|               | ACGIH, OSHA, and DOE Exposure Standards and Action   |
|               | Levels.                                              |
+---------------+------------------------------------------------------+
| Relevance to  | Compare personal exposure levels against recognized  |
| OELs          | occupational exposure standards, e.g., 8-hour        |
|               | time-weighted average (TWA) concentration,           |
|               | short-term exposure level (STEL), peak or ceiling    |
|               | concentration, or average sound pressure level, dBA, |
|               | and Action Levels.                                   |
|               |                                                      |
|               | Document if the sampling and/or operation was a      |
|               | partial day event                                    |
|               |                                                      |
|               | Describe the impact of the sample duration on the    |
|               | operation if it was extended to a full day- i.e.     |
|               | would exposure be in compliance or would             |
|               | over-exposure occur.                                 |
+---------------+------------------------------------------------------+
| Exposure      | Interpret monitoring/sampling results worker         |
| controls      | exposure level(s) relative to applicable             |
|               | occupational standards. Note: where personal         |
|               | protective equipment, such as respirators, hearing   |
|               | protectors, etc., was used by workers to attenuate   |
|               | exposures, the documented record should report the   |
|               | measured or estimated unattenuated level(s) of       |
|               | potential personal exposure, along with the type and |
|               | protection/attenuation factor of the PPE worn.       |
|               |                                                      |
|               | Example: *The workers wore Level C suits, with PAPR, |
|               | gloves and boots. Based on the sampling results, the |
|               | workers level of exposure exceeded the PEL. While    |
|               | the PPE would have eliminated some actual exposure,  |
|               | the operation is considered out of compliance with   |
|               | the OEL and corrective actions to reduce employee    |
|               | exposure are needed.*                                |
|               |                                                      |
|               | Example: *The workers wore ear plugs. Determine the  |
|               | adjusted NRR for the actual brand of equipment used  |
|               | and discuss the impact on the exposure.*             |
+---------------+------------------------------------------------------+
| Controls in   | Describe the impact of exposure hazard controls      |
| place at time | (e.g., engineering, administrative, work practice,   |
| of sampling   | personal protective equipment) in-place during       |
|               | sampling. Example: *The operation was                |
|               | administratively controlled during this trial period |
|               | to restrict the work to 2 hour exposure or less.     |
|               | Because of this time limitation on exposure, the OEL |
|               | was not exceeded. However, if the Administrative     |
|               | limit was not in place and exposure had occurred for |
|               | 6.5 hours or more, the OEL would have been exceeded. |
|               | A permanent limitation on exposure to 4 hours or     |
|               | less is required.*                                   |
+---------------+------------------------------------------------------+
| **5. Describe |                                                      |
| Expected      |                                                      |
| actions of    |                                                      |
| worker and    |                                                      |
| management    |                                                      |
| (Completed by |                                                      |
| IH            |                                                      |
| Pr            |                                                      |
| ofessional)** |                                                      |
+---------------+------------------------------------------------------+
| Needed        | Describe any recommended, additional control         |
| Control       | measures, (including engineering, administrative,    |
| Measures      | work practice controls, and/or personal protective   |
|               | equipment), to reduce worker exposures to within     |
|               | acceptable exposure levels and as low as             |
|               | practicable. Differentiate between long-term and     |
|               | interim control measures.                            |
|               |                                                      |
|               | Recommendations should be for hazard controls based  |
|               | on the following hierarchy:                          |
|               |                                                      |
|               | -   Elimination or substitution of the hazards where |
|               |     feasible                                         |
|               |                                                      |
|               | -   Engineering controls where feasible              |
|               |                                                      |
|               | -   Work practices and administration controls that  |
|               |     limit worker exposures, and                      |
|               |                                                      |
|               | -   Personal Protective Equipment                    |
+---------------+------------------------------------------------------+
| Need for      | Determine if the OSHA or BNL trigger has been        |
| Medical       | exceeded. State if medical surveillance is required  |
| Surveillance  | based on the sampling results.                       |
+---------------+------------------------------------------------------+
|               | If medical surveillance is required, inform          |
|               | supervision to identify all the exposure population  |
|               | and to require medical evaluation. Example: *The     |
|               | operation has the potential to expose workers above  |
|               | the Action Level. Identify any workers who have the  |
|               | potential to do this operation for 30 or more days   |
|               | in any 365 period and have them evaluated by the OMC |
|               | under the medical surveillance protocol.*            |
+---------------+------------------------------------------------------+
| Need for new  | State if additional training is needed for the       |
| or additional | exposed workers. Example: *Worker \# 2 had a total   |
| Training      | dose exceeding the Action Level. The worker needs    |
|               | renewed training in use of ear muffs and plugs and   |
|               | should retake the noise and hearing conservation     |
|               | class.*                                              |
+---------------+------------------------------------------------------+
|               | If training is required, inform supervision to       |
|               | identify all the exposure population and to require  |
|               | training. Example: *The operation has the potential  |
|               | to expose workers above the Occupational Exposure    |
|               | limit or Action Level. Identify any workers who have |
|               | the potential to do this operation for 30 or more    |
|               | days in any 365 period and have them trained as per  |
|               | BTMS.*                                               |
+---------------+------------------------------------------------------+
| Other         | Describe any other pertinent factors, hazards,       |
|               | controls, precautions, etc.                          |
+---------------+------------------------------------------------------+