+---------------------------+-------+-----+------+------+-----+-----+
| **Name(s) of "Sample"     | **    | **  | *    | *    | **  | **  |
| Risk Team Members: T.     | Point | 1** | *2** | *3** | 4** | 5** |
| Jones, J. Rubino, R.      | Value |     |      |      |     |     |
| Backofen, F. Horn**       | →**   |     |      |      |     |     |
|                           |       |     |      |      |     |     |
|                           | *     |     |      |      |     |     |
|                           | *Para |     |      |      |     |     |
|                           | meter |     |      |      |     |     |
|                           | ↓**   |     |      |      |     |     |
+---------------------------+-------+-----+------+------+-----+-----+
| **Name(s) of Specific     |       |     |      |      |     |     |
| Application Risk Team     |       |     |      |      |     |     |
| Members:**                |       |     |      |      |     |     |
|                           |       |     |      |      |     |     |
| T. Jones, J. Rubino, R.   |       |     |      |      |     |     |
| Backofen, F. Horn         |       |     |      |      |     |     |
+---------------------------+-------+-----+------+------+-----+-----+
| **Job Title: Archiving    | **F   | **  | **   | *    | **[ | *   |
| photographic negatives**  | reque | [\< | [\<] | *[\< | \<] | *\> |
|                           | ncy** | ]{. | {.un | ]{.u | {.u | onc |
| **Job Number or Job       |       | und | derl | nder | nde | e/s |
| Identifier: PG_NEGS**     | **    | erl | ine} | line | rli | hif |
|                           | (B)** | ine | once | }onc | ne} | t** |
|                           |       | }on | /mon | e/we | onc |     |
|                           |       | ce/ | th** | ek** | e/s |     |
|                           |       | yea |      |      | hif |     |
|                           |       | r** |      |      | t** |     |
+---------------------------+-------+-----+------+------+-----+-----+
| **Job Description:        | **    | *   | *    | **   | **P | *   |
| Retrieving and filing BNL | Sever | *Fi | *Med | Lost | art | *De |
| photographic negatives    | ity** | rst | ical | Ti   | ial | ath |
| from file areas located   |       | Aid | Tre  | me** | Dis | or  |
| in buildings 197B and     | **    | Onl | atme |      | abi | Per |
| 493**                     | (C)** | y** | nt** |      | lit | man |
|                           |       |     |      |      | y** | ent |
|                           |       |     |      |      |     | Dis |
|                           |       |     |      |      |     | abi |
|                           |       |     |      |      |     | lit |
|                           |       |     |      |      |     | y** |
+---------------------------+-------+-----+------+------+-----+-----+
| Training Procedures List  | **Li  | **V | **Un | **Po | **P | **M |
| (Optional):               | kelih | ery | like | ssib | rob | ult |
|                           | ood** | U   | ly** | le** | abl | ipl |
| Applicable Standard       |       | nli |      |      | e** | e** |
| Operating Procedures:     | **    | kel |      |      |     |     |
| TQ-BACKSAFE               | (D)** | y** |      |      |     |     |
+---------------------------+-------+-----+------+------+-----+-----+
| Approved by: Richard      |       |     |      |      |     |     |
| Backofen Date03/18/08     |       |     |      |      |     |     |
| Rev. #:2                  |       |     |      |      |     |     |
|                           |       |     |      |      |     |     |
| (signature on file at     |       |     |      |      |     |     |
| 197b room 101)            |       |     |      |      |     |     |
+---------------------------+-------+-----+------+------+-----+-----+
| **Stressors (if           |       | **  |      |      | **  |     |
| applicable, please list   |       | Rea |      |      | Com |     |
| all)**                    |       | son |      |      | men |     |
|                           |       | for |      |      | ts: |     |
|                           |       | Re  |      |      | No  |     |
|                           |       | vis |      |      | c   |     |
|                           |       | ion |      |      | han |     |
|                           |       | (if |      |      | ges |     |
|                           |       | ap  |      |      | ne  |     |
|                           |       | pli |      |      | ces |     |
|                           |       | cab |      |      | sar |     |
|                           |       | le) |      |      | y** |     |
|                           |       | :Pe |      |      |     |     |
|                           |       | rio |      |      |     |     |
|                           |       | dic |      |      |     |     |
|                           |       | re  |      |      |     |     |
|                           |       | vie |      |      |     |     |
|                           |       | w** |      |      |     |     |
+---------------------------+-------+-----+------+------+-----+-----+

<table>
<colgroup>
<col style="width: 12%" />
<col style="width: 11%" />
<col style="width: 23%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 13%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 4%" />
</colgroup>
<thead>
<tr class="header">
<th></th>
<th></th>
<th></th>
<th colspan="9"><strong>Before Additional Controls</strong></th>
<th></th>
<th colspan="7"><p><strong>After Additional</strong></p>
<p><strong>Controls</strong></p></th>
<th></th>
</tr>
<tr class="odd">
<th><strong>Activity</strong></th>
<th><strong>Hazard</strong></th>
<th><strong>Control(s)</strong></th>
<th colspan="2"><blockquote>
<p><strong>Stressor</strong></p>
</blockquote></th>
<th colspan="2"><blockquote>
<p><strong># of People A</strong></p>
</blockquote></th>
<th colspan="2"><blockquote>
<p><strong>Frequency B</strong></p>
</blockquote></th>
<th><blockquote>
<p><strong>Severity C</strong></p>
</blockquote></th>
<th><blockquote>
<p><strong>Likelihood D</strong></p>
</blockquote></th>
<th><blockquote>
<p><strong>Risk* AxBxCxD</strong></p>
</blockquote></th>
<th><h1 id="controls-added-to-reduce-risk">Control(s) Added to Reduce
Risk</h1></th>
<th><h1 id="stressors">Stressors</h1></th>
<th><blockquote>
<p><strong># of People A</strong></p>
</blockquote></th>
<th><blockquote>
<p><strong>Frequency B</strong></p>
</blockquote></th>
<th><blockquote>
<p><strong>Severity C</strong></p>
</blockquote></th>
<th colspan="2"><blockquote>
<p><strong>Likelihood D</strong></p>
</blockquote></th>
<th><blockquote>
<p><strong>Risk* AxBxCxD</strong></p>
</blockquote></th>
<th><blockquote>
<p><strong>% Risk Reduction</strong></p>
</blockquote></th>
</tr>
</thead>
<tbody>
<tr class="odd">
<td>Driving to building 493 when necessary</td>
<td>See <a
href="http://www.bnl.gov/PGA/Docs/OSH/JRA/PG_JRA_DRIVING.doc">JRA_PG_DRIVE</a></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td>Archiving negatives in building 493</td>
<td><p>Environmental factors (comfort), Dropped objects, pinching
between files, paper cuts, pinch between cabinets, strain from bending,
reaching</p>
<p>Employee is sometimes working in building alone</p></td>
<td>Safety step stools, adequate lighting, TQ-BackSafe, Employee’s cell
phone</td>
<td>N</td>
<td colspan="2">1</td>
<td colspan="2">3</td>
<td colspan="2">2</td>
<td>1</td>
<td>6</td>
<td>Look into adding emergency phone in file area or require that
someone else be in the building during operation</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td>Archiving in building 197B</td>
<td>Dropped objects, strain/sprain for bending, bump from sharp edges on
file cabinet drawers.</td>
<td>Adequate lighting, TQ-BACKSAFE</td>
<td>N</td>
<td colspan="2">1</td>
<td colspan="2">3</td>
<td colspan="2">2</td>
<td>1</td>
<td>6</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
</tbody>
</table>

  ------------- ---------------- ---------------- -------------- ----------------- -----------------
  **\*Risk:**   **0 to 20**      **21 to 40**     **41-60**      **61 to 80**      **81 or greater**

                **Negligible**   **Acceptable**   **Moderate**   **Substantial**   **Intolerable**
  ------------- ---------------- ---------------- -------------- ----------------- -----------------