+------------+----------+---------------+---+------+--------------+-------+
|            |          |               | 1 |      |              |       |
|            |          |               | \ |      |              |       |
|            |          |               | . |      |              |       |
|            |          |               | * |      |              |       |
|            |          |               | * |      |              |       |
|            |          |               | G |      |              |       |
|            |          |               | S |      |              |       |
|            |          |               | R |      |              |       |
|            |          |               | P |      |              |       |
|            |          |               | N |      |              |       |
|            |          |               | U |      |              |       |
|            |          |               | M |      |              |       |
|            |          |               | B |      |              |       |
|            |          |               | E |      |              |       |
|            |          |               | R |      |              |       |
|            |          |               | * |      |              |       |
|            |          |               | * |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 2\.        | 3\.      |               |   | 4\.  |              |       |
| **Flight/  | **Hard   |               |   | **   |              |       |
| Mission:** | ware/GFE |               |   | Part |              |       |
|            | Name:**  |               |   | N    |              |       |
|            |          |               |   | umbe |              |       |
|            |          |               |   | r:** |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 5\.        |          |               |   |      |              |       |
| **Brief    |          |               |   |      |              |       |
| d          |          |               |   |      |              |       |
| escription |          |               |   |      |              |       |
| of         |          |               |   |      |              |       |
| ha         |          |               |   |      |              |       |
| rdware/GFE |          |               |   |      |              |       |
| (not to    |          |               |   |      |              |       |
| exceed     |          |               |   |      |              |       |
| block      |          |               |   |      |              |       |
| size):**   |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| ***Ground  |          |               |   |      |              |       |
| Safety     |          |               |   |      |              |       |
| Review     |          |               |   |      |              |       |
| Qu         |          |               |   |      |              |       |
| estions*** |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| A YES      |          |               |   |      |              | **Yes |
| answer to  |          |               |   |      |              | /     |
| any of the |          |               |   |      |              | No**  |
| following  |          |               |   |      |              |       |
| questions  |          |               |   |      |              |       |
| may        |          |               |   |      |              |       |
| require    |          |               |   |      |              |       |
| submission |          |               |   |      |              |       |
| of a       |          |               |   |      |              |       |
| Ground     |          |               |   |      |              |       |
| Safety     |          |               |   |      |              |       |
| Data       |          |               |   |      |              |       |
| Package.   |          |               |   |      |              |       |
| Final      |          |               |   |      |              |       |
| det        |          |               |   |      |              |       |
| ermination |          |               |   |      |              |       |
| will be    |          |               |   |      |              |       |
| made by    |          |               |   |      |              |       |
| the GSRP   |          |               |   |      |              |       |
| Chairman   |          |               |   |      |              |       |
| upon       |          |               |   |      |              |       |
| review of  |          |               |   |      |              |       |
| the        |          |               |   |      |              |       |
| checklist. |          |               |   |      |              |       |
| (Provide   |          |               |   |      |              |       |
| an         |          |               |   |      |              |       |
| e          |          |               |   |      |              |       |
| xplanation |          |               |   |      |              |       |
| of a yes   |          |               |   |      |              |       |
| answer to  |          |               |   |      |              |       |
| any of the |          |               |   |      |              |       |
| following  |          |               |   |      |              |       |
| questions  |          |               |   |      |              |       |
| in the     |          |               |   |      |              |       |
| remarks    |          |               |   |      |              |       |
| block 18   |          |               |   |      |              |       |
| on page 2. |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 6\. Does   |          |               |   |      |              |       |
| the        |          |               |   |      |              |       |
| hardware   |          |               |   |      |              |       |
| require    |          |               |   |      |              |       |
| preflight  |          |               |   |      |              |       |
| or         |          |               |   |      |              |       |
| postflight |          |               |   |      |              |       |
| ground     |          |               |   |      |              |       |
| processing |          |               |   |      |              |       |
| at KSC     |          |               |   |      |              |       |
| other than |          |               |   |      |              |       |
| in         |          |               |   |      |              |       |
| stallation |          |               |   |      |              |       |
| or removal |          |               |   |      |              |       |
| into or    |          |               |   |      |              |       |
| from the   |          |               |   |      |              |       |
| Orbiter or |          |               |   |      |              |       |
| carrier?   |          |               |   |      |              |       |
| [(i.e.     |          |               |   |      |              |       |
| i          |          |               |   |      |              |       |
| nspection, |          |               |   |      |              |       |
| filling,   |          |               |   |      |              |       |
| testing,   |          |               |   |      |              |       |
| etc.)]{.   |          |               |   |      |              |       |
| underline} |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 7\. Does   |          |               |   |      |              |       |
| the        |          |               |   |      |              |       |
| hardware   |          |               |   |      |              |       |
| contain    |          |               |   |      |              |       |
| p          |          |               |   |      |              |       |
| otentially |          |               |   |      |              |       |
| hazardous  |          |               |   |      |              |       |
| materials  |          |               |   |      |              |       |
| such as:   |          |               |   |      |              |       |
| chemicals, |          |               |   |      |              |       |
| micro      |          |               |   |      |              |       |
| organisms, |          |               |   |      |              |       |
| radi       |          |               |   |      |              |       |
| oisotopes, |          |               |   |      |              |       |
| or         |          |               |   |      |              |       |
| b          |          |               |   |      |              |       |
| iological? |          |               |   |      |              |       |
| Provide    |          |               |   |      |              |       |
| hazard and |          |               |   |      |              |       |
| toxicity   |          |               |   |      |              |       |
| codes if   |          |               |   |      |              |       |
| a          |          |               |   |      |              |       |
| pplicable. |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 8\. Does   |          |               |   |      |              |       |
| the item   |          |               |   |      |              |       |
| contain    |          |               |   |      |              |       |
| fluid? If  |          |               |   |      |              |       |
| yes        |          |               |   |      |              |       |
| describe   |          |               |   |      |              |       |
| the fluid. |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 9\. Does   |          |               |   |      |              |       |
| item       |          |               |   |      |              |       |
| require    |          |               |   |      |              |       |
| any ground |          |               |   |      |              |       |
| support    |          |               |   |      |              |       |
| equipment  |          |               |   |      |              |       |
| (GSE) such |          |               |   |      |              |       |
| as:        |          |               |   |      |              |       |
| electrical |          |               |   |      |              |       |
| equipment, |          |               |   |      |              |       |
| tools      |          |               |   |      |              |       |
| etc.,      |          |               |   |      |              |       |
| provided   |          |               |   |      |              |       |
| by the     |          |               |   |      |              |       |
| developer, |          |               |   |      |              |       |
| to process |          |               |   |      |              |       |
| the flight |          |               |   |      |              |       |
| hardware   |          |               |   |      |              |       |
| at KSC?    |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 10\. Could |          |               |   |      |              |       |
| ground     |          |               |   |      |              |       |
| personnel  |          |               |   |      |              |       |
| be exposed |          |               |   |      |              |       |
| to         |          |               |   |      |              |       |
| excessive  |          |               |   |      |              |       |
| surface    |          |               |   |      |              |       |
| touch      |          |               |   |      |              |       |
| te         |          |               |   |      |              |       |
| mperatures |          |               |   |      |              |       |
| (less than |          |               |   |      |              |       |
| 0^o^C or   |          |               |   |      |              |       |
| greater    |          |               |   |      |              |       |
| than       |          |               |   |      |              |       |
| 45^o^C)    |          |               |   |      |              |       |
| from the   |          |               |   |      |              |       |
| flight     |          |               |   |      |              |       |
| hardware   |          |               |   |      |              |       |
| or GSE?    |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 11\. Can   |          |               |   |      |              |       |
| ground     |          |               |   |      |              |       |
| personnel  |          |               |   |      |              |       |
| be exposed |          |               |   |      |              |       |
| to sharp   |          |               |   |      |              |       |
| edges,     |          |               |   |      |              |       |
| pr         |          |               |   |      |              |       |
| otrusions, |          |               |   |      |              |       |
| or moving  |          |               |   |      |              |       |
| parts from |          |               |   |      |              |       |
| the        |          |               |   |      |              |       |
| hardware?  |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 12\. Does  |          |               |   |      |              |       |
| the        |          |               |   |      |              |       |
| hardware   |          |               |   |      |              |       |
| contain    |          |               |   |      |              |       |
| any        |          |               |   |      |              |       |
| ionizing   |          |               |   |      |              |       |
| or         |          |               |   |      |              |       |
| no         |          |               |   |      |              |       |
| n-ionizing |          |               |   |      |              |       |
| radiation  |          |               |   |      |              |       |
| source     |          |               |   |      |              |       |
| (e.g. RF   |          |               |   |      |              |       |
| tr         |          |               |   |      |              |       |
| ansmitter, |          |               |   |      |              |       |
| r          |          |               |   |      |              |       |
| adioactive |          |               |   |      |              |       |
| material)? |          |               |   |      |              |       |
| A yes      |          |               |   |      |              |       |
| answer     |          |               |   |      |              |       |
| will       |          |               |   |      |              |       |
| require    |          |               |   |      |              |       |
| submittal  |          |               |   |      |              |       |
| of a       |          |               |   |      |              |       |
| ground     |          |               |   |      |              |       |
| safety     |          |               |   |      |              |       |
| data       |          |               |   |      |              |       |
| package.   |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 13\. Does  |          |               |   |      |              |       |
| the        |          |               |   |      |              |       |
| hardware   |          |               |   |      |              |       |
| or its GSE |          |               |   |      |              |       |
| contain    |          |               |   |      |              |       |
| any stored |          |               |   |      |              |       |
| energy     |          |               |   |      |              |       |
| (i.e.,     |          |               |   |      |              |       |
| m          |          |               |   |      |              |       |
| echanical, |          |               |   |      |              |       |
| pressure,  |          |               |   |      |              |       |
| or         |          |               |   |      |              |       |
| el         |          |               |   |      |              |       |
| ectrical)? |          |               |   |      |              |       |
| If yes,    |          |               |   |      |              |       |
| describe   |          |               |   |      |              |       |
| the stored |          |               |   |      |              |       |
| energy.    |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 14\. Could |          |               |   |      |              |       |
| ground     |          |               |   |      |              |       |
| personnel  |          |               |   |      |              |       |
| be exposed |          |               |   |      |              |       |
| to         |          |               |   |      |              |       |
| voltages   |          |               |   |      |              |       |
| in excess  |          |               |   |      |              |       |
| of 30      |          |               |   |      |              |       |
| volts AC   |          |               |   |      |              |       |
| or 50      |          |               |   |      |              |       |
| volts DC   |          |               |   |      |              |       |
| during     |          |               |   |      |              |       |
| nominal    |          |               |   |      |              |       |
| m          |          |               |   |      |              |       |
| aintenance |          |               |   |      |              |       |
| or ground  |          |               |   |      |              |       |
| handling   |          |               |   |      |              |       |
| of the     |          |               |   |      |              |       |
| hardware?  |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 15\.       |          |               |   |      |              |       |
| Commercial |          |               |   |      |              |       |
| off the    |          |               |   |      |              |       |
| shelf      |          |               |   |      |              |       |
| (COTS)     |          |               |   |      |              |       |
| GSE:\      |          |               |   |      |              |       |
| a. Has it  |          |               |   |      |              |       |
| been       |          |               |   |      |              |       |
| modified   |          |               |   |      |              |       |
| from its   |          |               |   |      |              |       |
| original   |          |               |   |      |              |       |
| design/    |          |               |   |      |              |       |
| operation? |          |               |   |      |              |       |
|            |          |               |   |      |              |       |
| b\. Is it  |          |               |   |      |              |       |
| being used |          |               |   |      |              |       |
| outside of |          |               |   |      |              |       |
| its        |          |               |   |      |              |       |
| intended   |          |               |   |      |              |       |
| p          |          |               |   |      |              |       |
| arameters? |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 16\. Does  |          |               |   |      |              |       |
| the item   |          |               |   |      |              |       |
| require    |          |               |   |      |              |       |
| fluid      |          |               |   |      |              |       |
| servicing  |          |               |   |      |              |       |
| (e.g. gas, |          |               |   |      |              |       |
| liquid,    |          |               |   |      |              |       |
| c          |          |               |   |      |              |       |
| ryogenics, |          |               |   |      |              |       |
| and        |          |               |   |      |              |       |
| pr         |          |               |   |      |              |       |
| opellants) |          |               |   |      |              |       |
| or         |          |               |   |      |              |       |
| hazardous  |          |               |   |      |              |       |
| material   |          |               |   |      |              |       |
| handling   |          |               |   |      |              |       |
| (e.g.      |          |               |   |      |              |       |
| sample     |          |               |   |      |              |       |
| pr         |          |               |   |      |              |       |
| eparation) |          |               |   |      |              |       |
| at KSC?    |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 17\. Has   |          |               |   |      |              |       |
| the item   |          |               |   |      |              |       |
| completed  |          |               |   |      |              |       |
| the        |          |               |   |      |              |       |
| a          |          |               |   |      |              |       |
| ppropriate |          |               |   |      |              |       |
| Flight     |          |               |   |      |              |       |
| Safety     |          |               |   |      |              |       |
| Review?    |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 18\.       |          |               |   |      |              |       |
| **         |          |               |   |      |              |       |
| Remarks:** |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| The        |          |               |   |      |              |       |
| Ha         |          |               |   |      |              |       |
| rdware/GFE |          |               |   |      |              |       |
| provider   |          |               |   |      |              |       |
| hereby     |          |               |   |      |              |       |
| certifies  |          |               |   |      |              |       |
| that the   |          |               |   |      |              |       |
| ha         |          |               |   |      |              |       |
| rdware/GFE |          |               |   |      |              |       |
| complies   |          |               |   |      |              |       |
| with all   |          |               |   |      |              |       |
| applicable |          |               |   |      |              |       |
| re         |          |               |   |      |              |       |
| quirements |          |               |   |      |              |       |
| of KHB     |          |               |   |      |              |       |
| 1700.7.    |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 19\.       |          | 20**.         |   |      | 21\.         |       |
| **Name     |          | Signature:**  |   |      | **Date**     |       |
| (print):** |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+
| 22\.       |          | 23\. **Fax    |   |      | 24\.         |       |
| **Phone    |          | Number:**     |   |      | **Electronic |       |
| Number:**  |          |               |   |      | Mail         |       |
|            |          |               |   |      | Address:**   |       |
+------------+----------+---------------+---+------+--------------+-------+
| **\        |          |               |   |      |              |       |
| Send to:   |          |               |   |      |              |       |
| NA         |          |               |   |      |              |       |
| SA/SA-C3** |          |               |   |      |              |       |
|            |          |               |   |      |              |       |
| *          |          |               |   |      |              |       |
| *Executive |          |               |   |      |              |       |
| Secretary, |          |               |   |      |              |       |
| GSRP**     |          |               |   |      |              |       |
|            |          |               |   |      |              |       |
| **Kennedy  |          |               |   |      |              |       |
| Space      |          |               |   |      |              |       |
| Center, FL |          |               |   |      |              |       |
| 32899**    |          |               |   |      |              |       |
+------------+----------+---------------+---+------+--------------+-------+

> GSRP Chairman:

  ---------------------------------------------------------- ------------
  25\. **Name: Signature**                                   26\.
                                                             **Date:**

  ---------------------------------------------------------- ------------

Instructions for the Certification for Ground Safety for KSC 20-201.

(See
[HTTP://kscsma.ksc.nasa.gov/GSRP/INDEX.htm](http://kscsma.ksc.nasa.gov/GSRP/INDEX.htm))

**REQUIREMENTS**

-   Hardware/software developers and operators are responsible for the
    preparation of ground safety analysis, documentation of compliance
    and presentation to the GSRP for pre launch and post landing
    operations that occur at KSC and contingency landing sites.

-   This form will be used by the Ground Safety Review Panel to
    determine the need for a complete Safety Data Package (SDP). If a
    SDP is **[NOT]{.underline}** required, the form shall serve as the
    approval for ground processing at KSC. Submittal and approval shall
    be completed prior to use.

> **DEFINITIONS**

-   CATEGORY 1 cargo/hardware. See SSP 30599, Table 4.10-1 Category 1
    Constraints.

-   GFE ( Government Furnished Equipment). A category of hardware and
    software provided by the government to perform functions not covered
    by the Prime Vehicle Contractor.

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```
-   GSE ( Ground Support Equipment). Equipment (hardware/software) used
    at KSC to test, transport, access, handle, maintain, measure,
    calibrate, verify, service and protect flight hardware/software.

> **INSTRUCTIONS**

-   Block 1. Not applicable to the hardware.

-   Block 2. State the Flight STS number and ISS mission for the
    assigned item. (If applicable)

-   Block 3. State the name of the item. Use the same name for the item
    as indicated on the manifest.

-   Block 4. State the part number for the item. Use the same part
    number for the item as indicated on the manifest. If the part number
    changes a new form will need to be submitted.

-   Block 5. State a description of the item, describe the size, shape,
    weight, characteristics of the items. Do not exceed block size.

-   Block 6. Explain in block 18 any processing activities of preflight
    and post flight that is required; other than ship and shoot and/or
    land and ship.

-   Blocks 7 - 11. Self explanatory.

-   Block 12. The presence of any ionizing or non-ionizing radiation
    requires the submittal of a Ground Safety Package.

-   Blocks 13 - 18. Self explanatory.

-   Blocks 19 - 24. To be filled in by the item provider that is
    certifying compliance with the requirements of KHB 1700.7.

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```
-   Send completed form to the address shown on page 2.