+---------------------------+-------+-----+------+------+-----+-----+
| **Name(s) of "Sample"     | **    | **  | *    | *    | **  | **  |
| Risk Team Members:** R.   | Point | 1** | *2** | *3** | 4** | 5** |
| Backofen, J. Geata,K.     | Value |     |      |      |     |     |
| Backofen, T. Walsh, N.    | →**   |     |      |      |     |     |
| McIntosh, F. Horn, N.     |       |     |      |      |     |     |
| Bernholc                  | *     |     |      |      |     |     |
|                           | *Para |     |      |      |     |     |
|                           | meter |     |      |      |     |     |
|                           | ↓**   |     |      |      |     |     |
+---------------------------+-------+-----+------+------+-----+-----+
| **Name(s) of Specific     |       |     |      |      |     |     |
| Application Risk Team     |       |     |      |      |     |     |
| Members:**                |       |     |      |      |     |     |
+---------------------------+-------+-----+------+------+-----+-----+
| **Job Title: Tabletop     | **F   | **  | **   | *    | **[ | *   |
| Paper Folder Operation**  | reque | [\< | [\<] | *[\< | \<] | *\> |
|                           | ncy** | ]{. | {.un | ]{.u | {.u | onc |
| **Job Number or Job       |       | und | derl | nder | nde | e/s |
| Identifier:               | **    | erl | ine} | line | rli | hif |
| PG_JRA_TFOLD**            | (B)** | ine | once | }onc | ne} | t** |
|                           |       | }on | /mon | e/we | onc |     |
|                           |       | ce/ | th** | ek** | e/s |     |
|                           |       | yea |      |      | hif |     |
|                           |       | r** |      |      | t** |     |
+---------------------------+-------+-----+------+------+-----+-----+
| **Job Description:        | **    | *   | *    | **   | **P | *   |
| Operation of Baum         | Sever | *Fi | *Med | Lost | art | *De |
| Tabletop folder**         | ity** | rst | ical | Ti   | ial | ath |
|                           |       | Aid | Tre  | me** | Dis | or  |
|                           | **    | Onl | atme |      | abi | Per |
|                           | (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 |      |      |     |     |
|                           | (D)** | y** |      |      |     |     |
+---------------------------+-------+-----+------+------+-----+-----+
| Approved by: R.. Backofen |       |     |      |      |     |     |
| Date: 3/21/06 Rev. #: 1   |       |     |      |      |     |     |
|                           |       |     |      |      |     |     |
| (signature on file in     |       |     |      |      |     |     |
| building 197B room 1-101) |       |     |      |      |     |     |
+---------------------------+-------+-----+------+------+-----+-----+
| **Stressors (if           |       | **  |      |      | *   |     |
| applicable, please list   |       | Rea |      |      | *Co |     |
| all)**                    |       | son |      |      | mme |     |
|                           |       | for |      |      | nts |     |
|                           |       | Re  |      |      | :** |     |
|                           |       | vis |      |      |     |     |
|                           |       | ion |      |      |     |     |
|                           |       | (if |      |      |     |     |
|                           |       | ap  |      |      |     |     |
|                           |       | pli |      |      |     |     |
|                           |       | cab |      |      |     |     |
|                           |       | le) |      |      |     |     |
|                           |       | :** |      |      |     |     |
+---------------------------+-------+-----+------+------+-----+-----+

<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: 2%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 0%" />
<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="10"><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><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 colspan="2"><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><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>Loading of stock to be folded into machine</td>
<td>Paper cuts/bruises from paper handling/dropped load</td>
<td>Safety shoes, machine guarding</td>
<td colspan="2">N</td>
<td colspan="2">1</td>
<td>3</td>
<td>1</td>
<td colspan="2">2</td>
<td colspan="2">6</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td rowspan="2"><p>Setup of folder</p>
<p>Setup of folder (cont.)</p></td>
<td>Cut, bruise from dropped gate</td>
<td>Proper lifting techniques, safety shoes</td>
<td colspan="2">N</td>
<td colspan="2">1</td>
<td>3</td>
<td>1</td>
<td colspan="2">1</td>
<td colspan="2">3</td>
<td>IH ergonomic assessment and operator training</td>
<td>N</td>
<td>1</td>
<td>3</td>
<td>1</td>
<td>1</td>
<td colspan="2">3</td>
<td></td>
</tr>
<tr class="odd">
<td>Cut, bruise, pinch from inadvertent startup of equipment</td>
<td>Machine guarding of power switch</td>
<td colspan="2">N</td>
<td colspan="2">1</td>
<td>3</td>
<td>1</td>
<td colspan="2">1</td>
<td colspan="2">3</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td rowspan="3">Operation of folder</td>
<td>Loose clothing, jewelry, hair, caught in moving equipment</td>
<td>Proper clothing, hair clips, machine guarding, area
restrictions</td>
<td colspan="2">N</td>
<td colspan="2">1</td>
<td>3</td>
<td>2</td>
<td colspan="2">2</td>
<td colspan="2">12</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td>Hearing loss from excessive noise</td>
<td>Hearing protection requirement and posting, Noise and Hearing
Conservation program,</td>
<td colspan="2">N</td>
<td colspan="2">1</td>
<td>3</td>
<td>4</td>
<td colspan="2">1</td>
<td colspan="2">12</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td>Struck by item propelled after falling into moving machinery</td>
<td>“No tools” policy, machine guarding</td>
<td colspan="2">N</td>
<td colspan="2">1</td>
<td>3</td>
<td>4</td>
<td colspan="2">1</td>
<td colspan="2">12</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td>Unloading folded sheets from machine</td>
<td>Overexertion, strain, dropped load, tripping</td>
<td>Safety shoes, area check prior to operation</td>
<td colspan="2">N</td>
<td colspan="2">1</td>
<td>3</td>
<td>1</td>
<td colspan="2">1</td>
<td colspan="2">3</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td>Clearing jammed sheets from folder</td>
<td>Pinch hazard, dropped gate</td>
<td></td>
<td colspan="2">N</td>
<td colspan="2">1</td>
<td>3</td>
<td>1</td>
<td colspan="2">2</td>
<td colspan="2">6</td>
<td>De-energize equipment prior to attempting to clear jam</td>
<td>N</td>
<td>1</td>
<td>3</td>
<td>1</td>
<td>1</td>
<td colspan="2">3</td>
<td>50%</td>
</tr>
</tbody>
</table>

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

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