**[MSD Project Hazard Guide]{.smallcaps}**

**[Principal Investigator:]{.smallcaps}**

**[Building: Room(s):]{.smallcaps}**

**[Instructions:]{.underline}**

**The MSD Project Hazard Guide is intended to simplify the process of
identifying potential environment, health or safety concerns in
Materials Sciences Division research laboratories. Each MSD Principal
Investigator who maintains a lab at LBNL or supervises students,
post-docs or staff who work in a lab at LBNL is asked to fill this form
out annually. Your responses will be reviewed by Rick Kelly, the
Division Facility and EH&S Manager, to determine appropriate safety
controls are in place for your work. *MSD* *PIs who do not work at LBNL
and do not supervise personnel who work at LBNL need not complete this
form.***

**[The Guide is composed of two parts:]{.underline}**

**Part 1: Complete by checking "yes" or "no" to 29 questions pertaining
to the presence of potentially hazardous equipment, materials or
operations in your lab. Please answer all 29 questions.**

**Part 2: Complete only those questions that correspond to questions in
part 1 to which you answered "yes". For each requirement, please answer
"Y" for yes and "N" for no or NA for "not applicable". Where you answer
"yes", indicate the building/room number(s) where the potential hazard
is present.**

**Please return these completed forms by the FWP due date by:**

-   **Printing the form out (complete by hand) and returning to
    Tennessee Gock at LBNL MS 67R3207**

-   **Printing the electronically completed form out and returning to
    Tennessee Gock at LBNL MS 67R3207**

-   **E-mailing the electronically completed form to Tennessee Gock at
    TGock@lbl.gov.**

**Thank You.**

**[Part 1: Check "Yes" or "No" to indicate if a hazard is present in
your labs at LBNL.]{.underline}**

(Note--Part 2 must be filled out only for items checked "Yes" in part
1).

+---+--------------------+---------------------+---+-------------------+
|   | **Topic**          | **Hazard**          | * |                   |
|   |                    |                     | * |                   |
|   |                    |                     | I |                   |
|   |                    |                     | s |                   |
|   |                    |                     | t |                   |
|   |                    |                     | h |                   |
|   |                    |                     | i |                   |
|   |                    |                     | s |                   |
|   |                    |                     | h |                   |
|   |                    |                     | a |                   |
|   |                    |                     | z |                   |
|   |                    |                     | a |                   |
|   |                    |                     | r |                   |
|   |                    |                     | d |                   |
|   |                    |                     | p |                   |
|   |                    |                     | r |                   |
|   |                    |                     | e |                   |
|   |                    |                     | s |                   |
|   |                    |                     | e |                   |
|   |                    |                     | n |                   |
|   |                    |                     | t |                   |
|   |                    |                     | i |                   |
|   |                    |                     | n |                   |
|   |                    |                     | y |                   |
|   |                    |                     | o |                   |
|   |                    |                     | u |                   |
|   |                    |                     | r |                   |
|   |                    |                     | l |                   |
|   |                    |                     | a |                   |
|   |                    |                     | b |                   |
|   |                    |                     | ? |                   |
|   |                    |                     | ( |                   |
|   |                    |                     | A |                   |
|   |                    |                     | n |                   |
|   |                    |                     | s |                   |
|   |                    |                     | w |                   |
|   |                    |                     | e |                   |
|   |                    |                     | r |                   |
|   |                    |                     | Y |                   |
|   |                    |                     | e |                   |
|   |                    |                     | s |                   |
|   |                    |                     | o |                   |
|   |                    |                     | r |                   |
|   |                    |                     | N |                   |
|   |                    |                     | o |                   |
|   |                    |                     | ) |                   |
|   |                    |                     | * |                   |
|   |                    |                     | * |                   |
+===+====================+=====================+===+===================+
| 1 | Lasers (Class 3b   | Eye/skin damage,    |   | Yes               |
|   | and 4)             | fire                |   |                   |
+---+--------------------+---------------------+---+-------------------+
|   |                    |                     |   | No                |
+---+--------------------+---------------------+---+-------------------+
| 2 | "Health hazard"    | Toxicity,           |   | Yes               |
|   | gases (toxic       | corrosively         |   |                   |
|   | gases, corrosive   |                     |   |                   |
|   | gases)             |                     |   |                   |
+---+--------------------+---------------------+---+-------------------+
|   |                    |                     |   | No                |
+---+--------------------+---------------------+---+-------------------+
| 3 | Flammable          | Fire, explosion     |   | Yes               |
|   | compressed or      |                     |   |                   |
|   | liquefied gas      |                     |   |                   |
+---+--------------------+---------------------+---+-------------------+
|   |                    |                     |   | No                |
+---+--------------------+---------------------+---+-------------------+
| 4 | Pyrophoric gas     | Fire, explosion     |   | Yes               |
|   | (compressed or     |                     |   |                   |
|   |                    |                     |   |                   |
|   | liquefied)         |                     |   |                   |
+---+--------------------+---------------------+---+-------------------+
|   |                    |                     |   | No                |
+---+--------------------+---------------------+---+-------------------+
| 5 | Pressure systems   | Pressure explosion  |   | Yes               |
|   | (Other than DOT    |                     |   |                   |
|   | gas cylinders)     |                     |   |                   |
+---+--------------------+---------------------+---+-------------------+
|   |                    |                     |   | No                |
+---+--------------------+---------------------+---+-------------------+
| 6 | Energized          | Shock, burn, arch   |   | Yes               |
|   | Electrical R&D     | flash               |   |                   |
|   | Work \>50 volts    |                     |   |                   |
|   | (shock potential)  |                     |   |                   |
+---+--------------------+---------------------+---+-------------------+
|   |                    |                     |   | No                |
+---+--------------------+---------------------+---+-------------------+
| 7 | Highly reactive    | Fire, explosion,    |   | Yes               |
|   | chemicals, air     | burns               |   |                   |
|   | reactive chemicals |                     |   |                   |
+---+--------------------+---------------------+---+-------------------+
|   |                    |                     |   | No                |
+---+--------------------+---------------------+---+-------------------+
| 8 | Glovebox Work      | Toxicity, reaction, |   | Yes               |
|   | (other than purely | fire                |   |                   |
|   | for product        |                     |   |                   |
|   | protection)        |                     |   |                   |
+---+--------------------+---------------------+---+-------------------+
|   |                    |                     |   | No                |
+---+--------------------+---------------------+---+-------------------+
| 9 | Confined Space     | Oxygen deficiency,  |   | Yes               |
|   | entry (e.g.,       | unsafe atmosphere,  |   |                   |
|   | tanks, pits,       | physical hazards    |   |                   |
|   | vaults, vessels)   |                     |   |                   |
+---+--------------------+---------------------+---+-------------------+
|   |                    |                     |   | No                |
+---+--------------------+---------------------+---+-------------------+
| 1 | Potentially oxygen | Oxygen deficiency   |   | Yes               |
| 0 | deficient space    |                     |   |                   |
|   | (other than        |                     |   |                   |
|   | confined spaces)   |                     |   |                   |
+---+--------------------+---------------------+---+-------------------+
|   |                    |                     |   | No                |
+---+--------------------+---------------------+---+-------------------+
| 1 | Potentially        | Infection           |   | Yes               |
| 1 | biohazardous       |                     |   |                   |
|   | materials (Risk    |                     |   |                   |
|   | group/biosafety    |                     |   |                   |
|   | level 2 or higher) |                     |   |                   |
+---+--------------------+---------------------+---+-------------------+
|   |                    |                     |   | No                |
+---+--------------------+---------------------+---+-------------------+
| 1 | Liquid cryogen     | Oxygen              |   | Yes               |
| 2 | (LN, LHe)          | displacement, cold  |   |                   |
|   |                    | burns, pressure     |   |                   |
|   |                    | explosions          |   |                   |
+---+--------------------+---------------------+---+-------------------+
|   |                    |                     |   | No                |
+---+--------------------+---------------------+---+-------------------+
| 1 | Human samples or   | Human subject       |   | Yes               |
| 3 | information        | protection          |   |                   |
+---+--------------------+---------------------+---+-------------------+
|   |                    |                     |   | No                |
+---+--------------------+---------------------+---+-------------------+
| 1 | Vertebrate animal  | Protection of       |   | Yes               |
| 4 | samples (not       | animal research     |   |                   |
|   | commercially       | subjects            |   |                   |
|   | available)         |                     |   |                   |
+---+--------------------+---------------------+---+-------------------+
|   |                    |                     |   | No                |
+---+--------------------+---------------------+---+-------------------+

  ---- --------------------- ---------------------- --- -------------------
  15   X-rays Machine        Irradiation                Yes
       (capable of creating                             
       x-rays in air,                                   
       intentionally or                                 
       incidentally)                                    

                                                        No

  16   Radionuclide work     Radiation exposure         Yes

                                                        No

  17   Sealed radioactive    Radiation exposure         Yes
       sources                                          

                                                        No

  18   Welding, torch        Fire, burns                Yes
       soldering, brazing                               
       other torch work (not                            
       lab use of Bunsen                                
       Burners or similar)                              

                                                        No

  19   Lifting devices       Lifting device failure     Yes
       (cranes, hoists and   resulting in injury        
       equipment used with                              
       them)                                            

                                                        No

  20   Loud noise (\> 85     Hearing damage             Yes
       dBA)                                             

                                                        No

  21   Respirator Use        Toxicity due to            Yes
                             respirator misuse          

                                                        No

  22   Explosives            Explosion                  Yes

                                                        No

                                                        No

  23   Flammable solvents    Fire, explosion            Yes

                                                        No

  24   Particularly          Cancer, adverse            Yes
       hazardous substances  reproductive outcomes,     
       (Potent carcinogens,  toxicity                   
       reproductive toxins,                             
       highly acutely toxic                             
       materials)                                       

                                                        No

  25   Beryllium and         Chronic beryllium          Yes
       compounds             disease                    

                                                        No

  26   Strong magnetic       Interference with          Yes
       fields (\> 5 gauss in medical implants,          
       open area)            accelerated metal          
                             items                      

                                                        No

  27   Powerful RF/MW        Shock, heating and         Yes
       sources               burns                      

                                                        No

  28   Home Made or          Shock                      Yes
       non-listed electrical                            
       equipment \>50 volts                             

                                                        No

  29   Hazardous, biological Improper waste             Yes
       or radioactive waste  disposal, exposure,        
       generation            infection                  

                                                        No
  ---- --------------------- ---------------------- --- -------------------

**[Part 2: Detailed Hazard Inventory\
]{.underline}**Note: Complete only those items to which you answered
"Yes" in part 1.

+---+------------+-------------------+---+------------------+------------+
|   | **Topic**  | **Key             | * | **Requirement**  | **Indicate |
|   |            | Requirements**    | * |                  | Applicable |
|   |            |                   | Y | **(Answer Yes,   | Room(s)**  |
|   |            |                   | / | No, NA)**        |            |
|   |            |                   | N |                  |            |
|   |            |                   | * |                  |            |
|   |            |                   | * |                  |            |
|   |            |                   |   |                  |            |
|   |            |                   | * |                  |            |
|   |            |                   | * |                  |            |
|   |            |                   | N |                  |            |
|   |            |                   | A |                  |            |
|   |            |                   | * |                  |            |
|   |            |                   | * |                  |            |
+===+============+===================+===+==================+============+
| 1 | Lasers     | *An AHD is        |   | 1\) Do you have  |            |
|   | (Class 3b  | required* for     |   | an authorized    |            |
|   | or 4)      | Class 3B or 4     |   | and current      |            |
|   |            | lasers. Users     |   | Activity Hazard  |            |
|   |            | must complete     |   | Document for the |            |
|   |            | training and have |   | use of the class |            |
|   |            | laser eye exam.   |   | 3b or 4 lasers?  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) Have all     |            |
|   |            |                   |   | laser users      |            |
|   |            |                   |   | completed EHS280 |            |
|   |            |                   |   | (Laser safety    |            |
|   |            |                   |   | training)?       |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 3\) Have all     |            |
|   |            |                   |   | laser users      |            |
|   |            |                   |   | completed and    |            |
|   |            |                   |   | received credit  |            |
|   |            |                   |   | (EHS0288) for a  |            |
|   |            |                   |   | laser eye exam   |            |
|   |            |                   |   | (available from  |            |
|   |            |                   |   | Health           |            |
|   |            |                   |   | Services)?       |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 4\) For class 4  |            |
|   |            |                   |   | lasers, are      |            |
|   |            |                   |   | interlock        |            |
|   |            |                   |   | systems tested   |            |
|   |            |                   |   | at least         |            |
|   |            |                   |   | semiannually and |            |
|   |            |                   |   | in proper        |            |
|   |            |                   |   | operating order? |            |
+---+------------+-------------------+---+------------------+------------+
| 2 | "Health    | *An AHD is        |   | 1\) Do you have  |            |
|   | Hazard"    | required* for     |   | an authorized    |            |
|   | gases      | NFPA Health       |   | and current      |            |
|   | (          | Hazard Gas Class  |   | Activity Hazard  |            |
|   | compressed | 3 or 4 (very and  |   | Document for the |            |
|   | or         | extremely toxic), |   | use of toxic     |            |
|   | liquefied  | or Class 2 gases  |   | gases, or has    |            |
|   | toxic or   | (moderately       |   | your use of a    |            |
|   | corrosive  | toxic) with poor  |   | very small       |            |
|   | gases)     | warning           |   | quantities (\<27 |            |
|   |            | properties (no    |   | cubic feet at    |            |
|   |            | odors or          |   | ATP) of CO been  |            |
|   |            | irritation).      |   | authorized       |            |
|   |            | There is an       |   | without an AHD?  |            |
|   |            | exemption for     |   |                  |            |
|   |            | very small        |   |                  |            |
|   |            | cylinders of      |   |                  |            |
|   |            | carbon monoxide   |   |                  |            |
|   |            | (\<27 cubic feet) |   |                  |            |
|   |            | if certain        |   |                  |            |
|   |            | procedures are    |   |                  |            |
|   |            | followed.         |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) Have all     |            |
|   |            |                   |   | users completed  |            |
|   |            |                   |   | EHS0348,         |            |
|   |            |                   |   | Chemical Hygiene |            |
|   |            |                   |   | and Safety       |            |
|   |            |                   |   | training and     |            |
|   |            |                   |   | EHS231,          |            |
|   |            |                   |   | Compressed Gases |            |
|   |            |                   |   | and Cryogens?    |            |
+---+------------+-------------------+---+------------------+------------+
| 3 | Flammable  | *An AHD is        |   | 1\) Do you       |            |
|   | compressed | required* if      |   | possess \>400    |            |
|   | or         | total quantity of |   | cubic feet of    |            |
|   | liquefied  | gas in lab \>400  |   | flammable gas at |            |
|   | Gas        | cubic feet at ATP |   | a time?          |            |
|   |            | (2 standard large |   |                  |            |
|   |            | gas cylinders)?   |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) Do you       |            |
|   |            |                   |   | possess \<400    |            |
|   |            |                   |   | cubic feet of    |            |
|   |            |                   |   | flammable gas at |            |
|   |            |                   |   | a time?          |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 3\) Have all     |            |
|   |            |                   |   | users completed  |            |
|   |            |                   |   | EHS0348,         |            |
|   |            |                   |   | Chemical Hygiene |            |
|   |            |                   |   | and Safety       |            |
|   |            |                   |   | training?        |            |
+---+------------+-------------------+---+------------------+------------+
| 4 | Pyrophoric | *An AHD is        |   | 1\) Do you have  |            |
|   | gas        | required* for any |   | an authorized    |            |
|   | (c         | compressed or     |   | and current      |            |
|   | ompressed/ | liquefied         |   | Activity Hazard  |            |
|   | liquefied) | pyrophoric gas    |   | Document for the |            |
|   |            |                   |   | use or this gas? |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) Have all     |            |
|   |            |                   |   | users completed  |            |
|   |            |                   |   | EHS0348,         |            |
|   |            |                   |   | Chemical Hygiene |            |
|   |            |                   |   | and Safety       |            |
|   |            |                   |   | training?        |            |
+---+------------+-------------------+---+------------------+------------+
| 5 | P          | *High Hazard      |   | 1\) Do you have  |            |
|   | ressurized | Pressurized       |   | a "high hazard"  |            |
|   | systems    | Systems***-**-An  |   | pressurized      |            |
|   | (Other     | "Engineering      |   | system?          |            |
|   | than DOT   | Safety Note" or   |   |                  |            |
|   | gas        | equal is required |   |                  |            |
|   | cylinders) | for high hazard   |   |                  |            |
|   |            | systems,          |   |                  |            |
|   |            | including:        |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | 1\) All pressure  |   |                  |            |
|   |            | vessel systems    |   |                  |            |
|   |            | that contain      |   |                  |            |
|   |            | irritant, toxic,  |   |                  |            |
|   |            | infectious,       |   |                  |            |
|   |            | and/or            |   |                  |            |
|   |            | radioactive       |   |                  |            |
|   |            | fluids at any     |   |                  |            |
|   |            | pressure, other   |   |                  |            |
|   |            | than DOE          |   |                  |            |
|   |            | containers.       |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | 2\) All pressure  |   |                  |            |
|   |            | vessel systems    |   |                  |            |
|   |            | with oxygen or    |   |                  |            |
|   |            | flammable         |   |                  |            |
|   |            | contents.         |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | 3\) All           |   |                  |            |
|   |            | pressurized       |   |                  |            |
|   |            | equipment         |   |                  |            |
|   |            | (including        |   |                  |            |
|   |            | ASME-coded        |   |                  |            |
|   |            | vessels that have |   |                  |            |
|   |            | been structurally |   |                  |            |
|   |            | modified) that    |   |                  |            |
|   |            | operates at gas   |   |                  |            |
|   |            | pressures over 1  |   |                  |            |
|   |            | MPa gauge (150    |   |                  |            |
|   |            | psig) or at       |   |                  |            |
|   |            | liquid pressures  |   |                  |            |
|   |            | over 10 MPa gauge |   |                  |            |
|   |            | (1,500 psig), or  |   |                  |            |
|   |            | that contains     |   |                  |            |
|   |            | over 100 kJ       |   |                  |            |
|   |            | (75,000 ft-lb) of |   |                  |            |
|   |            | stored energy.    |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | *Note: Generally  |   |                  |            |
|   |            | does not include  |   |                  |            |
|   |            | DOT gas cylinders |   |                  |            |
|   |            | and commercial    |   |                  |            |
|   |            | pressure vessels  |   |                  |            |
|   |            | built to ASME     |   |                  |            |
|   |            | standards.*       |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) If yes to    |            |
|   |            |                   |   | question 1, do   |            |
|   |            |                   |   | you have an      |            |
|   |            |                   |   | Engineering      |            |
|   |            |                   |   | Safety Note for  |            |
|   |            |                   |   | this high hazard |            |
|   |            |                   |   | system system?   |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 3\) If yes to    |            |
|   |            |                   |   | question 1, do   |            |
|   |            |                   |   | you have an      |            |
|   |            |                   |   | Activity Hazard  |            |
|   |            |                   |   | Document for     |            |
|   |            |                   |   | this high hazard |            |
|   |            |                   |   | pressurized      |            |
|   |            |                   |   | system?          |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 4\) Has          |            |
|   |            |                   |   | everybody using  |            |
|   |            |                   |   | any pressurized  |            |
|   |            |                   |   | system completed |            |
|   |            |                   |   | EHS0231,         |            |
|   |            |                   |   | Pressure and     |            |
|   |            |                   |   | Cryogen Safety?  |            |
+---+------------+-------------------+---+------------------+------------+
| 6 | Energized  | Work on energized |   | 1\) Do           |            |
|   | Electrical | electrical        |   | individuals in   |            |
|   | R&D Work   | equipment         |   | your lab work on |            |
|   | \>50 volts | (probing,         |   | electrical       |            |
|   | (shock     | testing,          |   | equipment that   |            |
|   | potential) | repairing,        |   | is energized     |            |
|   |            | manipulating      |   | such that they   |            |
|   |            | energized         |   | may be exposed   |            |
|   |            | components)       |   | to \>50 V and 5  |            |
|   |            | requires specific |   | mA of current    |            |
|   |            | training that     |   | (probing,        |            |
|   |            | varies with the   |   | testing,         |            |
|   |            | degree of hazard. |   | repairing,       |            |
|   |            | Higher hazard     |   | manipulating)?   |            |
|   |            | work requires     |   |                  |            |
|   |            | Division Director |   | \--Have all such |            |
|   |            | approval.         |   | individuals      |            |
|   |            |                   |   | completed        |            |
|   |            |                   |   | EHS256, 249,     |            |
|   |            |                   |   | 116, 123, 267?   |            |
|   |            |                   |   |                  |            |
|   |            |                   |   | \--Have all such |            |
|   |            |                   |   | work been        |            |
|   |            |                   |   | authorized by    |            |
|   |            |                   |   | the Division     |            |
|   |            |                   |   | Director?        |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) Do           |            |
|   |            |                   |   | individuals in   |            |
|   |            |                   |   | your lab work on |            |
|   |            |                   |   | electrical       |            |
|   |            |                   |   | equipment that   |            |
|   |            |                   |   | is energized     |            |
|   |            |                   |   | such that that   |            |
|   |            |                   |   | may ONLY be      |            |
|   |            |                   |   | exposed to \<50  |            |
|   |            |                   |   | volts and \<1000 |            |
|   |            |                   |   | watts, or        |            |
|   |            |                   |   | 50-20,000 V AND  |            |
|   |            |                   |   | \<5 mA of        |            |
|   |            |                   |   | current?         |            |
|   |            |                   |   |                  |            |
|   |            |                   |   | \--Have all such |            |
|   |            |                   |   | individuals      |            |
|   |            |                   |   | completed        |            |
|   |            |                   |   | EHS0260          |            |
|   |            |                   |   | (Electrical      |            |
|   |            |                   |   | Hazard           |            |
|   |            |                   |   | Awareness)?      |            |
+---+------------+-------------------+---+------------------+------------+
| 7 | Highly     | *An AHD may be    |   | 1\) Do you have  |            |
|   | reactive   | required*. Each   |   | an authorized    |            |
|   | chemicals, | operation         |   | and current AHD  |            |
|   | air        | involving highly  |   | for this work?   |            |
|   | reactive   | reactive          |   |                  |            |
|   | chemicals  | chemicals must be |   |                  |            |
|   |            | individually      |   |                  |            |
|   |            | reviewed to       |   |                  |            |
|   |            | determine if an   |   |                  |            |
|   |            | AHD is required.  |   |                  |            |
|   |            | Examples include  |   |                  |            |
|   |            | the use of alkali |   |                  |            |
|   |            | metals,           |   |                  |            |
|   |            | pyrophoric        |   |                  |            |
|   |            | materials,        |   |                  |            |
|   |            | unstable          |   |                  |            |
|   |            | materials,        |   |                  |            |
|   |            | extreme           |   |                  |            |
|   |            | oxidizers.        |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) If no AHD,   |            |
|   |            |                   |   | have you had an  |            |
|   |            |                   |   | assessment       |            |
|   |            |                   |   | conducted by the |            |
|   |            |                   |   | EH&S Division or |            |
|   |            |                   |   | the MSD EH&S     |            |
|   |            |                   |   | Manager to       |            |
|   |            |                   |   | determine the    |            |
|   |            |                   |   | need for an AHD  |            |
|   |            |                   |   | for this work?   |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 3\) Have all     |            |
|   |            |                   |   | users completed  |            |
|   |            |                   |   | EHS0348,         |            |
|   |            |                   |   | Chemical Hygiene |            |
|   |            |                   |   | and Safety       |            |
|   |            |                   |   | training?        |            |
+---+------------+-------------------+---+------------------+------------+
| 8 | Glovebox   | *An AHD may be    |   | 1\) Do you have  |            |
|   | Work       | required*. Each   |   | an authorized    |            |
|   | (other     | operation         |   | and current AHD  |            |
|   | than       | involving the use |   | for this work?   |            |
|   | purely for | of a glove box    |   |                  |            |
|   | product    | must be           |   |                  |            |
|   | p          | individually      |   |                  |            |
|   | rotection) | reviewed to       |   |                  |            |
|   |            | determine if an   |   |                  |            |
|   |            | AHD is required.  |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) If no AHD,   |            |
|   |            |                   |   | have you had an  |            |
|   |            |                   |   | assessment       |            |
|   |            |                   |   | conducted by the |            |
|   |            |                   |   | EH&S Division or |            |
|   |            |                   |   | the MSD EH&S     |            |
|   |            |                   |   | Manager to       |            |
|   |            |                   |   | determine the    |            |
|   |            |                   |   | need for an AHD  |            |
|   |            |                   |   | for this work?   |            |
+---+------------+-------------------+---+------------------+------------+
| 9 | Confined   | *An AHD may be    |   | 1\) Do you have  |            |
|   | Spaces     | required. Some    |   | a                |            |
|   | Entry      | confined spaces   |   | permit-required  |            |
|   | (e.g.,     | require permits   |   | confined space?  |            |
|   | tanks,     | to enter*, others |   |                  |            |
|   | pits,      | do not. A         |   |                  |            |
|   | vaults,    | confined space is |   |                  |            |
|   | vessels)   | defined as:       |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | 1\) Hard to       |   |                  |            |
|   |            | enter/exit        |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | 2\) Not intended  |   |                  |            |
|   |            | for occupancy     |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | 3\) Big enough to |   |                  |            |
|   |            | allow physical    |   |                  |            |
|   |            | entry.            |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | If the confined   |   |                  |            |
|   |            | space also has    |   |                  |            |
|   |            | the *potential*   |   |                  |            |
|   |            | to contain        |   |                  |            |
|   |            | atmospheric or    |   |                  |            |
|   |            | physical hazards  |   |                  |            |
|   |            | of any type, it   |   |                  |            |
|   |            | is a              |   |                  |            |
|   |            | permit-required   |   |                  |            |
|   |            | space.            |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) Do you have  |            |
|   |            |                   |   | a non-permit     |            |
|   |            |                   |   | required         |            |
|   |            |                   |   | confined space?  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 3\) If yes to    |            |
|   |            |                   |   | question 1, do   |            |
|   |            |                   |   | you have an      |            |
|   |            |                   |   | authorized and   |            |
|   |            |                   |   | current AHD for  |            |
|   |            |                   |   | this work?       |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 4\) If no AHD,   |            |
|   |            |                   |   | have you had an  |            |
|   |            |                   |   | assessment       |            |
|   |            |                   |   | conducted by the |            |
|   |            |                   |   | EH&S Division or |            |
|   |            |                   |   | the MSD EH&S     |            |
|   |            |                   |   | Manager to       |            |
|   |            |                   |   | determine the    |            |
|   |            |                   |   | need for an AHD  |            |
|   |            |                   |   | for this work?   |            |
+---+------------+-------------------+---+------------------+------------+
| 1 | P          | *AHD may be       |   | 1\) Do you have  |            |
| 0 | otentially | required* if      |   | an authorized    |            |
|   | oxygen     | oxygen level may  |   | and current AHD  |            |
|   | deficient  | go lower than 18% |   | for this work?   |            |
|   | space      | in a credible     |   |                  |            |
|   | (other     | event (e.g.       |   |                  |            |
|   | than       | quench,           |   |                  |            |
|   | confined   | earthquake,       |   |                  |            |
|   | spaces)    | spill)            |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) If no AHD,   |            |
|   |            |                   |   | have you had an  |            |
|   |            |                   |   | assessment       |            |
|   |            |                   |   | conducted by the |            |
|   |            |                   |   | EH&S Division or |            |
|   |            |                   |   | the MSD EH&S     |            |
|   |            |                   |   | Manager to       |            |
|   |            |                   |   | determine the    |            |
|   |            |                   |   | need for an AHD  |            |
|   |            |                   |   | for this work?   |            |
+---+------------+-------------------+---+------------------+------------+
| 1 | P          | *A Biological Use |   | 1\) Do you have  |            |
| 1 | otentially | Authorization may |   | an approved and  |            |
|   | bi         | be required for   |   | current          |            |
|   | ohazardous | organisms         |   | Biological Use   |            |
|   | materials  | classified as     |   | Authorization    |            |
|   | (Risk      | "Risk group 2" or |   | (BUA)?           |            |
|   | group      | higher and rDNA   |   |                  |            |
|   | /biosafety | work.* May apply  |   |                  |            |
|   | level 2 or | to bacteria,      |   |                  |            |
|   | higher)    | fungi, virus,     |   |                  |            |
|   |            | parasite, animal  |   |                  |            |
|   |            | tissue including  |   |                  |            |
|   |            | blood, primate    |   |                  |            |
|   |            | cell lines, any   |   |                  |            |
|   |            | material that     |   |                  |            |
|   |            | could be          |   |                  |            |
|   |            | contaminated with |   |                  |            |
|   |            | these such as     |   |                  |            |
|   |            | blood or tissue.  |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) If no BUA,   |            |
|   |            |                   |   | have you had an  |            |
|   |            |                   |   | assessment       |            |
|   |            |                   |   | conducted by the |            |
|   |            |                   |   | EH&S Division or |            |
|   |            |                   |   | the MSD EH&S     |            |
|   |            |                   |   | Manager to       |            |
|   |            |                   |   | determine the    |            |
|   |            |                   |   | need for an BUA  |            |
|   |            |                   |   | for this work?   |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 3\) Have users   |            |
|   |            |                   |   | completed EHS739 |            |
|   |            |                   |   | (Biosafety)?     |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 4\) Have users   |            |
|   |            |                   |   | of potentially   |            |
|   |            |                   |   | infectious       |            |
|   |            |                   |   | primate tissue,  |            |
|   |            |                   |   | including blood, |            |
|   |            |                   |   | completed        |            |
|   |            |                   |   | EHS0735          |            |
|   |            |                   |   | (Bloodborne      |            |
|   |            |                   |   | pathogen         |            |
|   |            |                   |   | training)?       |            |
+---+------------+-------------------+---+------------------+------------+
| 1 | Liquid     | *An AHD may be    |   | 1\) Do you use   |            |
| 2 | Cryogen    | required*. Use    |   | more than 10     |            |
|   | (LN, LHe)  | large quantities  |   | liters of liquid |            |
|   |            | of LN or LHe may  |   | cryogen?         |            |
|   |            | require an AHD.   |   |                  |            |
|   |            | Use of cryogen in |   |                  |            |
|   |            | superconducting   |   |                  |            |
|   |            | systems may       |   |                  |            |
|   |            | require an AHD.   |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) Do you use a |            |
|   |            |                   |   | superconducting  |            |
|   |            |                   |   | system that      |            |
|   |            |                   |   | contains \> 10   |            |
|   |            |                   |   | liters of        |            |
|   |            |                   |   | cryogen?         |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 3\) Do you have  |            |
|   |            |                   |   | an authorized    |            |
|   |            |                   |   | and current AHD  |            |
|   |            |                   |   | for this work?   |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 4\) If no AHD,   |            |
|   |            |                   |   | have you had an  |            |
|   |            |                   |   | assessment       |            |
|   |            |                   |   | conducted by the |            |
|   |            |                   |   | EH&S Division or |            |
|   |            |                   |   | the MSD EH&S     |            |
|   |            |                   |   | Manager to       |            |
|   |            |                   |   | determine the    |            |
|   |            |                   |   | need for an AHD  |            |
|   |            |                   |   | for this work?   |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 5\) Have all     |            |
|   |            |                   |   | cryogen users    |            |
|   |            |                   |   | completed        |            |
|   |            |                   |   | EHS0231,         |            |
|   |            |                   |   | Compressed Gas   |            |
|   |            |                   |   | and Cryogen      |            |
|   |            |                   |   | Safety?          |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 6\) Do you have  |            |
|   |            |                   |   | cryo gloves and  |            |
|   |            |                   |   | eye/face         |            |
|   |            |                   |   | protective       |            |
|   |            |                   |   | devices          |            |
|   |            |                   |   | available in all |            |
|   |            |                   |   | locations where  |            |
|   |            |                   |   | liquid cryogen   |            |
|   |            |                   |   | is used?         |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 7\) Do you have  |            |
|   |            |                   |   | need to          |            |
|   |            |                   |   | transport \>5    |            |
|   |            |                   |   | liters of liquid |            |
|   |            |                   |   | cryogen in an    |            |
|   |            |                   |   | elevator?        |            |
+---+------------+-------------------+---+------------------+------------+
| 1 | Human      | *Human Subjects   |   | 1\) Are your     |            |
| 3 | samples or | Committee         |   | human materials  |            |
|   | i          | approval* may be  |   | identifiable     |            |
|   | nformation | required for      |   | (tracable to the |            |
|   |            | *research* where: |   | donor)?          |            |
|   |            |                   |   |                  |            |
|   |            | 1.  *Any type* of |   |                  |            |
|   |            |     biological    |   |                  |            |
|   |            |     sample is     |   |                  |            |
|   |            |     obtained from |   |                  |            |
|   |            |     living        |   |                  |            |
|   |            |     persons who   |   |                  |            |
|   |            |     can be        |   |                  |            |
|   |            |     identified as |   |                  |            |
|   |            |     the donor.    |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | 2\. Identifiable  |   |                  |            |
|   |            | personal          |   |                  |            |
|   |            | information       |   |                  |            |
|   |            | obtained from any |   |                  |            |
|   |            | living persons    |   |                  |            |
|   |            | (e.g. health      |   |                  |            |
|   |            | history, food     |   |                  |            |
|   |            | consumption).     |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) If yes to    |            |
|   |            |                   |   | question 1, do   |            |
|   |            |                   |   | you have a       |            |
|   |            |                   |   | current          |            |
|   |            |                   |   | ap               |            |
|   |            |                   |   | proval/exemption |            |
|   |            |                   |   | from the Human   |            |
|   |            |                   |   | Subjects         |            |
|   |            |                   |   | Committee to use |            |
|   |            |                   |   | human samples or |            |
|   |            |                   |   | information?     |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 3\) Have         |            |
|   |            |                   |   | individuals      |            |
|   |            |                   |   | using human      |            |
|   |            |                   |   | materials        |            |
|   |            |                   |   | completed EHS740 |            |
|   |            |                   |   | and the          |            |
|   |            |                   |   | refresher        |            |
|   |            |                   |   | training EHS742, |            |
|   |            |                   |   | as necessary?    |            |
+---+------------+-------------------+---+------------------+------------+
| 1 | Vertebrate | *Animal Welfare   |   | 1\) Do you have  |            |
| 4 | animal     | Committee         |   | a current        |            |
|   | samples    | approval*         |   | approval to use  |            |
|   | (not       | required when:    |   | animal materials |            |
|   | co         |                   |   | from the Animal  |            |
|   | mmercially | 1.  Working with  |   | Welfare          |            |
|   | available) |     vertebrate    |   | Committee?       |            |
|   |            |     animals       |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | 2.  Working with  |   |                  |            |
|   |            |     samples from  |   |                  |            |
|   |            |     vertebrate    |   |                  |            |
|   |            |     animals, even |   |                  |            |
|   |            |     if the        |   |                  |            |
|   |            |     animals are   |   |                  |            |
|   |            |     not at LBNL   |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | Primary animal    |   |                  |            |
|   |            | cell lines        |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
| 1 | X-rays     | *An X-ray         |   | 1\) Do you have  |            |
| 5 | Machine    | Authorization or  |   | an approved and  |            |
|   | (capable   | AHD may be        |   | current X-Ray    |            |
|   | of         | required.*        |   | Use              |            |
|   | creating   |                   |   | Authorization    |            |
|   | x-rays in  | 1.  Equipment     |   | (XA) or Activity |            |
|   | air,       |     designed to,  |   | Hazard Document  |            |
|   | int        |     or capable    |   | (AHD)?           |            |
|   | entionally |     of, producing |   |                  |            |
|   | or         |     X-rays in air |   |                  |            |
|   | inc        |     require an    |   |                  |            |
|   | identally) |     X-Ray         |   |                  |            |
|   |            |     Authorization |   |                  |            |
|   |            |     and an X-ray  |   |                  |            |
|   |            |     engineering   |   |                  |            |
|   |            |     review.       |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | 2.  X-ray         |   |                  |            |
|   |            |     machines that |   |                  |            |
|   |            |     can only      |   |                  |            |
|   |            |     produce       |   |                  |            |
|   |            |     X-rays in a   |   |                  |            |
|   |            |     continuous    |   |                  |            |
|   |            |     vacuum        |   |                  |            |
|   |            |     usually do    |   |                  |            |
|   |            |     not require   |   |                  |            |
|   |            |     any formal    |   |                  |            |
|   |            |                   |   |                  |            |
|   |            |    authorization. |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | Machines that     |   |                  |            |
|   |            | produce           |   |                  |            |
|   |            | incidental X-rays |   |                  |            |
|   |            | (e.g. ion         |   |                  |            |
|   |            | implanter,        |   |                  |            |
|   |            | accelerator,      |   |                  |            |
|   |            | electron          |   |                  |            |
|   |            | microscope) may   |   |                  |            |
|   |            | need an AHD.      |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) Have users   |            |
|   |            |                   |   | of this          |            |
|   |            |                   |   | equipment        |            |
|   |            |                   |   | completed the    |            |
|   |            |                   |   | training         |            |
|   |            |                   |   | specified on the |            |
|   |            |                   |   | XA or AHD?       |            |
+---+------------+-------------------+---+------------------+------------+
| 1 | Ra         | *A Radiation Work |   | 1\) Do you have  |            |
| 6 | dionuclide | Authorization     |   | a current and    |            |
|   | work       | (RWA) or Low      |   | authorized RWA   |            |
|   |            | Activity Source   |   | or LAS for this  |            |
|   |            | Authorization     |   | work?            |            |
|   |            | (LAS) is          |   |                  |            |
|   |            | generally         |   |                  |            |
|   |            | required.*        |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) Have         |            |
|   |            |                   |   | individuals who  |            |
|   |            |                   |   | work with        |            |
|   |            |                   |   | radionuclides    |            |
|   |            |                   |   | completed        |            |
|   |            |                   |   | EHS0400 and      |            |
|   |            |                   |   | other training   |            |
|   |            |                   |   | specified on the |            |
|   |            |                   |   | RWA or LAS?      |            |
+---+------------+-------------------+---+------------------+------------+
| 1 | Sealed     | *A Sealed Source  |   | 1\) Do you have  |            |
| 7 | r          | authorization* is |   | a current and    |            |
|   | adioactive | generally         |   | authorized       |            |
|   | sources    | required          |   | Sealed Source    |            |
|   |            |                   |   | Authorization    |            |
|   |            |                   |   | (SSA) for this   |            |
|   |            |                   |   | work?            |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) Have         |            |
|   |            |                   |   | individuals      |            |
|   |            |                   |   | working with the |            |
|   |            |                   |   | source been      |            |
|   |            |                   |   | trained as       |            |
|   |            |                   |   | specified in the |            |
|   |            |                   |   | SSA?             |            |
+---+------------+-------------------+---+------------------+------------+
| 1 | Welding,   | A *"Hot Work      |   | 1\) Do you       |            |
| 8 | torch      | Permit*" is       |   | obtain a "Hot    |            |
|   | soldering, | required from the |   | Work Permit" for |            |
|   | brazing    | Fire Department.  |   | all use of open  |            |
|   | other      |                   |   | flame other than |            |
|   | torch work |                   |   | lab use of       |            |
|   | (not lab   |                   |   | Bunsen and       |            |
|   | use of     |                   |   | similar burners? |            |
|   | Bunsen     |                   |   |                  |            |
|   | Burners or |                   |   |                  |            |
|   | similar)   |                   |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) Have all     |            |
|   |            |                   |   | users of such    |            |
|   |            |                   |   | equipment        |            |
|   |            |                   |   | completed EHS535 |            |
|   |            |                   |   | "Hot work"       |            |
|   |            |                   |   | training?        |            |
+---+------------+-------------------+---+------------------+------------+
| 1 | Lifting    | *Annual           |   | 1\) Have all of  |            |
| 9 | devices    | inspection may be |   | your lifting     |            |
|   | (cranes,   | required*.        |   | devices been     |            |
|   | hoists and | Lifting devices   |   | inspected and    |            |
|   | equipment  | must generally be |   | tagged within    |            |
|   | used with  | inspected and     |   | the last year?   |            |
|   | them)      | labeled annually  |   |                  |            |
|   |            | by Facilities.    |   |                  |            |
|   |            | Inspection by     |   |                  |            |
|   |            | users is also     |   |                  |            |
|   |            | required before   |   |                  |            |
|   |            | use. Shackles and |   |                  |            |
|   |            | hoist rings may   |   |                  |            |
|   |            | require periodic  |   |                  |            |
|   |            | non-destructive   |   |                  |            |
|   |            | testing.          |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) Have all     |            |
|   |            |                   |   | users of the     |            |
|   |            |                   |   | lifting device   |            |
|   |            |                   |   | completed the    |            |
|   |            |                   |   | following        |            |
|   |            |                   |   | required         |            |
|   |            |                   |   | training?        |            |
|   |            |                   |   |                  |            |
|   |            |                   |   | \--EHS210 \<2    |            |
|   |            |                   |   | tons             |            |
|   |            |                   |   |                  |            |
|   |            |                   |   | \--EHS206 \>2    |            |
|   |            |                   |   | tons             |            |
+---+------------+-------------------+---+------------------+------------+
| 2 | Loud noise | *Exposure         |   | 1\) Have sources |            |
| 0 | (\> 85     | measurement,      |   | of loud noise    |            |
|   | dBA)       | medical           |   | been evaluated   |            |
|   |            | examination and   |   | by EH&S to       |            |
|   |            | hearing           |   | determine if the |            |
|   |            | protectors may be |   | noise level is   |            |
|   |            | required*. If the |   | potentially      |            |
|   |            | noise is loud     |   | hazardous (\>85  |            |
|   |            | enough to         |   | dBA)             |            |
|   |            | interfere with    |   |                  |            |
|   |            | speech, a noise   |   |                  |            |
|   |            | measurement by    |   |                  |            |
|   |            | EH&S is required. |   |                  |            |
|   |            | IF the noise      |   |                  |            |
|   |            | averages \>85     |   |                  |            |
|   |            | dBA, annual       |   |                  |            |
|   |            | hearing testing   |   |                  |            |
|   |            | and the use of    |   |                  |            |
|   |            | hearing           |   |                  |            |
|   |            | protectors is     |   |                  |            |
|   |            | required.         |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) Have all     |            |
|   |            |                   |   | individuals      |            |
|   |            |                   |   | potentially      |            |
|   |            |                   |   | exposed to loud  |            |
|   |            |                   |   | noise on a       |            |
|   |            |                   |   | regular basis    |            |
|   |            |                   |   | been medically   |            |
|   |            |                   |   | examined         |            |
|   |            |                   |   | (EHS285),        |            |
|   |            |                   |   | provided with    |            |
|   |            |                   |   | hearing          |            |
|   |            |                   |   | protective       |            |
|   |            |                   |   | devices and      |            |
|   |            |                   |   | completed        |            |
|   |            |                   |   | training         |            |
|   |            |                   |   | (EHS0273)?       |            |
+---+------------+-------------------+---+------------------+------------+
| 2 | Respirator | *Training, fit    |   | 1\) Have users   |            |
| 1 | Use        | testing and       |   | of respirators   |            |
|   |            | medical approval  |   | completed EHS310 |            |
|   |            | is generally      |   | training, fit    |            |
|   |            | required*.        |   | testing of the   |            |
|   |            | Respirator users  |   | respirator and   |            |
|   |            | must be medically |   | received a       |            |
|   |            | approved by       |   | medical approval |            |
|   |            | Health Services   |   | to wear a        |            |
|   |            | and trained and   |   | respirator (or   |            |
|   |            | fit tested by     |   | EH&S has waved   |            |
|   |            | EH&S.             |   | some of these    |            |
|   |            |                   |   | requirements in  |            |
|   |            |                   |   | the case of      |            |
|   |            |                   |   | "voluntary use"  |            |
|   |            |                   |   | of the           |            |
|   |            |                   |   | respirator)?     |            |
+---+------------+-------------------+---+------------------+------------+
| 2 | Explosives | *Work with        |   | 1\) Do you have  |            |
| 2 |            | explosives is     |   | an authorized    |            |
|   |            | generally not     |   | and current AHD  |            |
|   |            | permitted at      |   | for this work?   |            |
|   |            | LBNL*. Exceptions |   |                  |            |
|   |            | may be granted    |   |                  |            |
|   |            | for very minute   |   |                  |            |
|   |            | quantities, which |   |                  |            |
|   |            | *may require an   |   |                  |            |
|   |            | AHD.*             |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) If not to    |            |
|   |            |                   |   | question 1, have |            |
|   |            |                   |   | you had an       |            |
|   |            |                   |   | assessment       |            |
|   |            |                   |   | conducted by the |            |
|   |            |                   |   | EH&S Division or |            |
|   |            |                   |   | the MSD EH&S     |            |
|   |            |                   |   | Manager to       |            |
|   |            |                   |   | determine the    |            |
|   |            |                   |   | need for an AHD  |            |
|   |            |                   |   | for this work?   |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 3\) Have users   |            |
|   |            |                   |   | completed        |            |
|   |            |                   |   | EHS0348,         |            |
|   |            |                   |   | Chemical Hygiene |            |
|   |            |                   |   | and Safety?      |            |
+---+------------+-------------------+---+------------------+------------+
| 2 | Flammable  | Generally no      |   | 1\) Do you work  |            |
| 3 | Solvents   | formal            |   | with large       |            |
|   |            | authorization of  |   | quantities of    |            |
|   |            | work is required. |   | solvents at one  |            |
|   |            | *An AHD may be    |   | time (\>10       |            |
|   |            | required for      |   | liters)?         |            |
|   |            | large-scale, high |   |                  |            |
|   |            | temperature or    |   |                  |            |
|   |            | unusual use of    |   |                  |            |
|   |            | flammable         |   |                  |            |
|   |            | solvents.*        |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | However, use of   |   |                  |            |
|   |            | unusually large   |   |                  |            |
|   |            | quantities (\>10  |   |                  |            |
|   |            | liters) in        |   |                  |            |
|   |            | equipment or      |   |                  |            |
|   |            | experiments       |   |                  |            |
|   |            | should be         |   |                  |            |
|   |            | reviewed by the   |   |                  |            |
|   |            | MSD EH&S Manager. |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) If you       |            |
|   |            |                   |   | answered yes to  |            |
|   |            |                   |   | question 1, have |            |
|   |            |                   |   | you had an       |            |
|   |            |                   |   | assessment       |            |
|   |            |                   |   | conducted by the |            |
|   |            |                   |   | EH&S Division or |            |
|   |            |                   |   | the MSD EH&S     |            |
|   |            |                   |   | Manager to       |            |
|   |            |                   |   | determine the    |            |
|   |            |                   |   | need for an AHD  |            |
|   |            |                   |   | for this work?   |            |
+---+------------+-------------------+---+------------------+------------+
| 2 | Pa         | An *AHD may be    |   | 1\) Do you have  |            |
| 4 | rticularly | required* in some |   | an authorized    |            |
|   | hazardous  | cases. PI must    |   | and current AHD  |            |
|   | substances | specifically      |   | for this work?   |            |
|   | (Potent    | authorize work    |   |                  |            |
|   | ca         | with particularly |   |                  |            |
|   | rcinogens, | hazardous         |   |                  |            |
|   | re         | materials.        |   |                  |            |
|   | productive |                   |   |                  |            |
|   | toxins,    | Substances of     |   |                  |            |
|   | highly     | high acute        |   |                  |            |
|   | acutely    | toxicity which    |   |                  |            |
|   | toxic      | may be fatal or   |   |                  |            |
|   | materials) | cause damage to   |   |                  |            |
|   |            | target organs as  |   |                  |            |
|   |            | a result of a     |   |                  |            |
|   |            | single exposure,  |   |                  |            |
|   |            | or are capable of |   |                  |            |
|   |            | causing intense   |   |                  |            |
|   |            | irritation that   |   |                  |            |
|   |            | can result in     |   |                  |            |
|   |            | pulmonary edema   |   |                  |            |
|   |            | should be         |   |                  |            |
|   |            | classified as     |   |                  |            |
|   |            | particularly      |   |                  |            |
|   |            | hazardous. This   |   |                  |            |
|   |            | also includes     |   |                  |            |
|   |            | chemicals that    |   |                  |            |
|   |            | can cause         |   |                  |            |
|   |            | chemical          |   |                  |            |
|   |            | asphyxia, and     |   |                  |            |
|   |            | severe, acute     |   |                  |            |
|   |            | systemic          |   |                  |            |
|   |            | (body-wide)       |   |                  |            |
|   |            | poisoning.        |   |                  |            |
|   |            | Examples are      |   |                  |            |
|   |            | *chemical*        |   |                  |            |
|   |            | *warfare agents   |   |                  |            |
|   |            | or surrogates,    |   |                  |            |
|   |            | biotoxin,s        |   |                  |            |
|   |            | cyanide salts,    |   |                  |            |
|   |            | dimethyl mercury, |   |                  |            |
|   |            | hydrofluoric      |   |                  |            |
|   |            | acid, acrolein*.. |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | *Potent           |   |                  |            |
|   |            | carcinogens that  |   |                  |            |
|   |            | always require    |   |                  |            |
|   |            | review by the     |   |                  |            |
|   |            | EH&S Manager      |   |                  |            |
|   |            | are:*             |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | *4-Nitrodiphenyl  |   |                  |            |
|   |            | \[92-93-3\]*      |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | *Ethylenimine     |   |                  |            |
|   |            | \[151-56-4\]*     |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | *al               |   |                  |            |
|   |            | pha-Naphthylamine |   |                  |            |
|   |            | \[134-32-7\]*     |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | *b                |   |                  |            |
|   |            | eta-Propiolactone |   |                  |            |
|   |            | \[57-57-8\]*      |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | *Chloromethyl     |   |                  |            |
|   |            | methyl ether      |   |                  |            |
|   |            | \[107-30-2\]      |   |                  |            |
|   |            | 2-Ac              |   |                  |            |
|   |            | etylaminofluorene |   |                  |            |
|   |            | \[53-96-3\]*      |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | *3,3\'-           |   |                  |            |
|   |            | Dichlorobenzidine |   |                  |            |
|   |            | \[91-94-1\]       |   |                  |            |
|   |            | 4-Dimethyl        |   |                  |            |
|   |            | amino-azobenezene |   |                  |            |
|   |            | \[60-11-7\]*      |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | *Bis(c            |   |                  |            |
|   |            | hloromethyl)ether |   |                  |            |
|   |            | \[542-88-1\]      |   |                  |            |
|   |            | N-Nit             |   |                  |            |
|   |            | rosodimethylamine |   |                  |            |
|   |            | \[62-75-9\]*      |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | *b                |   |                  |            |
|   |            | eta-Naphthylamine |   |                  |            |
|   |            | \[91-59-8\]*      |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | *Benzidine        |   |                  |            |
|   |            | \[92-87-5\]*      |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | *4-Aminodiphenyl  |   |                  |            |
|   |            | \[92-67-1\]*      |   |                  |            |
|   |            |                   |   |                  |            |
|   |            | *Aflatoxins*      |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) If you       |            |
|   |            |                   |   | answered no to   |            |
|   |            |                   |   | question 1, have |            |
|   |            |                   |   | you reviewed and |            |
|   |            |                   |   | authorized the   |            |
|   |            |                   |   | use of           |            |
|   |            |                   |   | particularly     |            |
|   |            |                   |   | hazardous        |            |
|   |            |                   |   | substances?      |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 3\) Have you had |            |
|   |            |                   |   | an assessment    |            |
|   |            |                   |   | conducted by the |            |
|   |            |                   |   | EH&S Division or |            |
|   |            |                   |   | the MSD EH&S     |            |
|   |            |                   |   | Manager to       |            |
|   |            |                   |   | determine the    |            |
|   |            |                   |   | need for an AHD  |            |
|   |            |                   |   | for this work?   |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 4\) Have users   |            |
|   |            |                   |   | completed        |            |
|   |            |                   |   | EHS0348,         |            |
|   |            |                   |   | Chemical Hygiene |            |
|   |            |                   |   | and Safety?      |            |
+---+------------+-------------------+---+------------------+------------+
| 2 | Beryllium  | *An AHD may be    |   | 1\) Have you had |            |
| 5 | and        | required*. All    |   | an assessment    |            |
|   | compounds  | uses of beryllium |   | conducted by the |            |
|   |            | compounds and     |   | EH&S Division or |            |
|   |            | beryllium metal   |   | the MSD EH&S     |            |
|   |            | must be reviewed  |   | Manager to       |            |
|   |            | by the MSD EH&S   |   | determine the    |            |
|   |            | Manager and the   |   | need for an AHD  |            |
|   |            | EH&S Division.    |   | for this work?   |            |
|   |            | EH&S must approve |   |                  |            |
|   |            | the purchase of   |   |                  |            |
|   |            | beryllium and     |   |                  |            |
|   |            | compounds.        |   |                  |            |
|   |            | Individuals with  |   |                  |            |
|   |            | potential         |   |                  |            |
|   |            | beryllium         |   |                  |            |
|   |            | exposure may be   |   |                  |            |
|   |            | offered medical   |   |                  |            |
|   |            | survaillance.     |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) Have users   |            |
|   |            |                   |   | completed        |            |
|   |            |                   |   | EHS0348,         |            |
|   |            |                   |   | Chemical Hygiene |            |
|   |            |                   |   | and Safety and   |            |
|   |            |                   |   | EHS0342,         |            |
|   |            |                   |   | Beryllium        |            |
|   |            |                   |   | Safety?          |            |
+---+------------+-------------------+---+------------------+------------+
| 2 | Strong     | *An AHD may be    |   | 1\) Do you have  |            |
| 6 | magnetic   | required*. Strong |   | an AHD           |            |
|   | fields (\> | magnetic fields,  |   | addressing       |            |
|   | 5 gauss in | typically         |   | strong magnetic  |            |
|   | open area) | associated with   |   | field safety?    |            |
|   |            | superconducting   |   |                  |            |
|   |            | magnets, need to  |   |                  |            |
|   |            | be reviewed to    |   |                  |            |
|   |            | establish the 5   |   |                  |            |
|   |            | Gauss limit on    |   |                  |            |
|   |            | the fringe field  |   |                  |            |
|   |            | and to establish  |   |                  |            |
|   |            | safety controls.  |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) If no to     |            |
|   |            |                   |   | question 1. have |            |
|   |            |                   |   | you had an       |            |
|   |            |                   |   | assessment       |            |
|   |            |                   |   | conducted by the |            |
|   |            |                   |   | EH&S Division or |            |
|   |            |                   |   | the MSD EH&S     |            |
|   |            |                   |   | Manager to       |            |
|   |            |                   |   | determine the    |            |
|   |            |                   |   | need for an AHD  |            |
|   |            |                   |   | for this work?   |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 3\) Have you     |            |
|   |            |                   |   | established the  |            |
|   |            |                   |   | extent of the    |            |
|   |            |                   |   | magnetic field   |            |
|   |            |                   |   | at the 5 Gauss   |            |
|   |            |                   |   | level and        |            |
|   |            |                   |   | demarcated this  |            |
|   |            |                   |   | area?            |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 4\) Is the room  |            |
|   |            |                   |   | posted to warn   |            |
|   |            |                   |   | individuals of   |            |
|   |            |                   |   | the magnetic     |            |
|   |            |                   |   | field hazards?   |            |
+---+------------+-------------------+---+------------------+------------+
| 2 | Powerful   | An assessment is  |   | 1\) Have you had |            |
| 7 | RF/MW      | appropriate for   |   | an assessment of |            |
|   | sources    | equipment that    |   | the potential    |            |
|   |            | can generate      |   | for exposure to  |            |
|   |            | strong RF/MW      |   | RF/MW radiation? |            |
|   |            | fields (typically |   |                  |            |
|   |            | \>500 watts) in   |   |                  |            |
|   |            | occupied lab      |   |                  |            |
|   |            | space, or that    |   |                  |            |
|   |            | could leak into   |   |                  |            |
|   |            | occupied lab      |   |                  |            |
|   |            | space.            |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
| 2 | Home Made  | *An evaluation by |   | 1\) Have you had |            |
| 8 | or         | the Electrical    |   | an evaluation of |            |
|   | non-listed | Engineering Group |   | the electrical   |            |
|   | electrical | is required*. All |   | safety of this   |            |
|   | equipment  | electrical        |   | equipment by the |            |
|   | \>50 volts | equipment over 50 |   | Electrical       |            |
|   |            | volts that is not |   | Engineering      |            |
|   |            | listed by a       |   | Group or EH&S?   |            |
|   |            | "Nationally       |   |                  |            |
|   |            | recognized        |   |                  |            |
|   |            | testing           |   |                  |            |
|   |            | laboratory" such  |   |                  |            |
|   |            | as the            |   |                  |            |
|   |            | Underwriters Lab  |   |                  |            |
|   |            | (UL) \[but        |   |                  |            |
|   |            | excluding "CE"\], |   |                  |            |
|   |            | including all     |   |                  |            |
|   |            | home made         |   |                  |            |
|   |            | electrical        |   |                  |            |
|   |            | equipment, must   |   |                  |            |
|   |            | reviewed by the   |   |                  |            |
|   |            | LBNL AHJ program. |   |                  |            |
+---+------------+-------------------+---+------------------+------------+
| 2 | Hazardous, | *Hazardous        |   | 1\) Have         |            |
| 9 | biological | chemical waste    |   | generators of    |            |
|   | or         | storage is a type |   | hazardous or     |            |
|   | r          | of "formally      |   | radioactive      |            |
|   | adioactive | authorized"       |   | waste completed  |            |
|   | waste      | activity and is   |   | training, as     |            |
|   | generation | subject to        |   | applicable?      |            |
|   |            | quarterly         |   |                  |            |
|   |            | inspections*.     |   | \--EHS604, 614   |            |
|   |            | Hazardous,        |   | (Chemical)       |            |
|   |            | radioactive and   |   |                  |            |
|   |            | biological wastes |   | \--EHS622        |            |
|   |            | are managed       |   | (Radioactive or  |            |
|   |            | somewhat          |   | mixed)           |            |
|   |            | differently.      |   |                  |            |
|   |            |                   |   | \--EHS730        |            |
|   |            |                   |   | (Biohazardous)   |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 2\) Have         |            |
|   |            |                   |   | managers of      |            |
|   |            |                   |   | Satellite        |            |
|   |            |                   |   | accumulation     |            |
|   |            |                   |   | Areas (SAAs)     |            |
|   |            |                   |   | completed the    |            |
|   |            |                   |   | SAA Management   |            |
|   |            |                   |   | Class EHS614?    |            |
+---+------------+-------------------+---+------------------+------------+
|   |            |                   |   | 3\) Is a system  |            |
|   |            |                   |   | in place to      |            |
|   |            |                   |   | ensure that      |            |
|   |            |                   |   | waste is         |            |
|   |            |                   |   | disposed of      |            |
|   |            |                   |   | within 6 months  |            |
|   |            |                   |   | of generation,   |            |
|   |            |                   |   | is properly      |            |
|   |            |                   |   | stored and is    |            |
|   |            |                   |   | appropriately    |            |
|   |            |                   |   | labeled?         |            |
+---+------------+-------------------+---+------------------+------------+

**Part 2A**

**Line Management Authorization of Work**

**As the Principal investigator, I authorize the scope of work described
in this Project Hazard Guide and Line Management Authorization Record.**

**Name: Date:**