[EMS, FUA and SAD/ASE Checklist for Light Sources Directorate
Reviews]{.underline}

(Light Sources Directorate ES&H personnel and the Environmental
Compliance Representative can assist in completing this form)

  ------------------------------------------------ ----------------------
  [Review Committee:]{.underline}                  [Date:]{.underline}
                                                        

  [Project Name (and \# if any):]{.underline}      
                                                   
  ------------------------------------------------ ----------------------

This checklist identifies issues associated with this project that may
impact the Directorate Environmental Management System, Occupational
Health & Safety Management System, Facility Use Agreements, Safety
Assessment Documents & Accelerator Safety Envelopes, and NEPA documents.
This checklist will be completed during a review process, if needed, and
form part of the documentation of that review.

**[[Significant environmental Aspects associated with this
project:]{.underline}]{.smallcaps}**

Check off any environmental aspects that are associated with this
project ([NSLS and NSLS-II Environmental Management System aspects
matrices](http://www.nsls.bnl.gov/esh/EMS-OHSAS/) show the significant
aspects).

For criteria, go to the SBMS Subject Area titled [Identification of
Environmental Aspects and
Impacts](https://sbms.bnl.gov/sbmsearch/subjarea/31/31_SA.cfm?parentID=31).

+---+------------+---+---------------+---+--------------------+---+-----------+
|   | # Industr  | # | # Work wit    | # | #                  | # | #         |
|   | ial Waste  |   | h Engineered  |   |  Power Consumption |   |  Historic |
|   | Generation |   | Nanomaterials |   |                    |   | al Contam |
|   |            |   |               |   |                    |   | ination ( |
|   |            |   |               |   |                    |   | groundwat |
|   |            |   |               |   |                    |   | er, soil) |
+---+------------+---+---------------+---+--------------------+---+-----------+
| # | # Hazard   | # | # Atmosphe    | # | # Engine           | # | # Soil A  |
|   | ous Waste  |   | ric Emissions |   | ered Nanomaterials |   | ctivation |
|   | Generation |   |               |   |                    |   |           |
+---+------------+---+---------------+---+--------------------+---+-----------+
| # | # Radioact | # | # Liqu        | # | # His              | # | Tr        |
|   | ive Waste  |   | id Effluents  |   | torical Monuments/ |   | ansuranic |
|   | Generation |   |               |   | Cultural Resources |   | Waste     |
|   |            |   |               |   |                    |   | G         |
|   |            |   |               |   |                    |   | eneration |
+---+------------+---+---------------+---+--------------------+---+-----------+
| # | # Mi       | # | # St          | # | # Sens             | # | #         |
|   | xed Waste  |   | orage or Use  |   | itive/Endangered S |   |  Other Re |
|   | Generation |   | of Chemicals  |   | pecies and Sensiti |   | gulatory  |
|   |            |   | or Radioactiv |   | ve Habitats (inclu |   |           |
|   |            |   | e Materials\* |   | ding Pine Barrens) |   | Req       |
|   |            |   |               |   |                    |   | uirements |
|   |            |   |               |   |                    |   |           |
|   |            |   |               |   |                    |   | # -       |
|   |            |   |               |   |                    |   | recycling |
|   |            |   |               |   |                    |   |           |
|   |            |   |               |   |                    |   | #         |
+---+------------+---+---------------+---+--------------------+---+-----------+
| # | # Medi     | # | # Wate        | # | # En               | # | # NONE    |
|   | cal Waste  |   | r Consumption |   | vironmental Noise  |   |           |
|   | Generation |   |               |   |                    |   |           |
+---+------------+---+---------------+---+--------------------+---+-----------+
| \ |            |   |               |   |                    |   |           |
| * |            |   |               |   |                    |   |           |
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| : |            |   |               |   |                    |   |           |
| * |            |   |               |   |                    |   |           |
| * |            |   |               |   |                    |   |           |
|   |            |   |               |   |                    |   |           |
|   |            |   |               |   |                    |   |           |
|   |            |   |               |   |                    |   |           |
|   |            |   |               |   |                    |   |           |
|   |            |   |               |   |                    |   |           |
| * |            |   |               |   |                    |   |           |
| * |            |   |               |   |                    |   |           |
+---+------------+---+---------------+---+--------------------+---+-----------+

**[[Applicable Regulatory Requirements:]{.underline}]{.smallcaps}**

Check off any BNL [Subject Areas](https://sbms.bnl.gov/) that are
applicable to this process:

Note: PI's should consider subscribing to the Subject Area Subscription
Service as a means of staying informed of changes to the Subject Area
requirements.

+---+-------------------------------+---+---------------------------------+
| # | # Drinking Water              | # | # Radioactive Waste Management  |
|   |                               |   |                                 |
+---+-------------------------------+---+---------------------------------+
| # | # Environmental Monitoring    | # | # Reg                           |
|   |                               |   | ulated Medical Waste Management |
+---+-------------------------------+---+---------------------------------+
| # | # Hazardous Waste Management  | # | # Spill Response                |
|   |                               |   |                                 |
+---+-------------------------------+---+---------------------------------+
| # | # Liquid Effluents            | # | # Stor                          |
|   |                               |   | age and Transfer of Hazardous & |
|   |                               |   |                                 |
|   |                               |   | # Non­­-hazardous Materials       |
+---+-------------------------------+---+---------------------------------+
| # | # Mixed Waste Management      | # | # Transfer of Hazardous o       |
|   |                               |   | r Radioactive Materials On-Site |
+---+-------------------------------+---+---------------------------------+
| # | # National Enviro             | # | # Transport of Hazardous or     |
|   | nmental Policy Act (NEPA) and |   |  Radioactive Materials Off-Site |
|   |  Cultural Resource Evaluation |   |                                 |
+---+-------------------------------+---+---------------------------------+
| # | # Non-R                       | # | # Underground Injection Control |
|   | adioactive Airborne Emissions |   |                                 |
+---+-------------------------------+---+---------------------------------+
| # | # PCB Management              | # | # Regula                        |
|   |                               |   | ted Industrial Waste Management |
+---+-------------------------------+---+---------------------------------+
| # | # Pollution Prev              | # | #                               |
|   | ention and Waste Minimization |   | Working with Nanomaterials ES&H |
+---+-------------------------------+---+---------------------------------+
| # | # R                           | # | # None                          |
|   | adioactive Airborne Emissions |   |                                 |
+---+-------------------------------+---+---------------------------------+

**[Facility Use
Agreement](https://sbms.bnl.gov/sbmsearch/subjarea/37/37_SA.cfm) (FUA)**

Answer "Yes" or "No" for each category below.

  -------------------------- ---------------- -------- ------------------------------
  **Category**               **Applicable**            **Elements and Details**

                             **Yes**          **No**    

  Radiological Source Terms                            *See FUA Table 4.1.1 for
                                                       details.*

  Chemical, Toxic,                                     *See FUA Table 4.1.2 for
  Biological & Hazardous                               details.*
  Source Terms                                         

  Physical Source Terms                                *See FUA Table 4.1.3 for
                                                       details.*

  If yes, do any terms                                 
  require an update to the                             
  FUA: Y or N? If yes,                                 
  describe below and issue a                           
  memo to the appropriate                              
  Light Sources Directorate                            
  ESH Manager: **     **                               
  -------------------------- ---------------- -------- ------------------------------

Safety Assessment Document (SAD)/Accelerator Safety Envelope (ASE)

+----------------------+---+------------------------+---+------------------+
| Does this project    |   |                        |   |                  |
| include components   |   |                        |   |                  |
| that exceed or are   |   |                        |   |                  |
| not included in the  |   |                        |   |                  |
| safety boundaries    |   |                        |   |                  |
| described in the SAD |   |                        |   |                  |
| or the ASE: Y or N?  |   |                        |   |                  |
| If yes, describe     |   |                        |   |                  |
| below and issue a    |   |                        |   |                  |
| memo to the          |   |                        |   |                  |
| appropriate Light    |   |                        |   |                  |
| Sources Directorate  |   |                        |   |                  |
| ESH Manager:         |   |                        |   |                  |
+----------------------+---+------------------------+---+------------------+
| **[Job/Facility Risk |   |                        |   |                  |
| Assessments          |   |                        |   |                  |
| (JRA                 |   |                        |   |                  |
| /FRA)]{.underline}** |   |                        |   |                  |
|                      |   |                        |   |                  |
| Does this project    |   |                        |   |                  |
| include components   |   |                        |   |                  |
| that exceed or are   |   |                        |   |                  |
| not included in the  |   |                        |   |                  |
| jobs, hazards,       |   |                        |   |                  |
| controls or risks    |   |                        |   |                  |
| described in the     |   |                        |   |                  |
| JRA/FRAs: Y or N? If |   |                        |   |                  |
| yes, describe below  |   |                        |   |                  |
| and issue a memo to  |   |                        |   |                  |
| the appropriate      |   |                        |   |                  |
| Light Sources        |   |                        |   |                  |
| Directorate ESH      |   |                        |   |                  |
| Manager:             |   |                        |   |                  |
+----------------------+---+------------------------+---+------------------+
| **[NEPA              |   |                        |   |                  |
| Environmental        |   |                        |   |                  |
| Assessment           |   |                        |   |                  |
| (EA)]{.underline}**  |   |                        |   |                  |
|                      |   |                        |   |                  |
| Does this project    |   |                        |   |                  |
| include components   |   |                        |   |                  |
| that exceed or are   |   |                        |   |                  |
| not included in the  |   |                        |   |                  |
| NEPA EA:             |   |                        |   |                  |
|                      |   |                        |   |                  |
| Y or N? If yes,      |   |                        |   |                  |
| describe below and   |   |                        |   |                  |
| issue a memo to the  |   |                        |   |                  |
| appropriate Light    |   |                        |   |                  |
| Sources Directorate  |   |                        |   |                  |
| ESH Manager:         |   |                        |   |                  |
+----------------------+---+------------------------+---+------------------+
| **     **            |   |                        |   | **     **        |
+----------------------+---+------------------------+---+------------------+
| **Reviewer's Name**  |   | **Reviewer's           |   | **Date**         |
|                      |   | Signature**            |   |                  |
+----------------------+---+------------------------+---+------------------+