Attachment 1_Appendix 3_Job Hazard Analysis.pdf
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- Solicitation number
- RFP23-057-S
- Issued by
-
Department of Energy
About this file
This document contains a job hazard analysis form and related federal contract opportunity notice. The job hazard analysis form provides guidance for identifying potential workplace hazards and appropriate control measures for a given job or task. It includes a checklist of common hazards and recommended personal protective equipment or other controls.
The related federal contract opportunity is a request for proposal from Princeton Plasma Physics Laboratory seeking a qualified supplier to design, manufacture, and test a Variable Phase Controller for a neutral beam high voltage system. Interested firms meeting the capabilities for this engineering services project should review the attached RFP files and Statement of Work for requirements and specifications. Responses are due by the date specified in the solicitation. The applicable NAICS code is 541330 for engineering services.
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Text version
Reference:
Work Order # Work Permit # Work Planning # Procedure #
Written by (Print): Date: Division/Branch/Org:
Description of job/work to be performed:
Location of job/work to be performed:
Hazard (Check-off and Describe the source of the hazard) Control Measures (or Write # of Control(s) in Box) See Back
Chemicals SDS/MSDSs Available Training Provided Goggles Chemical Gloves
Ergonomic Issues (Repetitive Motion, Lifting, Physical Stresses, etc.)
Contact Safety for Briefing Worker Rotation Rest Breaks
Ionizing Radiation [Health Physics-HP] Radiation Work Permit (RWP)
Non-Ionizing Radiation (Lasers, Magnetic Fields (EMF), RF, etc.)
Contact Safety for high power lasers/EMF/RF Laser Safety Training Laser Permit (3b & 4)
Environmental Impacts (Environnemental Release, Hazardous Waste, etc.) [ES]
Contact ESD for guidance Spill Protection Waste Containers
Noise Hearing Protection Signs
Sharp objects/tools Cut Resistant Gloves Edge Protection Proper Use
Walking / Working Surfaces (Slips, Trips, Falls) Slip Resistant Shoes Tape/Cover Cords Cones/Marking
Falls / Elevated Work (4’ above surface) Fall Protection Training Personal Fall Arrest Guard Rails Approved Anchor Point (5,000 lbs.)
Contact Safety for Review (Required for roof work)
Ladders / scaffolds / manlifts Inspection Training Secure Ladders Personal Fall Arrest
Cranes / Rigging / Forklifts Trained/Qualified Personnel Lift Procedure ES-MECH-007 Hard Hats Safety Shoes
Welding / cutting / grinding / open flame Hot Work Permit [ESU] Face Shield Goggles Welding Gloves
Impairing a Security / Fire System [ESU] Contact Security Fire Door Permit ENG-025
Hot Surfaces / Cryogenics Cryogenic Training Insulated Gloves Face Shield Goggles
Heat or Cold Stress Rest Breaks Drinking Liquids Provided Proper Clothing
Steam Lockout/Tagout ESH-016
Electrical [Electrical Safety] Electrical Risk Assessment Shock Risk Assessment GFCI Arc Flash Risk Assessment Approved Equipment ENG-023
Lockout Tagout Simple Complex – procedure required
Task-Operating circuit breakers/disconnect switches ≥ 600 V.
PPE Category One – Minimum Arc Rating of 4 cal/cm3 Two - Minimum Arc Rating of 8 cal/cm3 Four - Minimum Arc Rating of 40 cal/cm3
Natural fiber long sleeve Shirt & pants AR (Long sleeve shirt/pants) or coveralls PPE Cat 1 PPE Cat 2 Face Shield or Flash Suit Hood PPE Cat 1 PPE Cat 2
Voltage rated Gloves: Class 0 Class 2
Hearing protection PPE Cat 2 Balaclava Leather Footwear Heavy Duty Leather Gloves
13,29
Confined Space Confined Space Permit
Oxygen Deficiency Class 1 Class 2 Class 3 Class 4
Trained Personnel Personal O2 Meter Escape pack
SCBA
Machinery / Machine tools Machine Guards Chip Guards Safety Glasses
Hand Tools / Power Tools GFCI Safety Glasses Insulated
Eye Hazards Safety Glasses Goggles
PPPL Environment, Safety & Health
JOB HAZARD
ANALYSIS
Approval:
Date Approved 11/6/2020 Rev 9
Appendix 3
For current procedure for Job Hazard Analyses, please review ESH-004.
Respiratory Hazards Ventilation Wet Methods Dust Mask/N95 (Voluntary Use
Only) Respirator (Training, Medical, Fit Test/ Contact Safety)
Falling Objects / Bumping Hazards Hard Hats Toe Boards Bump Caps Object Protection
Potential / Stored Energy (Springs, instability, capacitors, batteries, fans, hydraulics, pressure)
Lockout/Tagout ESH-016 Grounding Securing Objects
Foot Hazard Safety Shoes Proper Footwear( Closed Toe)
Trenching / Digging Digging Permit ENG-024 Shoring/Shielding/Sloping
Wall / Floor Penetrations Penetration Permit FAC-006 Class ‘0’ Electrical Gloves
Access / Escape / Communications Concerns Cell Phone/Radio
Biological (Bodily fluids, Insects, Poison plants), Virus
(COVID-19)
Insect Repellant Long Sleeves/Pants Gloves Social Distancing Face Coverings
Vehicle Use (include Construction & Special Purpose) / Fuel / Exhaust
Vehicle Inspection ENG-021 Trained Operator Spotter/Safety Watch Exhaust Control Spill Protection
Illumination (inadequate lighting) Temporary Lighting Flashlight
Working Alone (Requires Safety Approval).
Safety Must Review/Approve Buddy System Contact Site Protection
Pressure / Vacuum (cylinders, pressure tests) Compressed Gas Training Face Shield Safety Glasses ENG-014 Pressure Test Procedure
Others (interferences, impacts to other work, equipment or systems):
Fully evaluate work area
Comments:
For questions about these topics, contact the Safety Division except where noted in [brackets].
Safety = 2531, 2832 HP = 2311, 2315. ESD = 3380. ESU/Security = 2536, Electrical Safety = 3740
Control Measures (Write the number of the appropriate control next to the hazard to which it applies) Engineering Controls Administrative Controls Personal Protective Equipment (PPE)
01 - Platforms, Scaffolds 12 - Procedures 23 - Hard Hats 29 Safety Glasses/Goggles
02 - Use less hazardous chemicals 13 - Specific training for job/location 24 - Face Shields 30 - Coveralls
03 - Machine Guards, Chip Guards 14 - Worker Rotation, Rest Breaks 25 - Safety Shoes 31 - Boots / Booties
04 - Ventilation (fume hoods, elephant trunks, local exhaust systems)
15 - Permits (Confined Space, RWP, Hot Work, Digging, Penetrations, Flame)
26 - Ear Plugs/ Muffs 32 - Gloves (leather, kevlar, neoprene, nitrile, voltage rated)
05 - Fall Protection (Guardrails, toe boards)
16 - Signs & Labels, Warning alarms (“high level”)
27 - Respirator / Dust Mask
33 - Full Body Harness & lanyards
06 - Engineered Equipment Design 17 - System or Job Walk down 28 - Lab Coat / Apron 34 - Flame retardant / flash resistant clothing
18 - Safety watch, Buddy System 35 – Electrically insulated Mat / Tools
07 - Noise enclosure, absorption, mufflers
19 - Lockout/Tagout Emergency Equipment:
08 - Vibration dampeners 20 - Spill Containment 36 - Fire Extinguishers 40 - Retrieval Gear.
09 - Temporary lights 21 - Barricades 37 - Telephones/Radios 41 - First Aid Equip, 10 - Welding Screens 22 - Training / Qualification /
Certification
38 - Sprinkler System 42 - Alarms
11 - Mechanical lifting aids 39 - Eye Washes & Safety Showers
Safety Division Review Required | Safety Signature: Date
Other Review Required | Who? Signature: Date
COG / Supervisor or Designee Approval (Always Required) Signature: Date:
Personnel Briefed on this JHA (print):
JHA Forms must be kept for a minimum of one year after completion of work https://spportal.pppl.gov/bp/pppldocs/Procedures/esh004.pdf
| Written by Print Date DivisionBranchOrg: |
| Description of jobwork to be performed: |
| Location of jobwork to be performed: |
| Hazard Checkoff and Describe the source of the hazard: |
| Chemicals: |
| SDSMSDSs Available: Off |
| Goggles: Off |
| Training Provided: Off |
| undefined: Off |
| Chemical Gloves: Off |
| See BackSDSMSDSs Available Training Provided Goggles Chemical Gloves: |
| Ergonomic Issues Repetitive Motion Lifting Physical Stresses: Off |
| Contact Safety for Briefing: Off |
| Worker Rotation: Off |
| Rest Breaks: Off |
| See BackContact Safety for Briefing Worker Rotation Rest Breaks: |
| Ionizing Radiation Health PhysicsHP: |
| undefined_2: Off |
| Radiation Work Permit RWP: Off |
| See BackRadiation Work Permit RWP: |
| NonIonizing Radiation Lasers Magnetic Fields EMF RF: Off |
| Contact Safety for high power lasersEMFRF: Off |
| Laser Safety Training: Off |
| Laser Permit 3b 4: Off |
| See BackContact Safety for high power lasersEMFRF Laser Safety Training Laser Permit 3b 4: |
| Environmental Impacts Environnemental Release Hazardous: Off |
| Contact ESD for guidance: Off |
| Waste Containers: Off |
| Spill Protection: Off |
| See BackContact ESD for guidance Spill Protection Waste Containers: |
| Noise: |
| undefined_3: Off |
| Hearing Protection: Off |
| Signs: Off |
| See BackHearing Protection Signs: |
| Sharp objectstools: |
| undefined_4: Off |
| Cut Resistant Gloves: Off |
| Edge Protection: Off |
| Proper Use: Off |
| See BackCut Resistant Gloves Edge Protection Proper Use: |
| Slip Resistant Shoes: Off |
| ConesMarking: Off |
| TapeCover Cords: Off |
| Walking Working Surfaces Slips Trips Falls: Off |
| See BackSlip Resistant Shoes TapeCover Cords ConesMarking: |
| Falls Elevated Work 6 above surface: |
| Fall Protection Training: Off |
| Personal Fall Arrest: Off |
| undefined_5: Off |
| Approved Anchor Point 5000 lbs: Off |
| undefined_6: |
| See BackFall Protection Training Personal Fall Arrest Guard Rails Approved Anchor Point 5000 lbs Contact Safety for Review Required for roof work: |
| Ladders scaffolds manlifts: |
| Inspection: Off |
| Training: Off |
| Secure Ladders: Off |
| undefined_7: Off |
| Personal Fall Arrest_2: Off |
| See BackInspection Training Secure Ladders Personal Fall Arrest: |
| Cranes Rigging Forklifts: |
| TrainedQualified Personnel: Off |
| Hard Hats: Off |
| Lift Procedure ENG021: Off |
| undefined_8: Off |
| Safety Shoes: Off |
| See BackTrainedQualified Personnel Lift Procedure ENG021 Hard Hats Safety Shoes: |
| Hot Work Permit ESU: Off |
| Face Shield: Off |
| Goggles_2: Off |
| Welding cutting grinding open flame: Off |
| Welding Gloves: Off |
| See BackHot Work Permit ESU Face Shield Goggles Welding Gloves: |
| Impairing a Security Fire System ESU: |
| undefined_9: Off |
| Contact Security: Off |
| Fire Door Permit ENG025: Off |
| See BackContact Security Fire Door Permit ENG025: |
| Hot Surfaces Cryogenics: |
| Cryogenic Training: Off |
| Insulated Gloves: Off |
| Face Shield_2: Off |
| undefined_10: Off |
| Goggles_3: Off |
| See BackCryogenic Training Insulated Gloves Face Shield Goggles: |
| Heat or Cold Stress: |
| Rest Breaks_2: Off |
| Proper Clothing: Off |
| Drinking Liquids Provided: Off |
| undefined_11: Off |
| See BackRest Breaks Drinking Liquids Provided Proper Clothing: |
| Steam: |
| undefined_12: Off |
| LockoutTagout ESH016: Off |
| See BackLockoutTagout ESH016: |
| Electrical Electrical Safety: |
| undefined_13: Off |
| undefined_14: Off |
| undefined_15: Off |
| undefined_16: Off |
| Electrical Risk Assessment Shock Risk Assessment GFCI Arc Flash Risk Assessment Approved Equipment ENG023: |
| undefined_17: Off |
| undefined_18: Off |
| 13: |
| Simple: Off |
| Complex procedure required: Off |
| Natural fiber long sleeve Shirt pants: Off |
| PPE Cat 1: Off |
| PPE Cat 2: Off |
| PPE Cat 1_2: Off |
| PPE Cat 2_2: Off |
| toggle_76: Off |
| Hearing protection: Off |
| Leather Footwear: Off |
| Class 0: Off |
| PPE Cat 2 Balaclava: Off |
| Heavy Duty Leather Gloves: Off |
| Class 2: Off |
| One Minimum Arc Rating of 4 calcm3: Off |
| Two Minimum Arc Rating of 8 calcm3: Off |
| Four Minimum Arc Rating of 40 calcm3: Off |
| Confined Space: |
| undefined_19: Off |
| Confined Space Permit: Off |
| 1329Confined Space Permit: |
| Oxygen Deficiency: Off |
| Trained Personnel: Off |
| Personal O2 Meter: Off |
| Escape pack: Off |
| Class 1: Off |
| Class 2_2: Off |
| Class 3: Off |
| Class 4: Off |
| SCBA: Off |
| 1329Trained Personnel Personal O2 Meter Escape pack SCBA: |
| Machinery Machine tools: |
| undefined_20: Off |
| Machine Guards: Off |
| Chip Guards: Off |
| Safety Glasses: Off |
| 1329Machine Guards Chip Guards Safety Glasses: |
| Hand Tools Power Tools: |
| undefined_21: Off |
| GFCI: Off |
| Safety Glasses_2: Off |
| Insulated: Off |
| 1329GFCI Safety Glasses Insulated: |
| Eye Hazards: |
| undefined_22: Off |
| Safety Glasses_3: Off |
| Goggles_4: Off |
| 1329Safety Glasses Goggles: |
| Respiratory Hazards: |
| Ventilation: Off |
| Wet Methods: Off |
| Dust MaskN95 Voluntary Use: Off |
| undefined_23: Off |
| Respirator Training Medical Fit Test Contact Safety: Off |
| Ventilation Wet Methods Dust MaskN95 Voluntary Use Only Respirator Training Medical Fit Test Contact Safety: |
| Hard Hats_2: Off |
| Toe Boards: Off |
| Bump Caps: Off |
| Falling Objects Bumping Hazards: |
| undefined_24: Off |
| Object Protection: Off |
| Hard Hats Toe Boards Bump Caps Object Protection: |
| Potential Stored Energy Springs instability capacitors: Off |
| LockoutTagout ESH016_2: Off |
| Grounding: Off |
| Securing Objects: Off |
| LockoutTagout ESH016 Grounding Securing Objects: |
| Foot Hazard: |
| undefined_25: Off |
| Safety Shoes_2: Off |
| Boots: Off |
| Safety Shoes Boots: |
| Trenching Digging: |
| undefined_26: Off |
| Digging Permit ENG024: Off |
| ShoringShieldingSloping: Off |
| Digging Permit ENG024 ShoringShieldingSloping: |
| Wall Floor Penetrations: |
| undefined_27: Off |
| Penetration Permit FAC006: Off |
| Class 0 Electrical Gloves: Off |
| Penetration Permit FAC006 Class 0 Electrical Gloves: |
| Access Escape Communications Concerns: Off |
| Cell PhoneRadio: Off |
| Cell PhoneRadio_2: |
| Biological Bodily fluids Insects Poison plants Virus: Off |
| Insect Repellant: Off |
| Long SleevesPants: Off |
| Gloves: Off |
| Social Distancing: Off |
| Face Coverings: Off |
| Insect Repellant Long SleevesPants Gloves Social Distancing Face Coverings: |
| Vehicle Inspection ENG021: Off |
| Trained Operator: Off |
| Vehicle Use include Construction Special Purpose Fuel: Off |
| SpotterSafety Watch: Off |
| Exhaust Control: Off |
| Spill Protection_2: Off |
| Vehicle Inspection ENG021 Trained Operator SpotterSafety Watch Exhaust Control Spill Protection: |
| Illumination inadequate lighting: |
| undefined_28: Off |
| Temporary Lighting: Off |
| Flashlight: Off |
| Temporary Lighting Flashlight: |
| Safety Must ReviewApprove: Off |
| Buddy System: Off |
| Working Alone Requires Safety Approval: Off |
| Contact Site Protection: Off |
| Safety Must ReviewApprove Buddy System Contact Site Protection: |
| Compressed Gas Training: Off |
| Face Shield_3: Off |
| Safety Glasses_4: Off |
| Pressure Vacuum cylinders pressure tests: Off |
| ENG014 Pressure Test Procedure: Off |
| Compressed Gas Training Face Shield Safety Glasses ENG014 Pressure Test Procedure: |
| Others interferences impacts to other work equipment or: Off |
| Fully evaluate work area: Off |
| Fully evaluate work area_2: |
| Comments: |
| 01 Platforms Scaffolds: |
| 12 Procedures: |
| 23 Hard Hats: |
| 24 Face Shields: |
| 30 Coveralls: |
| 31 Boots Booties: |
| 26 Ear Plugs Muffs: |
| 06 Engineered Equipment Design: |
| 28 Lab Coat Apron: |
| 35 Electrically insulated Mat Tools: |
| 19 LockoutTagout: |
| Emergency Equipment: |
| 08 Vibration dampeners: |
| 20 Spill Containment: |
| 36 Fire Extinguishers: |
| 09 Temporary lights: |
| 21 Barricades: |
| 37 TelephonesRadios: |
| 10 Welding Screens: |
| 38 Sprinkler System: |
| 42 Alarms: |
| 11 Mechanical lifting aids: |
| 39 Eye Washes Safety Showers: |
| Safety Division Review Required Safety Signature: Off |
| undefined_29: |
| Date: |
| Other Review Required Who: Off |
| undefined_30: |
| Date_2: |
| Date_3: |
| Personnel Briefed on this JHA print 1: |
| Personnel Briefed on this JHA print 2: |
| Personnel Briefed on this JHA print 3: |
| Personnel Briefed on this JHA print 4: |
| 1: |
| 2: |
| 3: |
| 1_2: |
| 2_2: |
| 3_2: |
| 4: |
| 1_3: |
| 2_3: |
| 3_3: |
| 4_2: |
| Date1_af_date: |
| Text2: |
| Text1: |
| Text3: |
| Text4: |
| Text5: |
| Text6: |
| Guard Rails: Off |
| Safety Review: Off |
| Signature Appoval _af_image: |
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