RFP_EX_1.pdf

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U.S. DEPARTMENT OF JUSTICE - DRUG ENFORCEMENT ADMINISTRATION

-.;, __ ,ti HAZARD ASSESSMENT AND RECOGNITION PLAN

A. FILE INFORMATION

DIVISION I OFFICE I DATE SEIZED I CASE NO.

SITE SAFETY OFFICER (Name) AFFILIATION (if other than DEA. enter Agency name)

CHEMIST (Name)

I AFFILIATION (if other than DEA. enter Agency name)

B. LABORATORY TYPE AND HAZARDS

LABORATORY TYPE (Check) POTENTIAL CHEMICAL HAZARDS (Check) .OTHER POTENTIAL HAZARDS (Check)

0 Methamphetamine o Amphetamine o Respiratory Tox. D Flammables D Comp Gas Cyl inder 0 Slip/Trip/Fall Haza rd o cocaine I

D PCP D Systemic Tox. D Explosives D Heat Stress 0 Electrical Shock

O MDMA D GHB D External Tox. o o xidizers D Cold Stress 0 Burn Hazard n LSD n Other (Specify) n carcinogens n Pyrophorics n Confined Space n Leaking Containers o corrosives D Water Reactives D Limited Egress O Damaged Structure

Production Method: D Poor Visibility o Excavation

Specific High Hazard Chemical Other

C. SITE DESCRIPTION

LAB ADDRESS

SITE LOCATION & DESCRIPTION

STRUCTURE DESCRIPTION

WEATHER CONDITIONS

Wind Direction & Velocity I Temperature I D Ra in 0 Snow I Humidity

ESTIMATED TIME LAB SIZE

Entry Sec./Min . r ssessment Min./Hr. lProcessing Min./Hr. I n Small n Med. n Large

D. OTHER AGENCY FIELD SUPPORT

FIELD I NAME TELEPHONE NUMBER STANDBY LOCATION OFFICIAL CONTACTED NOTIFIED

SUPPORT {Include Junsdiction by City. State, or County) (Name) Date I Time

Fire Dept. I I

Ambulance I I I

Medivac I Helicopter I

Health I Dept. I

Hospita l

I Address

Emergency Room I

D1spossal

I Company I

Other I I

E. TEAM MEMBER ASSIGNMENTS

TEAM MEMBERS (Include Name. Affiliation & check Assignment box. TEAM MEMBERS (Include Name. Affiliation & check Assignment box:

E = Entry, A = Assessment. P = Processing) E A p E = Entry, A = Assessment, P = Processing) E A p

I C: 0 0 0 0 C:

I C: 0 0 D 0 C:

I C: 0 0 D D [

C: 0 0 0 D [

C: D D D D [

FORM DEA-482 (Revised 02/04) Continue on Page 2

F. SITE CONTROL CHECKLIST G. STAGES OF OPERATION

I Equipment

Site Control R equ irements Entry A ssessment Processing

Decontamination Duration

Level of Protection

SCBA

Samp ler/Witness

Air Purifying Respirator

PhotosNideo I APR Cartridge Type

Tyvek Suit

Emergency Procedures : Decon Saranex Suite

Tychem Suit

I Nomex Suit

Field Boots Fire

Chemical Boots

Boot Covers (Booties) Injury

Outer Gloves

Inner Gloves

Hard HaUHelmet

Face Shield

Other

H. HAZARD ASSESSMENT FINDINGS

1. Record location of atmosphere tests

2. Record LEL (PPM and %) and Oxygen reading for each location

3. If instrument is equipped with an additional toxic sensor, record reading

4 . Record Draeger Tube readings for locations tested ~ ~

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I. COMMENTS

Site Safety Officer (Signature & Date) C ase Agent (Signature & Date) Group S upe rviso r (Signature & Date)

HAZARD ASSESSMENT AND RECOGNITION PLAN

INSTRUCTIONS FOR DEA-482

GENERAL: Prepare an Original for retention in case file . No further distribution is required .

SECTION INSTRUCTIONS

SECTION A- FILE/INFORMATION · Self-explanatory.

SECTION B- LABORATORY TYPE AND HAZARDS

Laborato!fi Type. Check the box for known or suspected lab type. Write in the production method if known or suspected (example:

methamp etamine via Birch Method).

Potential Chemical Hazards. Check all boxes indicating known or suspected hazards. List any specific high hazard chemicals known or suspected of being present (example: ether, thionyl chloride, red phosphorus, etc.).

Other Potential Hazards. Check all boxes indicating known or suspected hazards. List any other hazards known or suspected of being present (example: Low overhead, unstable container storage, booby traps, etc.)

SECTION C- SITE DESCRIPTION

Lab Address. Enter street address. If none exists list nearest intersection, road number and nearest mile marker, GPS, coordinates, etc.

Site Location and Description . Description and location of lab at the address (example: detached garage 10 yards from house, outside storage shed near rear door of main building) .

Structure Description. Physical description, i.e., size, shape, type , condition , etc., (example: 10 X 10 wood barn, no windows;

small warehouse, fire damaged with opposing roll up doors) .

Weather Conditions. Enter the best estimate of conditions at anticipated time of entry/seizure .

Estimated Time. Enter the estimated duration of each phase of the lab seizure (entry, assessment, processing) .

Lab Size. Check appropriate box based on best estimate of size.

SECTION D- OTHER AGENCY FIELD SUPPORT · Self-Explanatory.

SECTION E • TEAM MEMBER ASSIGNMENTS · Self-Explanatory.

SECTION F • SITE CONTROL CHECKLIST

Site Control. List agency or department and agent/officer responsible for controlling perimeter access.

Decontamination. Identify the type of primary decontamination to be utilized for personnel exiting the hot zone (example: wet decon with solution C) .

Sampler/Witness. Agent or officer who will take chemical samples from lab and the witness .

PhotosNideo. Agent or officer who will take still photographs and/or videotape of the lab.

Emergency Procedures · Decon. Type and location of emergency decon (example: shower on lab truck; fire hose manned near front porch).

Fire . Rally point for all personnel to go in the event of a fire at the lab site (example: mailbox on street) .

!ni.!!IY..c Procedures for handling a medical emergency (example: cut out of suit and then turn over to EMTs; emergency decon, open SCBA bypass, inform EMTs).

SECTION G- STAGES OF OPERATION - For each stage of the raid note the following information.

Duration. Record the actual time worked for each stage. (example: assessment - 15 minutes).

Level of Protection. Write in the letter designation. (example: "B", i.e ., Level B Protection).

Check the type of equipment used during entry, assessment and processing. If an APR is used , enter the APR cartridge used.

(example: GME P100).

SECTION H- HAZARD ASSESSMENT FINDINGS

Enter the location where air monitoring readings are taken and time of each reading. LEL (Lower Explosive Limit) % and PPM (Parts Per Million} , oxygen °/'1,, and the results of any draeger tubes used. (example: kitchen , , O a.m., LEL %: 0%, LEL PPM: 100ppm, oxygen:

20.7%, ammonia o/b: 40ppm, toluene 57a : 100ppm).

Take additional readings as necessary.

SECTION I· COMMENTS. Include new hazards observed , equipment failures, recommendations , etc.