AF_Form_2755.doc
DOC document 84 KB Posted
- Attached to
- Medical Examination Services - Grissom ARB, IN
- Solicitation number
- FA4654-14-B-0001
About this file
Master Workplace Exposure Data Summary - AF 2755
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Text version
OCCUPATIONAL HEALTH EXAMINATION
Part 2, Workplace Exposure Data Summary Date (YYMMDD) 1 3 0 1 1 7 Workplace
Identifier
| 0 |
| 0 |
| 2 |
| 5 |
| F |
| A |
| F |
| S |
| 8 |
| 2 |
| 4 |
| A |
Base
Grissom ARB Organization
434 MXS/MXMCF
Workplace
Aircraft Fuel Systems Maintenance
BLDG NO/LOCATION
Dock 2
ROOM/AREA
Workplace Narrative
This workcenter is responsible for the repair of KC135-R Aircraft fuel systems and fuel systems components.
Tasks include fuel tank entries for sealant repair and chemical testing of bladder cells. Use of full-face airline respirators is required during de-puddling operations.
NOTE: Exposure Data indicates 8-Hour Time Weighted Average (TWA) exposure of contaminant in air at worker’s breathing zone.
Exposure Data
Source
Measured
Concentration
Or
Intensity Above
Limits?
(Y or N) Controls
| Fuel tank access panel removal JP-8 |
| 4.44 mg/m3 TWA |
| N |
| Industrial Ventilation |
| Benzene |
| 0.055 mg/m3 TWA |
| N |
| " |
| De-puddling of aft body fuselage JP-8 |
| 8.38 mg/m3 TWA |
| N |
| " |
| Benzene |
| 0.030 mg/m3 TWA |
| N |
| " |
| De-puddling fuel tank, center wing JP-8 |
| 19.9 mg/m3 TWA |
| N |
| " |
| De-puddling fuel tank #3 main JP-8 |
| 10.3 mg/m3 TWA |
| N |
| " |
Removal & replacement of body JP-8
Tank fuel cell Benzene
42.8 mg/m3 TWA
0.479 mg/m3 TWA N
N
Removal & replacement of JP-8
Components in main tank Benzene
| 20.4 mg/m3 TWA |
| N |
N
| Looking for leak in fuel tank JP-8 |
| 15.1 mg/m3 TWA |
| N |
| " |
| Benzene |
| 0.479 mg/m3 TWA |
| N |
| " |
| Seal, clean, repair fuel tank MEK |
| 2.00 mg/m3 TWA |
| N |
| " |
| Remove/replace components wing tank JP-8 |
| 10.6 mg/m3 TWA |
| N |
| " |
| Remove/replace components wing tank JP-8 |
| 29.1 mg/m3 TWA |
| N |
| " |
| Monitoring of attendant JP-8 |
| 1.08 mg/m3 TWA |
| N |
| " |
| Remove/replace hardware (struc) JP-8 |
| 2.74 mg/m3 TWA |
| N |
| " |
| Typical multi-task 8-hour JP-8 |
| 55.1 mg/m3 TWA |
| N |
| " |
| Exposure Benzene |
| 0.678 mg/m3 TWA |
| N |
| " |
| Blow-back operation, noise |
| 100.2 dB(A) |
| Y |
| " |
| Center wing tank repair JP-8 |
| 5.81 mg/m3 TWA |
| N |
| “ |
| Benzene |
| <0.01 mg/m3 TWA |
| N |
| “ |
PATIENT’S IDENTIFICATION (Use this space for
Mechanical Imprint) PATIENT’S NAME (Last, First, Middle Initial)
Sex
YEAR OF BIRTH
| RELATIONSHIP TO SPONSOR |
| COMPONENT/ STATUS |
| DEPART/SERVICE |
SPONSOR’S NAME
RANK/GRADE
SSAN OR IDENTIFICATION NO.
ORGANIZATION
AF FORM 2755
COPY 2 - Health Record
Jan 82
Source
Measured
Concentration
Or
Intensity Above
Limits?
(Y or N) Controls
| Purging JP-8 |
| 2.65 mg/m3 TWA |
| N |
| Industrial Ventilation |
| Benzene |
| <0.03 mg/m3 TWA |
| N |
| “ |
| Install bladder cell tank 1 JP-8 |
| 7.13 mg/m3 TWA |
| N |
| “ |
| Benzene |
| <0.0042 mg/m3 TWA |
| N |
| “ |
| Area sample by landing gear JP-8 |
| N/D |
| N |
| “ |
| Area sample during purging JP-8 |
| N/D |
| N |
| “ |
| Fuel cell install tank #1 JP-8 |
| 2.81 mg/m3 TWA |
| N |
| “ |
| Re-connect fuel pump #1 JP-8 |
| 3.94 mg/m3 TWA |
| N |
| “ |
| Install fuel cell in #2 tank JP-8 |
| 2.95 mg/m3 TWA |
| N |
| “ |
| Replace cell in #2 aft JP-8 |
| 2.26 mg/m3 TWA |
| N |
| “ |
Blow-back operation (noise)
Duration: 240 minutes
100.2 dB(A)
Limit: 15 minutes
| Y |
| Plugs or muffs w NRR of 16 or greater. |
AF Form 2755 Continuation Sheet
File details come from the government source that posted it. Updated .