A022 - RPO Quarterly Audit Checklist 9.25.19 (003).pdf
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- Attached to
- Warehousing Services at DLA Distribution San Diego, CA Federal contract opportunity
- Solicitation number
- SP3300-20-R-5001
- Issued by
- Defense Logistics Agency Distribution
About this file
This document contains a quarterly radioactive protection officer audit checklist and related federal contract opportunity. The audit checklist contains 12 sections with over 100 questions to evaluate compliance with radiation safety requirements at a Defense Logistics Agency distribution center. It addresses topics like radiation control committee meetings, dosimetry monitoring, emergency preparedness, inventory of radioactive materials, receiving, storage, shipping, instrumentation, decommissioning, excess materials, training, and audits.
The related federal contract opportunity is a solicitation for warehousing services at the DLA Distribution center in San Diego, California. The solicitation seeks a contractor to perform warehouse and distribution support services across three sites, involving depot level repairables, electronics, industrial, medical, general, construction, clothing, packaged petroleum, chemicals, steel, sheet metal, bar stock, ship and aviation repair parts, and boats/amphibious craft. The Defense Logistics Agency is the contracting agency.
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Text version
DD FORM 1423-1, FEB 2001
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
PREVIOUS EDITION MAY BE USED.
Form Approved OMB No. 0704-0188
The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:
TDP ________ TM _______ OTHER
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
15. TOTAL
16. REMARKS
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
Page of Pages
Item No.
Category Reference Requirement Answer Remarks
1 RADIATION CONTROL COMMITTEE
1a RCC RHPM Sec 2.C.5.a Have meetings been held at least once in each quarter?
1b RCC RHPM Sec 2.C.5.c Are RCC Minutes prepared for each meeting and signed by the Commander?
1c RCC RHPM Sec 2.C.5.c Are copies of the RCC Minutes sent to the RSO?
1d RCC RHPM Sec 2.C.5.d Do RCC Minutes follow the format in Appendix D of the manual and include each quarterly item?
DOSIMETRY
(if not applicable, place "X"s in the answer column)
2a Dosimetry RHPM Sec 5.H.1 Are there personnel in a bioassay monitoring program and if so, how many?
2b Dosimetry RHPM Sec 5.H.4 Do radiation workers receive a copy of their dosimetry records annually?
2c Dosimetry RHPM Sec 5.H.4 RHPM Sec 2.C.5.d
Have all exposure reports been reviewed, this review documented by the RPO and results of the review reported in the RCC Minutes?
2d Dosimetry RHPM Sec 5.H.6 Has the need for personal dosimetry been evaluated within the last year and documented in the RCC Minutes?
Date Last Evaluated:
2e Dosimetry RHPM Sec 5.H.7 Have all TLD storage locations been approved in writing by the RPO?
2f Public Dose Compliance RHPM Sec 5.E.3 Have public dose assessment calculations been completed?
[Show dose and date in remarks.]
2g Occupational Dose RHPM Sec 2.C.5.d
Are personal TLDs used to monitor occupational exposures?
If so, state the area(s) used and the highest occupational exposure recorded.
2h Occupational Dose RHPM Sec 2.C.5.d
Are area TLDs used to monitor occupational exposures? If so, state the area(s) used and the highest occupational exposure recorded.
2i Occupational Dose RHPM Sec 2.C.5.d
Are dose rate surveys used to monitor occupational exposures? If so state the highest estimated occupational exposure and where this is.
SAMPLE
Category Reference Requirement Answer Remarks
3 EMERGENCY PREPAREDNESS
3a Emergency Response RHPM Sec 7.A.3
Have emergency response organizations (Fire Department, Police, etc.) been informed within the last year where RAM is located and the type and quantity of RAM at each location?
Date last informed:
3b Emergency Response RHPM Sec 7.B.1 Has an emergency response exercise been conducted within the last fiscal year?
Date of last exercise:
3c Emergency Response RHPM Sec 7.B.3 Are critiques and lessons learned documented by the RPO for all exercises and drills?
3d Emergency Response RHPM Sec 7.B.3 Is a copy of the review provided to the DDC RSO?
3e Emergency Response RHPM Sec 7.B.3 Are lessons learned and corrective actions presented to the
RCC?
4 INVENTORY
4a Inventory RHPM Sec 4.D.1 Are rad inventories reviewed monthly by the RPO to verify the items are stored in a designated radioactive material location including wholesale and retail items?
4b Inventory RHPM Sec 4.D.2 Are Compliance Reports from the RPO Database reviewed quarterly, include wholesale and retail items, and attached to the RCC Minutes for that quarter?
4c General License Items 10 CFR 31
Are all Generally Licensed items (such as tritium Exit signs) owned by the DC inventoried every 6 months and results presented to the RCC?
Date of last inventory:
4d Inventory RHPM Sec 4.D.3 RHPM Sec 4.D.4
Is a physical inventory conducted in the 4th quarter of each physical year, include wholesale and retail items, and results presented to the RCC?
Date of last physical inventory:
4e Check Sources RHPM Sec. 3.B.3 Have the radioactive check sources been inventoried in the last year?
Date of last check-source inventory:
Category Reference Requirement Answer Remarks
5 RECEIVING OPERATIONS
5a Posting RHPM Sec 3.C.4 Are all RAM receiving areas approved and designated in writing by the RPO?
5b Control of Licensed Material
10 CFR 20.1802
When a package is identified as containing RAM, is the package placed in an area that is secured to preclude non-radiation workers from entering and to prevent loss or theft of the material?
5c Receiving Operations RHPM Sec 4.A.5 Are all RAM containers surveyed as prescribed in the
RHPM?
5d Posting
RHPM Sec 3.C.2 RHPM Sec 3.C.4 RHPM Sec 3.C.5 RHPM Sec 3.C.6 RHPM Sec 3.6.7
Are all entrances and areas accessible to personnel posted with the appropriate signs and Notices when radioactive material is present in the area?
5e Receiving Operations RHPM Sec 4.A.4
Are Radioactive Material Container Labels (with the isotope and activity written on them) affixed to 2 opposite sides of the container as soon as the material is identified and before movement from the area?
5f Leak Test
RHIP-DDC-01
V.B.2.a V.B.2.b
V.D.4.g.1)
Are RAM items identified in receiving as requiring a leak test checked for a current Leak Test Certificate, or the item tested for leakage and a Leak Test Certificate completed, and a Leak Test Label or required information applied to the container's outside before placed in storage?
5g Survey RHPM Sec 5.A.2 Are receiving areas surveyed each month for dose rate and contamination?
5h Posting RHPM Sec 3.C.8 Do all receiving areas contain an Operations Binder with the most current documents required by the RHPM?
Category Reference Requirement Answer Remarks
6 STORAGE OPERATIONS
6a Posting RHPM Sec 4.B.1 Are all RAM storage areas approved and designated in writing by the RPO?
6b Storage RHPM Sec 4.B.1 RHPM Sec 4.B.2
Are RAM storage areas secured to preclude non-radiation workers from entering and to prevent loss or theft of the material?
6c Posting
RHPM Sec 3.C.2 RHPM Sec 3.C.4 RHPM Sec 3.C.5 RHPM Sec 3.C.6 RHPM Sec 3.C.7
Are all entrances and areas accessible to personnel posted with the appropriate signs and Notices?
6d Posting RHPM Sec 3.C.8 Do all storage areas contain an Operations Binder with the most current documents required by the RHPM?
6e Posting RHPM Sec 3.C.9 Is a Visitor's Log available at all RAM storage areas?
6f Posting RHPM Sec 3.C.3
Do all containers of radioactive materal have two Radioactive Material Container Labels (with the isotope and activity written) attached and positioned so the label is visible?
6g Leak Test RHIP-DDC-01 V.D.4.g.1)
Are RAM items requiring leak testing identified on the outside of the container with information required by the RHIP?
6h Survey RHPM Sec 5.A.2 Are storage areas surveyed each quarter for dose rate and contamination?
7 PACKING / SHIPPING OPERATIONS
7a Posting RHPM Sec 3.C.4 Are all RAM packing and shipping areas approved and designated in writing by the RPO?
7b Shipping Operations RHPM Sec 4.E.1.d Is the RAM packing area designated as such and separated from other packing locations?
7c Control of Licensed Material
10 CFR 20.1802
Are packages identified as containing RAM secured to preclude non-radiation workers from entering the area and to prevent loss or theft of the material?
7d Posting
RHPM Sec 3.C.2 RHPM Sec 3.C.4 RHPM Sec 3.C.5 RHPM Sec 3.C.6 RHPM Sec 3.6.7
Are all entrances and areas accessible to personnel posted with the appropriate signs and Notices or located within a designated RAM area that is?
Category Reference Requirement Answer Remarks
7f Operation's Binder RHPM Sec 3.C.8
Do all packing and shipping areas contain an Operations Binder with the most current documents required by the RHPM? Note: If theses areas are located within a designated RAM area, only one Operational Binder is required for the RAM area.
7g Shipping RHPM Sec 4.E.1.b RHPM Sec 4.E.1.e
Are copies of Radioactive Material Movement Forms (or RSO approved equivalent) with dose rate and contamination survey information available for each shipment?
7h Leak Test RHIP-DDC-01 V.B.2.d
Are current Leak Test Certificates provided with each RAM shipment containing items requiring a leak test?
7i Shipping RHPM Sec 4.E.g Is license information obtained and readily available for shipments of specifically-licensed items transferred to other than DoD entities?
7j Surveys RHPM Sec 5.A.2 Are packing and shipping areas surveyed each quarter for dose rate and contamination?
8 INSTRUMENTS
8a Instruments RHPM Sec.3.A.2 Are an adequate number of calibrated instruments available to support mission operations?
8b Instruments RHPM Sec 3.B.1 Are instruments source-checked daily or prior to each use, whichever is least often, and the checks documented?
8c Instruments RHPM Sec 3.B.1 Is documentation readily available showing the laboratory(s) performing instrument calibration are licensed to do so?
9 DECOMMISSIONING & DECONTAMINATION
9a Facility Closure RHPM Sec 5.G.1
Have decommissioning files been established with the information required in the RHPM for all buildings where RAM has been/is located?
9b Facility Closure RHPM Sec 5.G.2
Have all former RAM areas currently housing non radioactive activities been approved for non-radiological use by the
RSO?
Category Reference Requirement Answer Remarks
10 EXCESS MATERIAL PENDING DISPOSAL
10a Excess Material RHPM Sec 8.B.4 Does the RPO have a current inventory of excess RAM pending disposal?
10b Excess Material RHPM Sec 8.B.4 Has the DoD Executive Agent been notified, at least annually, of all excess RAM awaiting disposal?
Date Executive Agent Notified:
Date Pick-Up Scheduled:
10c Excess Material RHPM Sec 8.B.4 Is a list of the RAM items pending disposal included with the annual physical inventory sent to the RSO?
11 TRAINING
11a Training RHPM Sec 9.B.1 Have all Radiation Workers received initial training as described in the RHPM?
11b Training RHPM Sec 9.B.1 RHPM Sec 9.B.3
Have all Radiation Workers received initial or refresher training within the last FY?
11c Training RHPM Sec 9.C.1 Have all individuals working within the vicinity of RAM areas or visitors to these areas received General Awareness training as described in the RHPM?
11d Training RHPM Sec 9.D
Have all female Radiation Workers and their supervisors received training as described in the RHPM for Declared Pregnant Females before performing duties and each FY thereafter?
11e Training RHPM Sec 9.F Have all members of the RCC been briefed about the function of the RCC and their particular duties?
11f Training RHPM Sec 9.G Have emergency response personnel received radiation protection training within the last FY?
12 AUDITS & REVIEWS
12a Audits RHPM Sec 2.D.a Is the DDC Radiation Checklist completed each quarter, signed by the RPO, and findings presented at the RCC?
12b Audits RHPM Sec 2.D.a Is the DDC Radiation Checklist forwarded to the RSO as an attachment to the RCC Minutes?
12c RHIP RHPM Sec 2.F.1.b Have RHIPs developed by the DC been approved by the
RCC?
12d RHIP RHPM Sec 2.F.1.f Are RHIPs reviewed every 2 years and is the review documented in the RCC Minutes for concurrence?
| 1.PDF |
| RPO Checklist for CDRL A022.pdf |
| Self Audit |
11.0.0.20130303.1.892433
| B. Exhibit.: Attachment J.11 |
| C. Category: Press space bar to mark X if Technical Data Package.: |
| Mark X if Technical Manual.: |
| Specify other category of data.: |
| D. System or item.: |
| E. Contract or PR number.: |
| F. Contractor.: |
| 1. Data item number.: A022 |
| 2. Title of data item.: Radioactive Protection Officer Quarterly Audit Checklist |
| 3. Subtitle of data item.: |
| 4. Authority (data acquisition document number).: N/A |
| 5. Contract reference. : Attachment J.1, Paragraph C-1.6.B |
| 6. Requiring office.: DLA Distribution J-7 |
| 7. D D 250 requirement.: See Block 16 |
| 8. Approval code.: |
| 9. Distribution statement required.: B |
| 10. Frequency.: See Block 16 |
| 11. As of date.: N/A |
| 12. Date of first submission.: See Block 16 |
| 13. Date subsequent submission required.: See Block 16 |
| 14. Distribution. Addressee for distribution, Line 1.: J-7 Contract Spec |
| 14.b. Number of draft copies to be delivered.: |
| Number of regular final copies.: |
| Number of reproducible final copies to be delivered. Explain reproducible copies in Item 16. : 1 |
| Addressee for distribution.: COR |
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| Remarks.: Submit the attached Radioactive Protection Officer (RPO) Quarterly Audit Checklist the 15th working day of each quarter. January 15 covers the quarter of October through December each year. April 15 covers the quarter of January through March each year. July 15 covers the quarter of April through June of each year. October 15 covers July through September of each year. |
The Quarterly Radiological Health Program Audit Checklist will be provided a minimum of 30 calendar days prior to the beginning of the Quarter (September, December, March, June of each year for the FY quarters) by the KO or designee.
Block 7 - Inspection and acceptance requirements:
The COR will review and provide acceptance after Installation Support for Distribution RPO reviews and comments.
Block 14 - Distribution - Contractor to submit original to COR and copy to the Contract Specialist.
| 17. Price group.: |
| 18. Estimated total price.: |
| G. Prepared by (signature).: |
| H. Date prepared.: |
| I. Approved by (signature).: |
| J. Date approved.: |
| Page number of this page.: 1 |
| Total number of pages.: 7 |
| Press this Reset button to clear the data from all fields.: |
| Total number of regular final copies.: 1 |
| SignatureField1: |
| SignatureField2: |
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