FBO_SOW_ALL_FACILITIES_WITH_LEAD_SAMPLING_GUIDE_SEP_2016-final.pdf

STATEMENT OF WORK

Industrial Hygiene Services for

National Guard Bureau Industrial Hygiene Region Northeast Army National Guard Facilities

September 2016

1 General.

1.1 Objective.

1.1.1 The purpose of this contract is to anticipate, recognize, and evaluate potential health hazards associated with processes performed at Army National Guard (ARNG) facilities and to provide sound recommendations for hazard control. The surveys will serve to establish a baseline of workplace conditions or update a previous baseline so that a worker’s history of exposures is provided for each civilian and military employee.

1.1.2 The Contractor shall provide the necessary personnel and materials required to conduct baseline, annual, and special industrial hygiene surveys and to prepare a comprehensive report for the specified facilities.

1.2 Description of Facilities. A list of typical processes that occur in ARNG maintenance facilities is included as attachment 2. This list is not all inclusive.

Using professional judgment list all potentially hazardous processes whether planned in the near future, currently operational, or previously occurred. Do not limit evaluation to the operations on this attached list.

1.2.1 Readiness Centers (RCs) or Armories. RCs and Armories provide space for units to support and train soldiers. They generally contain offices, classrooms, an assembly hall, and a kitchen. Some may contain an active, inactive (not converted), or converted indoor firing range and/or maintenance bay that are used during drill weekends. Include the presence of indoor firing ranges and their status as well as maintenance bays in the description of processes.

Some states have a reproduction room and/or photo developing room in a RC or Armory which must also be listed and assessed.

1.2.2 Army Aviation Support Facility (AASF). The AASF performs backup Aviation Unit Maintenance I (AVUMI) and limited Aviation Intermediate Maintenance (AVIM), which includes direct support maintenance.

1.2.3 Combined Support Maintenance Shop (CSMS). The CSMS provides field and sustainment level maintenance of all vehicles and equipment, except those that receive this level of maintenance at a Maneuver and Training Equipment Sites (MATES) with a sustainment maintenance mission or at another CSMS authorized to the State.

ARNG-CSG-P

Statement of Work, All Facilities

1.2.4 MATES. The MATES provides field and sustainment level maintenance and repair of heavy vehicles and equipment.

1.2.5 Field Maintenance Shop (FMS). The FMSs perform field level maintenance on all vehicles and equipment required for the supported units.

1.2.6 Training Sites/Installations. These areas contain many buildings such as classrooms, offices, barracks, mess halls (dining facilities), and support facilities (Department of Public Works).

1.2.7 Unit Training Equipment Site (UTES). The UTES performs field level maintenance and repair on heavy vehicles and equipment.

1.2.8 United States Property and Fiscal Office (USPFO). The USPFO consists of offices and meeting rooms.

1.2.9 USPFO Warehouse. The USPFO Warehouse receives, stores, and ships materials and equipment (to include hazardous materials) for the state ARNG.

1.2.10 Civil Support Team (CST). The CST program mission is to support civil authorities at domestic chemical, biological, radiological, nuclear, and high-yield explosives (CBRNE) incident sites by identifying CBRNE agents and substances, assessing current and projected consequences, advising on response measures, and assisting with appropriate requests for additional support.

1.3 Quotes and Contract Award.

1.3.1 Evaluation factors are price, past performance and technical capability indicating the ability to meet the requirements of the statement of work.

1.3.2 Price will include all cost factors to complete the surveys inclusive of travel cost to spend one full day at each facility. Price will not include costs for media and laboratory analyses.

1.3.3 Basis for award is “Best Value” with the quote that provides the greatest overall benefit to the government with consideration of price, past performance and technical capability and acceptability.

1.4 Equipment.

1.4.1 The ARNG Region Northeast Industrial Hygiene (IH) Office will provide government furnished equipment listed in attachment 3 for surveys under the condition that an equipment hand receipt (DA Form 2062) must be signed. The person signing the hand receipt acknowledges that they are responsible for damaged or lost equipment.

1.4.2 Contractor will not be responsible for normal wear and tear of government furnished equipment unless it is due to negligence. However, the contractor must notify the ARNG Region Northeast IH Office immediately if a piece of equipment is broken during the survey.

1.4.3 Contractor shall coordinate equipment loans in a timely manner by submitting the equipment request form (attach 3) at least two weeks prior to the date the equipment is required. We cannot guarantee that equipment will be available otherwise, and the contractor will be responsible for supplying equipment at no additional charge. Requests should be sent to the Region Northeast Industrial Hygienists points of contact to be provided upon award of contract.

1.4.4 Equipment must be returned immediately after completion of the survey in the same condition as it was received. If equipment is not returned within one week after completion of the survey, either the contract may not be renewed or the contractor will be responsible for supplying equipment at their expense for future surveys.

1.4.5 Government furnished equipment shipments will be paid for by the NGB Region Northeast IH Office.

1.4.6 In the event that government furnished equipment is not available, contractor will be responsible for supplying the necessary equipment to complete the surveys as directed by a representative of the ARNG Region Northeast IH Office. The ARNG Region Northeast IH Office will reimburse the contractor for this expense or pay the equipment rental company directly.

1.5 Scheduling and Coordination.

1.5.1 The contractor shall contact the ARNG Region Northeast IH Office to verify the State Safety and Occupational Health (SOH) point of contact (POC) information provided in attachment 8. The contractor must contact the SOH POC prior to scheduling with the facility to make sure it is all right to do so, to determine if they will be going on the survey, and whether they want an in- and out-brief.

1.5.2 The contractor shall coordinate survey dates with the facilities’ POCs. The contractor shall provide survey dates to the SOH POC, the Region Northeast Industrial Hygienists, point of contact will be provided upon award of contract.

Contact the Region Northeast IH Office if a facility was closed or combined with another one.

1.5.3 Facilities have been grouped together by area in attachment 8. The contractor must perform the IH survey and submit ALL final reports for the first or preceding group before surveying the next group of facilities. Survey dates can be scheduled, but final reports must be submitted before actually performing the survey.

1.6 Payment.

1.6.1 The contract price will be paid in full after all final reports have been completed and accepted. No partial payments.

1.6.2 Final payment will not be made unless all equipment has been returned.

1.7 Media and Laboratory Analyses.

1.7.1 Sampling media will be provided or paid for by the ARNG Region Northeast IH Office. Media requirement shall be included on the equipment request form (attach 3).

1.7.2 The ARNG Region Northeast IH Office will provide names of laboratories or approve the use of other laboratories. The facility name and state must be written clearly on the chain of custody forms for lab analyses and/or grade D air tests. The contractor will instruct laboratories to bill the ARNG Region Northeast IH Office directly for services.

1.8 Personnel Qualifications. Field work must be performed by an individual with a minimum of 2 years experience as an industrial hygienist/industrial hygiene technician. A certified Industrial Hygienist must be certified by American Board of Industrial Hygiene to approve all work performed by the industrial hygienists and technicians. They must be proficient in the anticipation, recognition, evaluation, and control of environmental factors or stresses from the workplace, which may cause sickness, impaired health and well-being, or significant discomfort among workers. Resumes must be submitted to the NGB Region Northeast IH Office before being considered for work. The NGB Region Northeast IH Office reserves the right to request a change in industrial hygienist/industrial hygiene technician if there is a conflict or due to a lack of experience.

2 Descriptions of Tasks and Specifications

2.1 Evaluation of Processes. Each process evaluation must include a description, sampling, ventilation system evaluation, noise dosimetry, lighting, any additional information, and interpretation of results. Contractor must provide this information whether or not the process is performed during the survey. An explanation is required if an evaluation could not be performed or was not performed.

2.1.1 Process Description.

2.1.1.1 Describe the process, the basic tasks, and the area in which it’s located.

2.1.1.2 Describe the hazards associated with the process.

2.1.1.3 Report the number of personnel performing each process (on survey date and the total who perform the work), the process duration, and frequency (i.e. times per week/month/year).

2.1.1.4 List and evaluate any engineering controls associated with the process (described further in para 2.1.3). Describe administrative controls if in place.

2.1.1.5 Describe the appropriate personal protective equipment (PPE) required for the process (if possible). List PPE used and/or available at the facility.

2.1.2 Sampling.

2.1.2.1 Conduct breathing zone and general area sampling of processes in accordance with OSHA and NIOSH sampling methods. Calculate laboratory results as 8 hour time weighted average concentrations (TWA8), short term exposure limits (STELs), or ceiling (C) concentrations. Compare results to exposure standards published by OSHA and ACGIH.

2.1.2.2 At a minimum, conduct air sampling during the following processes when possible: wheel/brake maintenance/repair, welding, spray application of paints and coatings, and grinding. Refer to attachment 2 for a list of typical processes at ARNG Facilities to help determine the sampling necessary. This list is not complete. Do not limit sampling and evaluation of processes to this list.

2.1.2.3 Collect a Grade D air sample when breathing air systems are present (i.e. paint spray booths, abrasive blasting booths, and some welding areas).

2.1.2.4 Maintenance Facilities - Perform surface wipe sampling in office and break rooms to evaluate housekeeping practices and determine the absence or quantify the level of contamination from adjacent process work. Readiness

Centers and Armories - Collect surface wipe samples following the ARNG Lead Sampling Guide (attachment 9).

2.1.2.5 Discuss whether the sampling represents a normal process duration. For example, the employee may agree to weld for two hours to meet the laboratories required limit of detection, however, a normal welding job is normally ten minutes.

2.1.3 Ventilation system evaluation.

2.1.3.1 Evaluate the effectiveness of all general and local ventilation systems, i.e. welding, paint booth, vehicle exhaust, etc. Evaluate even if ventilation system is not being used during the survey. Note damaged or inoperable systems.

2.1.3.2 Use smoke candles or smoke tubes to evaluate airflow in paint and abrasive blasting booths and describe pattern of flow in report.

2.1.3.3 Identify any potential for contamination of clean air sources by contaminated air.

2.1.4 Noise dosimetry.

2.1.4.1 Conduct personal noise dosimetry on employees most likely to be exposed to noise. Dosimeters must be worn and collecting data for a minimum of 75% of the workday.

2.1.4.2 Perform dosimetry on a minimum of 50% of all maintenance employees. Provide an explanation in the report if this cannot be accomplished.

2.1.4.3 Set dosimeters to Army standards (3 dB exchange rate and 85 dBA TWA8) IAW DA PAM 40-501.

2.1.4.4 Present results for individuals as the TWA8. If there are three or more dosimetry results for a similar exposure group (SEG) calculate the occupational exposure group (OEG) upper threshold level (UTL). Use DA PAM 40-501 as the standard; not OSHA. The UTL calculation and noise RACs are included in TG 181.

2.1.5 Lighting. Measure lighting in all areas of the facility. Report measurements in footcandles (fc).

2.1.6 Additional information. Include any other information pertinent to the process.

2.1.7 Interpretation of Results and Further Recommendations. Interpret results of measurements, sampling, and observations. Include an explanation if a process evaluation could not be performed. Recommend repeat or additional evaluation if applicable.

2.2 Physical Condition of Facility and Personnel Concerns.

2.2.1 If peeling paint is present, collect a bulk sample. Evaluate condition, location and quantity of damaged paint.

2.2.2 Perform a visual inspection for suspected asbestos containing material (ACM). Collect a bulk sample if there is damaged suspect ACM. Note the condition, location, and quantity of any ACM and/or suspect ACM. See reporting requirements in paragraph 3.

2.2.3 Note the location and extent of water damage and/or visible mold. Discuss potential source of water incursion.

2.2.4 Determine if there are any indoor air quality concerns through employee interviews. Measure carbon dioxide, carbon monoxide, temperature, and relative humidity and note outdoor levels.

2.2.5 Evaluate ergonomic concerns such as work practices that require repetitive motions, heavy lifting, standing in place for long periods, and awkward work positions. Recommend adjustments to work stations, the use of appropriate equipment such as carts/dollies and anti-fatigue mats, and other ergonomic improvements if appropriate.

2.2.6 Evaluate housekeeping and hygiene practices pertaining to material storage, handling, and cross contamination into clean administrative areas.

2.3 Photographs. Photograph in color and clearly label in the appendices each primary process and engineering control. Include photographs of damaged or inoperable engineering controls and other deficiencies noted in the report.

2.5 Shop Layout. Obtain a shop floor plan or clearly depict the floor plan and note the location of primary processes identified during the survey. A fire evacuation plan from the facility can often be used for this purpose. Include floor plans and diagrams in the appendices.

2.7 State Employees and Contractors. Noise dosimetry, air sampling, and any other form of monitoring SHALL NOT be performed on State Employees or Contractor Employees. If a federal employee is not available to evaluate a process, use only general area sampling as close as possible to the process to provide a screening assessment.

3 Reporting Requirements.

3.1 Complete and fax an updated facility information form (attachment 8) to the ARNG Region North IH Office within five calendar days after completion of the survey.

3.2 If there is an urgent situation (such as overexposures, damaged and/or friable suspected asbestos materials, improper PPE during high hazard operations, etc.) that will be classified as a RAC 1 or 2, alert an onsite safety representative or facility supervisor immediately. Call or email the NGB Region North IH Office and SOH POC as soon as possible.

Additionally, within one week provide a summary of the situation with findings, recommendations, and any corrective actions already taken.

3.3 A draft report for each facility is due to the Region Northeast Industrial Hygienists Cynthia Harrison at cynthia.s.harrison2.civ@mail.mil and Jayson Allan at jayson.r.allan.civ@mail.mil., four weeks after the survey date. Do not wait until all surveys are completed before sending reports. Final reports are due two weeks after receipt of comments from the ARNG Region Northeast IH Office.

All comments that were made on the draft report must be implemented. If there are any issues or questions regarding the comments, contact the ARNG Region Northeast IH Office. The following should be included:

3.3.1 Four copies of a written report, which includes a minimum of:

3.3.1.1 The date of the survey, address, and the POC of the facility.

3.3.1.2 An executive summary of the entire survey. Maximum of 1-2 pages.

3.3.1.3 A table of contents for the report.

3.3.1.4 The survey specifications outlined in paragraph 2 of this SOW.

(See attach 4 for an example of format.)

3.3.1.5 A conclusion. Maximum of 1-2 paragraphs.

3.3.2 The following information shall be included in the appendices along with the information identified in paragraph 2. When applicable, appendices shall be referenced in the report. For example, “refer to Appendix A for lab analysis.”

3.3.2.1 Sampling sheets and laboratory analyses if applicable, to include noise dosimetry printouts for each record.

3.3.2.2 References. The list provided is only an example. Only the references used in writing the report should be included in the reference section.

Since publication dates may change, verify that the last published reference date is used.

3.3.3 The following information shall be provided as separate documentation from the report. At a minimum, it shall include:

3.3.3.1 Recommendations for engineering controls, administrative controls, and/or PPE to reduce exposures below action levels and/or PELs/TLVs if exceeded, to include risk assessment codes (RACs) for health hazards, noise, safety, and ergonomics and specific referenced citations. (See attach 5 for RACs)

3.3.3.2 Copy of field notes. Include vehicle and equipment and hazardous material lists.

3.3.3.3 Three copies of the noise exposure forms for each employee who wore a noise dosimeter. Provide the forms as three separate sets. Calculate the UTL if there are at least six dosimetry results for an OEG. Refer to TG 181 for procedures for calculating UTLs. (See attach 6 for an example of the form. The information on the form must be adapted depending on the results.)

3.3.3.4 Three copies of contaminant exposure forms for each employee that participated in air sampling. Provide the forms as three separate sets. (See attach 7 for form)

3.3.3.5 The entire report and supporting documents in electronic format as PDF files. Each facility report must be saved on a separate CD. A folder should be labeled as state_facility_city_yyyy_mmm (i.e. NJ_CSMS A_Trenton_2004_NOV). Within the folder, the files should be labeled separately as follows: facility_yy_report (for the report), facility_yy_medical (for medical forms), facility_yy_field notes (for field notes), and facility_yy_notification (for noise notification letters).

4 Points of contact. Contact the NGB Region Northeast IH Office for further information. Technical POCs are Cynthia Harrison (Cynthia.s.harrison2.civ@mail.mil) and Jayson Allan (jayson.r.allan.civ@mail.mil)

Attachments

1. Regulations and Standards

2. Typical Operations at ARNG Maintenance Facilities

3. Equipment Request Form

4. Example of Operation Description Format for Report

5. Risk Assessment Codes

6. DA 4700, Medical Record for Noise Exposure

7. DA 4700, Medical Record

8. List of Facilities

9. ARNG Lead Sampling Guide

Attachment 1 Regulations and Standards

1. Title 29, Code of Federal Regulations (CFR), Part 1910, Occupational Safety and Health Administration, current Ed. http://www.osha.gov/comp-links.html

2. Department of Defense Instruction (DODI) 6055.01, Department of Defense Occupational Safety and Health (OSH) Program, 14 October, 2014.

http://www.dtic.mil/whs/directives/corres/pdf/605501p.pdf

3. Army Regulation (AR) 11-34, The Army Respiratory Protection Program, 25 July 2013. http://armypubs.army.mil/epubs/pdf/r11_34.pdf

4. AR 40-5, Medical Services, Preventive Medicine, 25 May 2007.

http://armypubs.army.mil/epubs/pdf/R40_5.PDF

5. AR 385-10, The Army Safety Program, 27 November 2013.

http://armypubs.army.mil/epubs/pdf/r385_10.pdf

6. Department of the Army Pamphlet (DA PAM) 40-501, Medical Services, Army Hearing Program, 8 January 2015.

http://armypubs.army.mil/epubs/pdf/P40_501.pdf

7. DA PAM 40-11, Preventive Medicine, 22 July 2005, RAR issue date: 19 October 2009. http://armypubs.army.mil/epubs/pdf/p40_11.pdf

8. DA PAM 40-503, Medical Services, The Army Industrial Hygiene Program, 2 April 2013. http://armypubs.army.mil/epubs/pdf/P40_503.PDF

9. UFC 3-410-01FA, Heating, Ventilating, and Air Conditioning Systems, 1 July 2013, change 1, October 2014.

http://www.wbdg.org/ccb/DOD/UFC/ufc_3_410_01.pdf

10. Threshold Limit Values (TLVs) and Biological Exposure Indices (BEIs), American Conference of Governmental Industrial Hygienists (ACGIH), current Ed.

11. Industrial Ventilation – A Manual of Recommended Practice for Design, ACGIH, current Ed.

12. American National Standards Institute (ANSI)/International Safety Equipment Association (ISEA) Z358.1-2009, Emergency Eyewash and Shower Equipment.

13. ANSI/American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc. (ASHRAE) 55-2013, Thermal Environmental Conditions for Human Occupancy.

14. ANSI/ASHRAE 62.1-2013, Ventilation for Acceptable Indoor Air Quality.

15. RP-1-12, Office Lighting, ANSI/IESNA, 2012.

16. The Lighting Handbook, IESNA, current Ed.

17. OSHA Instruction Letter 02-02-058, Lead Exposure in Construction, Office of Health Compliance Assistance, 13 December 1993.

18. OSHA Standard Interpretation, Clarification of “as free as practicable” and lead contamination under 29 CFR 1926.62, dated January 13, 2003.

Notes:

1. Corps of Engineer standards should not be used.

2. Contact the Regional Industrial Hygiene Office for a copy of references if none is available.

Attachment 2 Typical Processes that occur at ARNG Facilities

This list is not all inclusive. Using professional judgment list all potentially hazardous processes whether planned in the near future, currently operational, or previously occurred.

Do not limit evaluation to the operations on this list.

CSMS

MATES

UTES

FMS

Vehicle and Equipment Maintenance, Inspection, and Repair Battery Charging and Maintenance Brake Pad Replacement Solvent Use and Parts Washing Vehicle Idling Welding, Grinding, and Cutting Metals Machining Spray Painting (Aerosol Can and/or Compressed Air Application) Canvas and Vinyl Repair Woodworking and Crate Construction Flammable and Combustible Materials Storage Warehousing and Storage Electronics Repair and Soldering Weapons Storage, Repair, and Test Firing Night Vision Device (NVD) Repair and Nitrogen Purging

AASF Rotary Aircraft Maintenance, Inspection, and Repair Confined Space Entry – Fuel Cells, Tail Boom Battery Charging and Maintenance Solvent Use and Parts Washing Welding, Grinding, and Cutting Metals Machining Spray Painting (Aerosol Can and/or Compressed Air Application) Aviation Life Support Equipment (ALSE) Canvas and Vinyl Repair Flammable and Combustible Materials Storage Warehousing and Storage Electronics Repair and Soldering Aircraft Blade Repairs (solvents, epoxy, asbestos)

Readiness Centers Armories Training Facilities

Firing Range Simulators (Noise)

Attachment 3 Equipment Request Form (ERF)

**Submit request form at least 2 weeks prior to date equipment is required** ***All Information requested below must be filled out***

Requested by & Company Name:

Date ERF Submitted:

Phone #: Outlook/AKO or CIV Email:

Number/Type of Facilities to Survey:

Date Equipment Needed: Last Day of Survey: Approximate

Date of Return:

Media #

MCE Asbestos Cassettes MCE Cassettes Pre-weighed PVC Cassettes Charcoal Tubes Silica Gel Tubes Lead Check Swabs Passive Samplers (list organics)

Wipe Media Ghost Wipes (Metals) PVC (Hex Chrome) Tubes & Caps Templates Disposable Gloves (100per) Other (List) Batteries (Note Size of Batt. Needed)

Ziploc Bags Ship to address:

Equipment # Air Sampling Pumps Model # - 224-44XR (1-4 LPM) Model # - 222-3 (50-200 mLPM) Model # - 210-1002 (20-225 mLPM) Air Sampling Pump Calibrator Air Sampling Pump Charger Air Velocity Meter Grade D Air Test Kit Indoor Air Quality Monitor Light (foot-candle) Meter Noise Dosimeter (703+) w/ IR Device Noise Dosimeter Calibrator Blaze Software 6.01 (Windows 7 or Vista?)

Sound Level Meter w/Octave Band Sound Level Meter (706RC) w/ IR Device Smoke Tubes Smoke Candles Other (list):

Manuals (list):

Labels/Forms:

*NOTE: ONLY use AMA for lead and asbestos samples AMA Chain of Custody Form AMA Fedex Labels ALS Chain of Custody Form ALS Fedex Labels

Attachment 4 Sample Process Description

CSMS Spray Painting Operation. The Paint Shop contained a large downdraft booth and was located adjacent to the vehicle maintenance bays in the “E” Wing of the CSMS. The dimensions of the booth were approximately

17.5 feet wide (17.5’ W), 40 feet long (40’ L), and 12.5 foot height (12.5’ H).

Vehicle sized swing hinge doors were installed at each end of the booth and four human entry/exit doors were approximately 3’W X 7’H. Two full time painters were assigned and reported that at the current workload they were required to paint for a duration of approximately four hours 2 to 3 days per week.

(1) Exhaust Ventilation. The average cross sectional air velocity in large paint booths is recommended by OSHA 29 CFR 1910.94 Table G-10 to be between 75 and 125 feet per minute (fpm) (reference X). The paint booth at the CSMS had an average cross sectional velocity of 64 fpm which did not meet the standard and one side of the booth performed much better than the other.

Smoke testing demonstrated that the ventilation system what somewhat effective from removing air from the booth. The system should be serviced and balanced.

Regular servicing and lubrication of belts, moving parts, and filtering systems will extend the life of the equipment and ensure effective performance (reference X).

(2) Booth Pressure. The booth relative to the adjacent work space was under the desired slight negative pressure. The ACGIH Ventilation Manual, Paragraph 13.75, explains that maintaining the paint booth under slight negative pressure will reduce the potential of toxic paint vapors escaping the booth into adjacent work areas (reference X).

(3) Pressure Gauge (Manometer). Manometers were installed on the booth supply and exhaust filter banks to show the pressure drop as required by the OSHA 29 CFR 1910.94(c)(7)(iii)[b] (reference X). The manometers needed fluid, to be zeroed, and to be marked correctly.

(4) Hazards and Assessments.

(a) Air Sampling. The chemical agent resistant coating (CARC) applied during this survey contained isocyanates, acetone, and iron oxide pigmentation.

Air sampling was performed on two personnel. Air sampling location, duration, and results are provided in Appendix X, Tables X-1 and X-2. All sampling results calculated as an 8 hour time weighted average concentration (TWA8) met published standards (references X-X).

(b) Sound Pressure Levels. A sound level meter was used to measure the pressure levels in the booth during spray painting and all levels were found below the Army criterion threshold level of 85 dBA (reference X) and are presented in Appendix X.

(5) Personal Protective Equipment (PPE). Personnel donned disposable coveralls (Tyvek), gloves, and supplied airline respirators.

(7) Emergency Equipment. An emergency eyewash and shower unit was provided next to the paint mixing area. The unit was documented as inspected weekly and provided tepid flushing fluid as recommended by ANSI/ISEA Z358.1- 2009, Emergency Eyewash and Shower Equipment (reference X).

Statement of Work, Maintenance Shops

Attachment 5

DERIVING RISK ASSESSMENT CODES (RACs) FOR CHRONIC HAZARDS Department of Defense Instruction 6055.01, Appendix to Enclosure 3

Department of Defense Occupational Safety and Health Program, 14 October 2014

1. DETERMINE THE HEALTH HAZARD SEVERITY CODE (HHSC). Use the following procedures to assess exposure and medical effects points and determine the health hazard severity category (HHSC). The HHSC reflects the magnitude of exposure to a single physical, chemical, or biological agent and the effects of chronic exposure.

a. Determine Exposure Points.

AER Possible?

Exposure Condition

95th percentile <10% of OEL

95th percentile between 10% of OEL and 50% of OEL

95th percentile between 50% of OEL and

OEL

95th percentile

>OEL

No 0 3 5 7 Yes 1 – 2 4 6 9

AER = Alternate exposure route, such as skin absorption, ingestion.

OEL = Occupational Exposure Limit, such as OSHA PEL or ACGIH® TLV®.

b. Determine Medical Effects Points.

Condition Points No medical effect, such as nuisance noise and nuisance odor 0 Temporary reversible illness requiring supportive treatment, such as eye irritation and sore throat

1 - 2

Temporary reversible illness with a variable but limited period of disability, such as metal fume fever

3 - 4

Permanent, non-severe illness or loss of capacity, such as permanent hearing loss

5 - 6

Permanent, severe, disabling, irreversible illness, such as asbestosis, lung cancer, or death

7 - 8

c. Determine the HHSC by totaling the points assessed.

Total Points (sum of Exposure Points [1a] and Medical Effects Points [1b])

HHSC

13 – 17 I

9 – 12 II

5 – 8 III

0 – 4 IV

B-1

APPENDIX B (CONTINUED)

2. DETERMINE THE EFFECT PROBABILITY CATEGORY (EPC). Use the following procedures to assess exposure frequency and duration to determine the effect probability category (EPC). The EPC is a function of the duration and frequency of exposure and the number of exposed personnel.

a. Determine Duration and Frequency of Exposure Points. Add exposure duration points and exposure frequency points, divide total by 2, then round UP.

Points

Exposure Duration

>8 hours/day

6-8 hours/day

4-6 hours/day

2-4 hours/day

1-2 hours/day

30-60 minutes/ day

15-30 minutes/ day

0-15 minutes/ day 8 8 6 5 4 3 2 1

Points

Exposure Frequency

Daily 2-3 times/week

Weekly

2-3 times/ month

Monthly

Quarterly or 2-3 times/year

Annual

Less than

Annual 8 7 6 5 4 3 2 1

b. Determine Number of Exposed Personnel Points.

Number of Exposed Workers Points < 5 1 - 2

5 - 9 3 - 4 10 - 49 5 - 6

> 49 7 - 8

c. Determine the EPC by totaling the points assessed.

Total Points (sum of Exposure Duration and Frequency Points [2a] and Exposed

Personnel Points [2b])

EPC

13 – 17 A 9 – 12 B 5 – 8 C 0 – 4 D

B-2

APPENDIX B (CONTINUED)

3. Determine the RAC for Chronic Hazards.

HHSC

EPC

A B C D I 1 1 2 3

II 1 2 3 4

III 2 3 4 5

IV 3 4 5 5

4. RAC Descriptor.

RAC Descriptor 1 Critical 2 Serious 3 Moderate 4 Minor 5 Negligible

B-3

DERIVING RACs FOR SAFETY HAZARDS

1. Use the matrix and descriptive definitions below as a model to determine the RAC for safety hazards:

a. Determine Accident Probability.

Code

Description

A Likely to occur immediately B Probably will occur in time C Possible to occur in time D Unlikely to occur

b. Determine Hazard Severity.

Code

Description

I Death, permanent total disability or loss of facility or asset

II

Permanent partial disability, temporary total disability in excess of 3 months or major property damage

III

Lost-workday injury or compensable injury or minor property damage

IV

Minimal threat to personnel or property, first-aid, minor supportive medical treatment, but still a violation of a standard

2. Determine the RAC for health hazards by using the following matrix to measure safety severity and mishap probability factors.

HAZARD

SEVERITY

CODE

ACCIDENT PROBABILITY CODE

A

B C D

I 1 1 2 3

II 1 2 3 4

III 2 3 4 5

IV 3 4 5 5

From Table 3 of Department of Defense Instruction 6055.1, Department of Defense Occupational Safety and Health Program, 19 August 1998 (reference 1).

3. RAC DESCRIPTOR

RAC DESCRIPTOR

1 CRITICAL

2 SERIOUS

3 MODERATE

4 MINOR

5 NEGLIGIBLE

Attachment 6 Noise Exposure

DA 4700 Medical Record The information on this form must be adapted as necessary depending on the results.

This form was designed with a drop down list to select options depending on the noise dosimetry results.

MEDICAL RECORD – SUPPLEMENTAL MEDICAL DATA

For use of this form, see AR 40-66; the proponent agency is the Office of The Surgeon General.

REPORT TITLE

WORKERS' OCCUPATIONAL NOISE DOSIMETRY DATA RECORD

OTSG APPROVED (Date)

PATIENT'S IDENTIFICATION (For typed or written entries give: Name --last, first, mi)

NAME:

SSN: - -

FACILITY

JOB DESCRIPTION/SERIES

SAMPLING DATE

1. DA Regulation requires employees to be notified of their exposure results from Industrial Hygiene Surveys.

Employee Occupational Exposure Group (OEG)

Noise Exposure (in dBA) RAC

TWA OEG UTL

Notes: TWA – Time Weighted Average over 8 hours

UTL – Upper Tolerance Level

2. Statistical calculations of this employee’s occupational exposure group indicate the personal measurement is valid and should be used rather than the group's calculated upper tolerance level .

3. This employee’s TWA for noise exposure was below the 85 dBA, the Army standard for single hearing protection.

Therefore, this employee need not be considered for the CT ARNG Hearing Conservation Program.

4. According to the noise survey performed, you are required by the DA’s Hearing Conservation Policy DA Pam 40-501, to:

a. Wear either earplugs or noise muffs whenever noise levels are greater than or equal to 85 dBA.

b. Wear both earplugs and noise muffs whenever noise levels are greater than 103 dBA.

c. Obey warning signs throughout the installation in noise hazardous areas and on equipment, which require personnel to wear hearing protection.

5. For additional information see the report regarding this survey.

6. If you have any questions regarding this matter contact the Occupational Health Nurse, at phone # ( ) -

PREPARED BY (Signature & Title) DEPARTMENT/SERVICE/CLINIC DATE

PRIVACY ACT STATEMENT

AUTHORITY: 5 U.S.C., Section 301; 10 U.S.C., Section 3013 PURPOSE: This form is used to store patient information in an automated computer system; retrieval of information is by the patient's SSN and is required to properly record Occupational Worksite Hazard Exposure Sampling Data.

DISCLOSURE: Personal information on this form is given on a voluntary basis. Failure to provide this information, however, may result in failure to obtain proper medical surveillance healthcare.

DA FORM 4700

1 MAY 78

HSXR-APG-Z OP 32 1 Jan 90

Attach 7

Attachment 7 Medical Record

DA 4700

MEDICAL RECORD – SUPPLEMENTAL MEDICAL DATA

For use of this form, see AR 40-66; the proponent agency is the Office of The Surgeon General.

REPORT TITLE

WORKERS' OCCUPATIONAL WORKSITE SAMPLING DATA RECORD

OTSG APPROVED (Date)

DIRECTORATE BLDG/ROOM

SPECIAL STUDY/REPORT NUMBER

JOB DESCRIPTION/SERIES

SAMPLING DATE

EXPOSURE

MONITORED

TYPE

SAMPLE*

PERMISSIBLE

EXPOSURE LIMIT

SAMPLING

RESULT

CALCULATED

TWA

EXPOSURE

CATEGORY**

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

*TYPE OF SAMPLE: G=General Area Sample P=Personal Sample Collected in the Breathing Zone of the Worker.

R=Personal Sample Collected on another worker, but representative of expected exposure for this worker.

**EXPOSURE CATEGORY

1. Measured Exposure levels are below permissible exposure limit.

2. Measured Exposure levels are close to permissible exposure limits: See Comments.

3. Measured Exposure levels are above permissible exposure limits: See Comments.

COMMENTS:

NOTE: REFER TO THE SPECIAL STUDY OR REPORT REFERENCED FOR DETAILS OF SAMPLING AND RESULTS.

(Continue on reverse)

PREPARED BY (Signature & Title) DEPARTMENT/SERVICE/CLINIC

INDUSTRIAL HYGIENE SECTION

DATE

PATIENT'S IDENTIFICATION (For typed or written entries give: Name --last, Middle; grade; date; hospital or medical facility)

NAME:

first, HISTORY/PHYSICAL

FLOW CHART

SSN:

OTHER EXAMINATION OR

EVALUATION

OTHER (SPECIFY)

UNIT PHONE NO:

DIAGNOSTIC STUDIES

TREATMENT

DA FORM 4700

1 MAY 78

HSXR-APG-Z OP 32 1 Jan 90

PERSONAL PROTECTIVE EQUIPMENT: R=Required - A=Available

(1) RESPIRATOR MANUFACTURER NIOSH TC NO. REQUIRED/AVAILABLE

Disposable ¼-Face Air Purifying ½-Face Air Purifying Full-Face Air Purifying Powered Air Purifying Airline Self-Contained Abrasive Blasting Hood

(2) GLOVES R A (3) EYES/FACE R A (4) HEARING R A (5) BODY R A (6) HEAD/FT R A

Acid Chemical Splash Muff Aprons Hard Hats Oil Safety/Impact Earplugs Coveralls Impermeable Boots Solvents Chemical/Safety Canal Caps Full Body Suit Safety/Conduct Shoes Hot Surface Full Face Shield Helmets Safety Belt/Harness Safety/Nonconduct Shoes Cold Surface Welding Heat Reflect Vest/Suit

Additional Comments:

PRIVACY ACT STATEMENT

AUTHORITY: 5 U.S.C., Section 301; 10 U.S.C., Section 3013 PURPOSE: This form is used to store patient information in an automated computer system; retrieval of information is by the patient's SSN and is required to properly record Occupational Worksite Hazard Exposure Sampling Data.

DISCLOSURE: Personal information on this form is given on a voluntary basis. Failure to provide this information, however, may result in failure to obtain proper medical surveillance healthcare.

Attachment 8 List of Facilities

See attached Market Research for list of facilities

Attachment 9 ARNG Lead Sampling Guide

ARMY NATIONAL GUARD

INDUSTRIAL HYGIENE SAMPLING GUIDE FOR

SURFACE LEAD IN READINESS CENTERS

26 OCTOBER 2015

1. REFERENCES. See Appendix A.

2. PURPOSE. The purpose of this guide is to provide clear instruction for conducting annual lead surface wipe sampling at Army National Guard (ARNG) Readiness Centers (RCs) that contain active, nonfunctional, closed, or disposed indoor firing ranges (IFRs).

The annual surface sampling to assess possible lead surface levels in the RC does not take the place of the mandated comprehensive industrial hygiene survey; active IFR industrial hygiene evaluation; or assessment of inactive IFRs identified for rehabilitation and conversion.

3. AUTHORITY.

a. Workplace Hazard Assessment. The Department of the Army Pamphlet (DA-

PAM) 40-503, paragraph 1-8b(3), mandates that facilities provide healthful work environments in accordance with the most stringent assessment standards (reference 1). The Occupational Health and Safety Administration (OSHA) through the Code of Federal Regulations (29 CFR 1910), have enforceable regulatory standards for workplace safety (reference 2).

b. Sampling Methodology. The American Society for Testing and Materials (ASTM)

International is an international standards organization that develops and publishes voluntary consensus technical standards for a wide range of materials, products (such as lead wipes), systems, and services, including surface wipe testing for lead (reference 3).

c. Evaluation Criteria. The recently signed Memorandum for the Chiefs of Staff

(COS) regarding possible lead in RCs (reference 4) sets forth the requirement to conduct surface wipe sampling annually and to set limitations on public and family member access to the RCs based on unacceptable sampling results. The memorandum requires surface levels less than forty micrograms per square foot (<40 μg/ft2) in areas that will accessed by the public or family members. Army National Guard Regulation (NGR) 385-15 paragraph 5-4 requires a housekeeping program sufficient to maintain all active IFR surfaces as free as practicable of accumulations of lead dust (reference 5). The Army National Guard Pamphlet (NG Pam) 420-15 paragraph 3-6(o) states that the lead surface goal in rehabilitated IFRs is <200 μg/ft2 prior to encapsulation (reference 6). The NG Pam 420-15 paragraph 3-6(p) also requires that annual testing continue after successful IFR surface cleaning, encapsulation, and enclosure (tile or linoleum) to verify that no lead migration from the substrate is occurring (reference 6).

SUBJECT: ARNG Industrial Hygiene Sampling Guide for Surface Lead in Readiness Centers, 26 October 2015

4. SAMPLING PLANNING AND INSTRUCTIONS.

a. Sampling Plan.

1) Identification of Personnel Qualified to Conduct Sampling. As responsible office for the execution of the surface wipe sampling program (reference 4), each ARNG Regional IH Office will make the final determination as to the qualification of personnel to conduct lead surface wipe sampling. All personnel performing the wipe sampling surveys must read this guidance and either demonstrate the skills necessary to perform the work or provide proof of certification in lead sampling prior to conducting the surveys.

2) Site Identification. Complete the Facility Information Spreadsheet provided with this document, ensuring the list of all RCs containing IFRs (regardless of status) in the state, district, or territory is complete. Identify the status of IFRs (active, nonfunctional, closed, or disposed) using the criteria outlined in the ARNG COS Memorandum (reference 4) in advance if possible.

3) Coordination and Travel Planning. Coordinate with the state, district, or territory representative in the Safety and/or Occupational Health Office to arrange dates and times to conduct sampling. Plan travel routes that allow multiple facilities to be visited in a day when feasible.

4) Team Member Designation. For quality control purposes and ease of performance, it is recommended that all sampling surveys be conducted by teams of at least two personnel. Because there is variability between each person’s technique and wiping pressure during sampling, a ‘sampler’ and ‘assistant’ should be designated in each team (reference 3). The ‘sampler’ will conduct all wiping within a state, district, or territory to maintain consistency in sampling results.

5) Sample Collection Plan. Thirty five (35) samples and three blanks will be collected from each RC with an active or nonfunctional (closed but not cleaned and converted) IFR. Twenty three (23) samples and two blanks will be collected from each RC with a closed (cleaned) or disposed IFR. Sampling will be conducted using the method outlined in the ASTM E 1728 (reference 3). Sample location and methods are discussed in paragraph 5c. Actual sample locations will be recorded on a floor plan of each facility.

b. Sampling Supplies. The ARNG Regional IH Offices will provide all sampling supplies to their designated sampling teams in the region and any deviation from the following listed materials must be approved.

1) Wipes. Use Environmental Express® Ghost Wipes™ with a valid expiration date or wipes meeting the criteria outlined in ASTM E1792 (reference 7).

2) Containers. Collected wipe samples will be stored and transported in individual plastic containers with secure, screw on lids. Wipes will not be placed directly into small re-sealable plastic bags because as the ASTM E1728 relates, laboratory recoverability is improved when using straight sided plastic containers (reference 3).

3) Bags. Plastic storage bags for collected wipe samples/plastic containers will be used to further protect samples.

4) Gloves. Disposable, one time use, powder free gloves are required for each sample (reference 3).

5) Templates. To achieve the desired laboratory detection limit of 40 μg/ft2, 30 centimeter (cm) by 30 cm pre-cut cardboard one time use templates must be used.

c. Surface Wipe Sampling Procedures.

1) Supply Request. Request supplies by e-mail no less than two weeks prior to the start of the surveys using the form in Appendix B. The provided supply packs will include administrative support items such as field data sheets, laboratory chain of custody and analysis request forms, pre-labeled shipping boxes, permanent markers, duct tape, gloves, and re-sealable bags.

2) Control, Storage, and Transportation of Sampling Supplies. Maintain wipes, templates, plastic tubes, and lids in closed, re-sealable bags until ready for use and keep clean and away from contamination. Maintain visual control of supplies at all times at facilities. Do not leave collected samples and supplies in vehicles overnight and avoid temperature extremes of heat or cold.

3) Damaged Supplies. Use only supplied wipes in undamaged packaging. If a wipe is found to be dried out or damaged, it must be discarded. If other supplies are found damaged or contaminated, do not use.

4) Surface Selection. Select floor surfaces that are “solid, hard, and non-porous” as much as possible. Choose locations near the edges of rooms where dust is most likely settled. Seek out locations under desks or cabinets where cleaning occurs less frequently. Table 1 (for RCs with active or nonfunctional IFRs) and Table 2 (for RCs with closed or disposed IFRs) list surface location, type, and collection quantity. If the locations listed in the table are not present at the RC, move on to the next location designation.

Table 1. Sample Collection for RCs with Active or Nonfunctional IFRs.

Sample Collection Location Surface Type Quantity Samples

IFR1 Floor 3 IFR1 Wall 3 per wall IFR1 Ceiling/Elevated Location 3 Floor Area Outside of IFR Floor 1 Drill Hall Floor 2 Rooms specifically occupied/rented by the public (Boy/Girl Scouts etc.)

Floor 1 per room Table / Desk 1 per room

Family Readiness Office Floor 1 per office Table / Desk 1 per office

Break Room Floor 1 Table 1

Kitchen Floor 1 Counter / Prep Area 1

Other Occupied Offices or Rooms (to reach a total of 35 samples)

Floor To be determined

Blanks N/A 3

TOTAL 38

1 Samples Determined by NGR 385-15 and NG Pam 420-15 (references 5 and 6).

Table 2. Sample Collection for RCs with Closed or Disposed IFRs.

Sample Collection Location Surface Type Quantity Samples

Former IFR Floor 2 Former IFR Wall 1 per wall Floor Area Outside of former IFR Floor 1 Drill Hall Floor 2 Rooms specifically occupied/rented by the public (Boy/Girl Scouts etc.)

Floor 1 per room Table / Desk 1 per room

Family Readiness Office Floor 1 per office Table / Desk 1 per office

Break Room Floor 1 Table 1

Kitchen Floor 1 Counter / Prep Area 1

Other Occupied Offices or Rooms (to reach a total of 23 samples)

Floor To be determined

Blanks N/A 2

TOTAL 25

5) Sampling Supplies. Use a new pair of gloves and a new, clean template for the collection of each sample (reference 3). No sampling supplies will be reused.

6) Template Placement. With clean hands and only touching the outer edges, the ‘assistant’ will place a clean template on the floor surface without disturbing existing dust. They will ensure the template has the ability to lay flat and secure the template to the floor surface by its outer edges with tape. Template location will be recorded on the facility floor plan. Without touching the wipe, the ‘assistant’ will tear open the top edge of the wipe packet and hold it ready for the ‘sampler’.

7) Sample Collection. The ‘sampler’ will don a pair of clean, powder free gloves;

remove the wipe from the open package, unfold it, and begin wiping in accordance with the method outlined in ASTM E 1728 and depicted in the following (reference 3).

a) “Using an open flat hand with the fingertips together, place the wipe on the surface to be sampled. Wipe the selected surface area, side to side, in an overlapping “S” pattern while applying moderate pressure to the fingertips. Wipe the surface so that the entire selected surface area is covered. Perform the wiping process using the fingers not the entire hand” (reference 3).

b) “Fold the wipe in half with the collected dust side folded inward, and repeat the preceding wiping procedure within the selected sampling area using an overlapping up and down “S” pattern” (reference 3).

c) “Fold the wipe in half again with the collected dust side folded inward, and repeat the wiping procedure one more time, around the perimeter, concentrating on collecting settled dust from all corners and edges within the selected surface area” (reference 3).

d) While the ‘sampler’ is collecting the wipe sample, the ‘assistant’ will ready the collection tube and cap.

8) Documentation and Labeling. Use a permanent marker to mark the side of the collection tube with the sampling identification (ID). The following sampling ID naming convention will be followed:

State two letter abbreviation (space) First Four Letters of Town/City of Readiness

Center Location (space) Sample Number (space)

Example: PA HARR 1, PA HARR 2, PA HARR 3, and so on.

9) Blanks. Prepare the number of blanks described in tables 1 and 2. While wearing a pair of clean gloves open a packet, remove the wipe, expose briefly to air and place into a plastic tube and label with sample ID criteria listed above.

10) Field Data Sheets. Fill out the provided field data sheets completely including signature and date. Use the example provided in Appendix C.

11) Sample Shipping. Fill out laboratory request for analysis of the selected laboratory and include a copy of the field data sheet with the analysis request and samples. Appendix D lists important details to include on the laboratory chain of custody. Keep a copy of the lab request and field data sheet. E-mail a copy of the lab request and field data sheet to the Regional ARNG IH Office.

d. Results Discussion. The Regional IH Office will receive sample results and will provide data in a ‘preliminary findings’ e-mail that will be followed by a formal published report summarizing results for the state, district, or territory.

5. ADDITIONAL ASSISTANCE. The technical point of contacts are the ARNG Regional Industrial Hygienists listed below.

a. Midwest Region: AK, IA, IL, IN, KS, MI, MN, MO, OH, ND, NE, SD, WI

1) Scott Carpenter, (410) 939-5819, scott.c.carpenter.civ@mail.mil

2) Randy Fritz, (303) 210-8722, randy.c.fritz.civ@mail.mil

b. Northeast Region: CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VA, VT, WV

1) Cindy Harrison, (410) 942-0273, cynthia.s.harrison2.civ@mail.mil

c. Southeast Region: AL, AR, FL, GA, KY, LA, MS, NC, OK, PR, SC, TN, TX, VI

1) Ken Fuller, (404) 559-4174, mandan.k.fuller.civ@mail.mil

2) Etienne Rodriguez, (404) 559-4174, etienne.rodriguez.civ@mail.mil

d. Southwest Region: AZ, CA, CO, GU, HI, ID, MT, NM, NV, OR, UT, WA, WY

1) Ron Faull, (916) 854-1491, ronald.w.faull.mil@mail.mil

FORSYTHE.KENNETH.A

USTIN.III.1244948533

Digitally signed by

FORSYTHE.KENNETH.AUSTIN.III.1244948533

DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USA, cn=FORSYTHE.KENNETH.AUSTIN.III.1244948533 Date: 2015.10.26 17:21:48 ‐04'00'

2 Encls KENNETH A. FORSYTHE, III

1. Facility Information Spreadsheet Chief, ARNG Industrial Hygiene

2. Wipe Sampling Field Data Sheet

APPENDIX A

REFERENCES

1. Department of the Army Pamphlet (DA-PAM) 40-503, The Army Industrial Hygiene Program, 2 April 2013.

2. Title 29 Code of Federal Regulations (CFR), Part 1910, 2015…