Document 44B9L380357qx1q8Lz3zw1Ej1

PLAINTIFF'S EXHIBIT 23 APPENDIX D - PLANT SPECIFIC ASSESSMENT QUESTIONNAIRE INDUSTRIAL HYGIENE ASSESSMENT CHECK LIST This questionnaire should be distributed to the specific plants selected for participation as part of the site assessment of the Industrial Hygiene program. This questionnaire should be completed by the plant industrial hygiene contact and site hygienist for that plant and copies available the week before foe site assessment The emphasis of the assessment is to review Industrial Hygiene,programs but also to ensure that documentation is complete. Please have written programs, documentation of training meetings, etc readily available for foe assessment team. This will help to speed the assessment along. ST00378IU SECTION L EDUCATION AND TRAINING fRrf. OSHA HAZCOM 29CER1910.1200) A- bWziird (jCi.YirHU.flU'/xJlO-r- (T) Current date of written HAZCOM program____________ . Show assessment team written HAZCOM program. a. New and transferred employee orientation program. G?e<vno>^ lx _______ transfers-from one dcpartment-to another? b. Does j'o-* tor - v| es - ckO differ toe t fitce fecUvuC-Ai Suf . cjeoeoj j lofevroiotN i5Utc1. TmiAhCAccHtfc. W'S /violWad? -yes -no ^ Show assessors examples otreoords. ? B. dhe*m`c-1 3. Current date of Chemical and Physical Agent Inventory. -- is uWtwVoC'i &. <Jod la.feJe 7. uJhe.Ce c Xr>cC (i) Are all the Data Sheets (MSDS and/or TIME) current? (Current dates are on the CPAI Index.) Has a list of chemicals without the most current date been prepared for the purpose of getting updates? Rev. 2-89 ST00378 15 section i. imATiM"AHtrrorogr Page H o?T Dow Employees . TXjhat is the orientation program for new or transferred employees? Are technical, supervisory, clerical, laboratory, and maintenance personnel cpC b. No (Si Is there a Chemical and Physical Agent Inventory for each Job assignment? a. Yes b. No 3j Does the Chemical and Physical Agent Inventory contain all significant chemical and physical stresses? a. Yes b. No ($y Is it updated annually? a. Yes. By whom? -- b Mo U.'haf ia AMUMC f^6(LtJjLuJU L&-< 5.--la it permanently stored? * i Ol ^vULlO -XW'c`l , wJx fila-iit. b% -He 1 6. Vho made the Judgement required to establish degree of exposure and hazard rating? t 7. How many chemicals on the inventory do not have IHGs? -i-i ^ ms&s (/B?) Do you have health information-for all your chemicals? vl/ aa. YYess b. No 7. Pr--Are the Consequences of exposure to Toxic Amount (CETA) or-Industrial -Hygiene Information sheets available fer all ohemioals? 'a^Xfes 7^, *c,c7. '^ (1Are Industrial Hygiene Data Sheets, Material Safety Data Sheets, and/or CETA guide available to employees at all times? a. Yes -b. No. Oyj *e written process descriptions, simplified flow sheets, floor plans, Job descriptions current? a. Yes. If-so--are-adequate precautions taken to pruiecfHie \b. No RtSTWCTO: tar vmm wMMn TJ*w Oew OmwmmI Cm*mt ST00378 I 6 / SECTION i: flHJ&TlON AND TRAINING- Page 2 of 3 Are the floor plans adequate for identifying sources of exposure and location of industrial hygiene samples? a. Yes b. No Are all process sampling points, sumps, and unloading/loading docks, and other known sources of exposure noted? a. Yes b. No Are employees informed of the stresses to which they may be exposed, and the consequences of exposure to toxic or harmful amounts of these stresses, on an annual basis? a. Yes b. No Are maintenance employees covered by your education and training program? a. Yes b. No '(ffi) How is the information comunicated? What is the involvement of supervision? W~7 are health bulletins (bulletins transmitting recently discovered health ' _e__ffects) handled, and the Information dlssemllnnaatted to employees? / /'18 V How are results of exposure monitoring communicated to employees and at what frequency? i9y Is docinentation of the above programs available? a. Yes. How long is it retained? b. No Non-Oow Employees 1*. What is the'orientation program for "short term" contractors, "long term" ^'contractors, and visitors? 2 How ate long-term and short-term contractors informed of the hazards they may .le exposed to and the evidence of control of these hazards? /\ 3 ^s docunentatibo of the above programs available? a. Yes. HoKlong is it retained? b. No \ Is there a Chemical and Physical Agent Inventory for non-Dow employees? a. Yes b. No msnUCTBD: tor wr aMtot Tito CatoMny otoy */ SCTIdn 17" aHJCAtlbn And training Page 3 of 3 5. Are Industrial Hygiene Data Sheets, Material Safety Data Sheets and/or CETA' guides made available to non-Dow employees? a. Yes. If so, are they returned eventually? b. No 'I 6. Are non-Dow employees informed of the stresses to which they may be exposed, and the consequences of exposure to toxic amounts of these stresses, on an annual basis? a. Yes b. No 7. Is Industrial Hygiene monitoring of non-Oow personnel done? a. Yes *Z b. No 8. Are non-Dow employees appraised of their monitoring data? -- a. Yes. By whom? b. No B How are health bulletins handled and the information dissi inated to non-Dow employees? 10^ Do you have contractors off the premises doing formulating or other opera tions for you using products shipped to them by you? a. Yes. If so, are the workers involved properly informed of the materials involved and their potential hazards? b. No ST00378I 7 ntsrwierxo: tor N wMMn Thw Oow 24 5.) Where is the location of chemical hazard data sheets? 6.-------Show assessors documentation records-(sign-up sheets) of the cinpluyee annual hazard cuuuiumluitlun piogiaut-- Explain the techniques used-to communicate this information to employees. A. 7.How are health bulletins (bulletins transmitting recently discovered health effects) handled, and the information disseminated to employees? - /IrU. /n\GS\\Pt i&ufona p&*aJE*ci ? 8. ' Inspect work areas for proper labeling on containers. - t+s-t*; O-u2 CC^4-tuu*JU*/ (jlIijuLu/ T H\{UUU&jLis ^Lryua/j.efefcL, Q-UQC- *CJ/ sUjLtUjtJ * D. Co n4rax T 9. What is the orientation and education program for "short term" contractors and "long term" contractors? - /4vw_" .`U_ 'fi.itj pyLfj^yrr^~cJI CL^ ft/ftjuubl'td luLOdUtn. hpu&UidLa - I4u.' doCAUXJLttfc^l 7 - AJJL. C'Hf-JUt Lkjudh SECnON n. RESPIRATORS (Ref. Safety StcL and OSHA Std. 29CF 1910.134) ST00378 I 8 1. Attach copy of the written Respirator Program. Where is it kept? 2. Explain how users are instructed and trained in the proper use of respirators and theii limitations for the chemicals handled. How often repeated? Show documentation records to assessors. 3. qualitative ((^quantitative) fit testing provided? How often repeated? Show documentation records to assessors. Rev. 2-89 ST003781 9 5ECTI0N II. RESPIRATOR? Page 1 of? Dow Employees My Are respirators required, provided, and used for other than lergencies? a. Yes. If so, what kind(s)? b. No Is there a written respirator program? a. Yes. Where is it kept? Please attach copy. b. No /3J Is there an Inspection, cleaning, and maintenance program? a. Yes b. No Are the written records of inspection of respirators maintained as required by the OSHAct (CFR 1910.134) or pertinent state act? a. Yes b. No you have a policy concerning beards and glasses or goggles with the use plrators? a. Yes. If so, what is it? b. No Are respirators and cartridges or canisters paepeely selected and approved for intended use? By shorn? Are users Instructed and trained- in the proper use of respirators and their limitations? a. Yes. If so, how often and by whom? b. No Is qualitative fit testing provided? -ft: r dust- a. Yes. If so, how often? b. No vW. d4*-*' o bta.<rted ? ^Is quantitative fit testing -provided? a?--es. If so, hew often? -- It. Hu 7 ? Are Individually assigned respirators provided where practicable? a. Yes. Are they marked to identify the owner? b. No Are respirators properly stored? a. Yes b. No - fUu butcK^ jrtJidiaoJt OcpfuG-zUiti icp-'tv- BtSTWICTtD: tar um wMMn 71m Om aiMIUHll. HkSPimrBg ^aqe Z of f ST0037820 (xij if air-supplied respirators are used, what is the source of air? a. Bottles b. Compressor - plant air c. Compressor - dedicated breathing air 3.) Are unique fittings used for breathing air lines to ensure against connecting into other systems? a. Yes b. No Is the quality of breathing air ensured? a. Yes. If so, how is it docimented? b. No Is the maintenance program for breathing air compressors written and adequate? a. Yes b. No Are backup persons with suitable rescue equipment provided for persons working in atmospheres which may have the potential of becoming imeedlately dangerous to life and health? a. Yes b. No Is there a regular inspection and evaluation to determine the continued effectiveness of the program? a. Yes b. No How is documentation of medical approval done for those who must wear respiratory protection? Non-Oow Employees <T\.. Are respirators used by non-Dow employees? W a. Yes b. No n2*^How does the respirator program for non-Dow employees differ from Dow ^^smployees? Are non-Dow employees fit tested with respirators? a. Yes b. No i: ST^4) Do you supply respirators for non-Dow employees? - 'CvKfhrOet'S b't j/Hedt'cat-fltf us>c > DoeanuuM > A .W ^t-c I k & iz-- und in 5 pe'th irs, mm--m--m----NtS DUCTED: ttfOM MMn Thm ` ST003782I SECT1W ill. VEMTIUXHPff ftage 1 of? Is local exhaust ventilation provided at any operation generating air contaminants? a. Yes. If so, at what operations? b. No Zj Are there any needs for local exhaust ventilation that have not been net? a. Yes. If so, where? b. No What criteria was used in determining optimum face velocities for local exhaust devices? What transport velocities for particulates have been used? How often is it measured? Are local exhaust ventilation devices inspected periodically for integrity and need for maintenance? a. Yes b. No How frequently are local exhaust devices checked for face velocity and static suction? Are local exhaust systems equipped with manometers or other devices to indicate air flow? a. Yes b. No 8. Are scrubbers or dust collection systems a part of any local exhaust or ventilation systems? a. Yes. If so, are these systems on a periodic maintenance schedule? (1) Yes. If so, how often are they cleaned. (2) No b. No . Are ventilation or exhaust systems interlocked with production processes? a. Yes. If so, for what purpose? b. No What is the regular inspection and maintenance schedule for general ventilation systems? Is there a probability that airborne contaminants removed from the workplace are being returned with makeup air in the same or other ventilation or air conditioning system? a. Yes. If so, where? b. No QA jkb hood 7 /flmm'kr ? brdtfJ-wa/ ? Fdc* v<Lic<LtU( MCSTRICnO: tor m wHMn Th Ovm SECTION ill: VEWTIEATIBff fraqe z of? What ventilation la provided for welding operations? Does It appear to be adequate or are iaproved Methods of controlling exposure Indicated? 'h Are blast gates used*In any ventilation systes? a. Yes. If so, are they locked In position? CD Yes (2) Ho b. No ST0037822 NtSlMcrO: tor om vMMn On flmwil ST0037823 25 4. How is documentation of medical approval done for those who must wear respiratory protection? \/ 5. Inspect respirator storage area for compliance with cartridge change frequency, cleaning, storage, and monthly inspection records. / / / / 6. / Are. respirators used by non-Dow employees? If yes\how does the Respirator Program for non-Dow employees differ from Dow employees? it operations have local^xnaust ventilation provided to capture air xtaminants? 1 What is. the regular inspection and maintenance schedule for ventilation systems? (t ventilation is provided for welding operations? Does it appear to be adequate are improved methods of controlling exposure indicated? SECTION IV. HEARING CONSERVATION (Ref. Dow Safety StcL, IHG and OSHA Std. 29CFR1910.95) 1. Attach copy of the written Hearing Conservation Program. Rev. 2-89 ST0037824 26 Rev. 2-89 ST0037825 SECTION ir HEWaMTE WfioH Page 1 of? Is there a written hearing conservation program? a. Yes. Does It meet OSHA standard 1910.95? (1) Yes (2) No b. No Are noise surveys conducted to define the potential exposure of employees to noise levels in excess of 80 dBA? a. Yes b. No 3. Are there any areas that exceed 90 dBA? a. Yes. If so, are they posted as high noise areas? (1) Yes (2) No b. No <55 Are employee exposures measured to determine those encountering a TWA of 85 dBA or greater? a. Y js b. No Is there a list of those employees exposed to a TWA of 85 dBA or greater? a. Yes b. No .6 Are employees exposed to a TWA of 85 dBA given base line and subsequent annual audiograms? a. Yes b. No Where and by whom are audiograms done? Have you reviewed the results of the audiograms of your employees with the physician or medical department who carries them out? a. Yes b. No 9. Are employees who are exposed to a TWA of 85 dBA or greater furnished ear protection, properly fitted, and trained in the proper use? a. Yes b. No *1 10. ' Have octave band analyses been made to determine the adequacy of the ear protection furnished to attenuate noise exposure? a. Yes b. No * Are before and after calibration records made for the noise measuring equipment? Yes No MSnilUTn: Mr m Th* Omm Clii*1 Cnmwwy mmty. ST0037826 SECTION IV. HEAftinfi C6n&hvation Page i ofT Is the calibration of the acoustic calibrator verified annually? a. Yes b. No 13. Are employees Informed of the hazards of excessive exposure to noise annually? a. Yes b. No ineerlng controls, work practices, and administrative controls sufficiently documented to demonstrate their effectiveness in controlling employee exposures to within acceptable limits? a. Yes b. No 15. Are sound enclosures and other noise reducing equipment regularly Inspected for integrity and effectiveness? a. Yes b. No Do purchase specifications for equipment include limits on noise levels when appropriate? a. Yes b. No 17. Are there any noisy areas that should be evaluated for possible noise level reduction engineering controls? a. Yes b. No Medical Ik Are employee noise exposure data readily available to the medical oepartme empploloyyeeesfeexxcperiencing a "significant threshold shift" in hearing J .faculty, are employees A. retested to verify a. /Yes b./ No change? erred to a qualified physician for a medical evaluation of the change? Yes b. No Ntsnucno: tor WM SCT10H IV. HEWIRg'coH^HVAticiT Page 3 ofT retrained and required to wear hearing protection? a. Yea ,b. Mo 0. identified tq^unit supervision? \Yes 3. Does the audlonetric testing room aeet acceptable background levels for testing hearing loss? a. /Y* 4. Is a functional test conducted for the audlonetric equipment? a. Yes. If so* how often? b. No 5. Ib an annual acoustic tWst conducted for the audlonetric equipment? a. Yes b. No 6. Vho reviews the audlograns? i ST 0037 827 ftOTMGTCD: tor M wMMw Tito Oto> 27 How many employees have experienced a "standard threshold shift" in hearing acuity? l' ST0037828 SECTION V, PROTECTIVE EQUIPMENTAVORK CLOTHING Is there a written Protective Equipment Policy? a. Yes bt No Is company-furnished work clothing provided? a. Yes lx No Is company-furnished work dothing worn off site? Yes. If so, are there potential contaminants that could be transported in the dothing? V ' Yes. If so, what is the contaminant? No Rev. 2-89 ST0037829 5ECTIW V. "PROTECTIVE ECUmHI/WMk fl-CTHTffiT ^aqe 1 ofj Is there a written protective equlpaent policy? a. Yes b. No flu^icuu^f 7. Please check the protective equipment provided and required: Slicker suit Shoes Boots Cloves _____ Safety glasses _____ Safety glasses/side shields Chemical worker's goggles ____ Other 3. Company-furnished Clothing (Ay Is work clothing furnished? -&&tk a. Yes b. No cwi1 Is work clothing furnished for maintenance employees? a. Yes A. Clean Clothing clean clothing required each day? Yes No Is clean clothing required each day for maintenance employees? a. Yes b. No Is clean clothing required each day for non-Dow employees? a. Yes b. No 5. Is company furnished work clothing worn off site? a. Yes. If so, are there potential contaminants that could be transported in the clothing? (1) Yes. If so, what is the contaminant? (2) No b. No MU I AN. TED: tor ua* wBW Tfc* Oom ST0037830 SCTIOd VT proTEctM EtiulfrcNT/wbfac CLOTHim! ftaqe i of 3 6. Laundering Company-furnished Clothing A. Where is company furnished clothing laundered? a. On site b. Off site - commerical laundry c. Off site - employee's home If at a hazards? a. Yes b. No ercial laundry, has the laundry been informed of potential What fabric is used for company furnished work clothing? a. Nomex b. Cotton c. Other. If so, what? A. Are there proper storage areas or cabinets for clean gloves, "rubber'* suits, etc.? a. Yes. Are they used? (1) Yes (2) No b. No Are there areas or cabinets for used equipment that is not yet ready for cleaning? a. Yes.' Are they used? (1) Yes (2) No b. No Are exposure data available to support the protective equipment practices? a. Yes b. No 10.) Are data available to support the selection of the particular type of protective equipment furnished? a. Yes b. No Who makes the decisions concerning the type of protective equipment supplied? How are industrial hygiene,, medical, safety, and production (health team) involved in making protective clothing decisions? 13A Are there chemicals with low vapor pressures which may present a contamina tion problem on protective clothing? a. Yes. If so, what measures are taken to prevent skin contact? b. No atSTWICTCD: Mr ttw SECTION V. PROTECTIVE EQUIPMENT^WORK CLOTIttHC Page 3 of 3 14-. How does the Protective Equipment Program for contractors differ from that for Dow employees? is) Is protective equipment inspected to determine its usefulness? a. Yes b. No Has the protective equipment, Including boots, been tested to determine ' whether it may increase exposure potential by acting as a sink for contaminants? a. Yes b. No - fW te-ZtwLuma-^ Pf ? . ST003783I SfSJAH.ru): lor uoo wMn Tho Oo Camnmmf omty. 28 Where is company furnished clothing laundered? a. On site b. Off site - commercial laundry c Off site - employee's home 5. Are there proper storage areas or cabinets for clean gloves, "rubber" suites, etc? a- Yes. Are they used? 1) Yes 2) No tx No 6. Who makes the decisions concerning the type of protective equipment supplied? Is Industrial Hygiene involved with these decisions? ; ST0037832 7. Are exposure data available to support the protective equipment practices? a. Yes b. No SECTION VI. DATA GENERATION AND MONITORING /Kc?*ifee.ac{ ds>-u. */ ufhotM 1 Is monitoring done according to a protocol? f * they ed spikes, blanks, and knowns prepared and used? 7 By whom? 3. If the out analytical work is done at this location (plant): (If not, go to question 4.) a. What analytical methods are used? Rev. 2-89 ST0037833 29 b. Are sampling efficiency and recovery data recorded? c Have results been corrected for sampling recovery and efficiency? d. Does the laboratory participate in round robins? e. What is die frequency of calibration of analytical equipment? f. What is the concentration range over which die method is validated? g. What is done with analytical reports? 4 \ Show assessors monitoring survey reportedpcithirotation (original^dnta) (before/after instrument calibrations, sample description, etc). sHcli'/i 'hu'/ie.d What is done with original data? How and where is it stored? iCKevmcwJ > <1 L.t> b. Is the maintenance and calibration (Quality Assurance Program) of the CAM* done according'to a written procedure? Ci-& c What is being done with data generated by the CAW? Rev. 2-89 ST0037834 SECTION VI" DATA GEHERATid^ AND MDNifORIHC Page 1 of 4 {ly Monitoring is done by whom? fe.) Is Monitoring done according to a protocol? ^ a. Yes b. No What Monitoring Methods are used? A", 4. Have the sampling and analytical Methods been validated? a. Yes. Are these docunented? b. No 5. Is additional validation of. sampling and analytical procedures indicated? a. Yes b. No 6. What is the sampling strategy? 7. Are statistical methods used? b. No ^8. Have seasonal variations been considered in the Monitoring plan? ^YV a. Yes r b. No V How often are standards. field spikes, blanks, and knowns prepared and used Where are they prepared? By whom? 10. What is the frequency of pump calibration? a. muj d. Annually b. Weekly e. Every survey c. Monthly f. Other. What? 11. Where is the analysis done? a. Industrial Hygiene Analytical Laboratory b. Plant Laboratory c. Central Analytical Laboratory d. Other. What? 12. If the analytical work is done at this location, a. What analytical methods are used? b. Are sampling efficiency and recovery data recorded? c. Have results been corrected for sampling recovery and efficiency? d. Does the laboratory participate in round robins? e. What is the frequency of calibration of analytical equipment? f. What is the concentration range over which the method is validated? g. What is done with analytical reports? aaamuenB: far w MMn THw Oow ST0037835 gCTlUH VI...DATA gNEMTTSTvtt MflMITMIHg t*age Z ofT 13. Is the Monitoring properly documented both during and after the survey? a. Yes b. Ho 14. What is done with original data? How and where is it stored? 15. Summarize personal sampling data by completing the form below with data collected during the past two years. See example. Total Number Material ..and Type Monitored of Samples Silica 125-T14 Number of Samples Less than Between 10k ft Between 50k ft 10k of IHG 50k of IHG 100k of IHG 75 25 22 Greater than 100k of IHG 3 16. How many long term (four hours or more) area samples were taken? Do any areas routlntely exceed STEL or celling exposure guidelines? 17. How many task oriented excursion samples were taken? Were any STEL or ceiling exposure guidelines exceeded? MISTWtCrED: Mr Dm Sow ST0037836 VI. KATA dtemito an6 Page % of" 18. Are TWA data obtained during the sane workdays as excursion sanples? a. Yes b. No 19. Were there an adequate nueber of samples collected? a. Yes b. No 20. Are the use of protective equipment and the occurrence of unusual events docueented in the reports of exposure results? a. Yes b. No 21. Have all plant activities, sampling, etc., been dociaented in reports? a. Yes b. No 22. Are these reports available and maintained according to the records reten tion policy? a. Yes b. No 23. Now many employees are in job classifications with hazard ratings of: a. 1 _____ b. 2 _____ e. 3 2A. Do exposure data support the hazard ratings? a. Yes b. No 25. Has the need for a continuous area monitor (CAN) been considered? a. Yes. Has a need been identified? b. No 26. Is a CAM in use? a. Yes b. No 27. What contaminant(s) does it monitor? 28. Is the maintenance and calibration of the ON done according to a written procedure? a. Yes b. No 29. Are CAM sample point locations docunented? a. Yes b. No XlSTXtCTEC: lor SCTIW VI. ~BAU HEMTRrAtft MHUfiMNE t*aqe of 4 30. If a CAM data point la nondetectable, is the detection Halt printed or documented? a. Yes b. No 31. What is being done with data generated by the CAM? Are TWA exposures calculated? 32. Vhat is the Quality Assurance Program used to assess the validity of data obtained? a. For Industrial Hygiene survey data? b. For CAM data? 33. If analytical proficiency has not been adequate, what steps were taken to rectify the situation? ST0037837 151 NIC 110: for im Hh Tbo 0w ST0037838 30 SECTION VH ASBESTOS (Ref. OSHA 29CFR192658) j^l?) Is asbestos (insulation, etc) present in this operation? a. Yes b. No (Go to next Section) e Do you have a "map" of the location of asbestos containing materials? Show assessor the documentation. Is there asbestos "Danger" sign(s) posted in areas to alert employees of hazards? Is the site "Competent Person" involved with all asbestos removal jobs? Do Dow employees remove asbestos containing materials? If so, show assessor written operating procedures. pr5cnrtfil kx^e. ^ hr. ccicktre SECTION vm. GENERAL Rev. 2-89 * ST0037839 sEcriwrvirr Page 1 ofT Dow Employees . 1. Where do employees store their lunch? 2. Where do employees eat or drink? 3. Is food or tobacco carried into process areas, laboratories, or other areas where chemicals are present? a. Ves b. No Is there a mandatory shower policy? a. Yes b. No Is there a written policy concerning the washing of face and hands before eating? a. Yes b. No Are toilet, showers, and change rooms adequate and clean? a. Yes. For women employed also? b. No Are there adequate nusbers of lockers? Are there any improvements which should be made in the change rooms and lunchrooms? a. Yes. If so, are they (1) double lockers? (2) street side and plant side? b* No Is there evidence of "tracking1' of chemicals from one area to another? a. Yes. If so, explain. r b. No How often are safety showers and eyewash stations inspected? Do job procedures retire the testing of eyewash and safety showers prior to commencing the job when the potential for their use exists? a. Yes b. No Do job procedures adequately define the hazards of the job and the protective equipment required? a. Yes b. No Are job procedures reviewed periodically with the involvement of Industrial hygiene? a. Yes b. No NKSlRK.ru: twr wi TXwOMi CnwwiiT-- ST0037840 gtflflN vlt: 6neral Page 2 ofT What shift schedules are worked? Are entry permits required for entry Into enclosed spaces? a. Yes. If so, are measurements made to determine oxygen content and the concentration of hazardous materials before Issuing the permit? (1) Yes (2) Mo b. No (\G'. Is welding, cutting or grinding being done on galvanized or zinc primed equipment? a. Yes. If so, has the potential personal exposure to zinc and lead been measured? (1) Yes (2) Mo b. No How Is the housekeeping? Are there specific recommendations for Improvement? e Are there any specific problems which could be eliminated by additional engineering control? a. Yes. If so, what are they? Is there an action plan to control them? b. No 19) Which work practices or procedures should be changed In order to reduce or s"'/ eliminate exposures to stresses? a. Yes. If so, what are they? Is there an action plan to control them? b. No Are any chemical stresses controlled by speciflo OSHA or state health stan dards (acrylonitrile, vinyl chloride, etc.)? a. Yes. If so, which ones? b. No Is there any asbestos In the plant? a. Yes. If so, is it identified? (!) Yes (2) No b. No Is any sandblasting done on site? a. Yes b. No What emergency plans have been written for use in case of spills or major releases? Do they Include the possible exposure to persons outside the fence line? flZSTfUCTZD: fer im SCT10H Vll. frage 3 of"? plamT Does the riaitlty have an industrial hygiene contact? a. -Yes b. No Vhat input does industrial hygiene contribute prior to process changes, plant modifications, and new construction? What is being done to prevent skin contact with cheaicals? Is denaatitls a problea at this location? a. Yes b. No Are solvents used for degreasing and cleaning being used with proper precaution? a. Yes b. No Are the differences between cheaicals which are absorbed through the skin aid those fclch are irritants to the skin identified and the differences appreciates? a. Yes. If so, is there appropriate control? (1) Yes (2) No b. No Non-Oow Eaployees Where oo non-Dow eaployees eat or drink? Where do non-Dow eaployees store their lunch? Is there a aandatory shower policy for non-Dow eaployees? a. Yes b. No Are change/shower rooms supplied for non-Dow eaployees? a. Yes. Are they adequate? b. No ST003784I raSTWICTtD: r IN* TTmOot action vra: 'mBdieaL" Page 1 of~1 Facility 1. Is there a Medical Surveillance Program? a. Yes b. No ge of employees participate in the Medical Surveillance roprlate medical opinions for respirator users? >logioal monitoring program? If so, for ehat chemicals? 3. How is medical surveillance of contractors administered? . How are results of medical exams communicated to employees? that percentage of employees participate in the Medical Surveillance Program? ST00378U2 ftismH.ru: m T)wOh ST0O378U3 31 Rev. 2-89 ST00378U4 ggnw IVT'ftAfflXTIBN Page 1 ofT -TVs agues' 4o ; 3aaW Source c^ueib&^s Facility ftdietMed hoiCJs/uC' lOi'ht 1. Are sealed sources, X-ray producing material or loose Isotopes of radioactive material present? a. Yes b. No. IF SO, OMIT REMAINDER OF THIS SECTION. 2. Is Form NRC-3 "Notice to Employees" or agreement state equivalent posted in an area accessible to employees? a. Yes b. No 3. Is there a similarly posted reference to where 10CFR 19, 20, 21, the NRC license or agreement state equivalent and notices of violation are available? a. Yes b. No A. Are radiation levels In- areas that are not controlled for purposes of radiation protection at levels below 2 mrea/hr or 100 mrem/7 days or equivalent State limits? a. Yes b. No 5 Are radiation tf i&J ~f?r3 Hlum/Hi ui MOO uuui/8 dayr) conspicuously posted with the radiation caution symbol and the words "Caution - Radiation Area"? a. Yes b. No 6. Are areas containing >10 times 10CFR20, Appendix C, quantities or equiva lent state limits of radioactive material posted with a sign bearing the radiation caution symbol and the words "Caution-Radioactive Materials'*? a. Yes b. No Does each Lsmlrntwao ar sealed source holder of radioactive material con taining greater than 10CFR20, Appendix C, quantities (or equivalent state limits) bear a label identifying the contents and a label stating "Caution - Radioactive Materials"? a. Yes b. No Are licensed radioactive materials^secured against unauthorized removal? a. Yes b. No f <9 wmwcTP: m TWe 0-- CIlilMlI CllMT ST0037845 32 V3 V)A APPENDIX E - ANALYnCAL LABORATORY ASSESSMENT QUESTIONNAIRE A * QUESTIONS FOR THE ASSESSMENT OF INDUSTRIAL HYGIENE ANALYTICAL LABORATORY OPERATIONS WITHIN THE DOW CHEMICAL COMPANY This appendix questionnaire is not meant to be ail inclusive but rather as a "trigger mechanism" to stimulate die assessor to ask the proper questions. Additional topics or areas of interest appropriate to the site being evaluated may be reviewed. 1. Is there access to a set of Dow's Industrial Hygiene (Reference) Procedures? Is there access to all relevant Dow Industrial Hygiene monitoring methods? 2 Which compounds are you analyzing at least once a year? 3. What monitoring method are used for each compound being analyzed? Are these Dow-validated methods? Indicate the method number, if it has cme. If not, is the method written down and kept in a methods manual? 4. If an alternative analytical method is used when a Dow-validated method exists, do you have documentation confirming the effectiveness of the alternative method in doing what it is intended to do? 5. How are the samples received at the analytical laboratory? 6. Are any samples sent outside The Dow Chemical Company for analysis? If so, what evaluation has been done of the outside laboratory to determine its ability to analyze the samples? 7. Are die samples logged in when received by die laboratory? 8. Does the laboratory assign the samples a number different from the one assigned1 by the industrial hygienist? 9. Are known (spiked) samples submitted with the unknowns for analysis by the laboratory? If so, how frequently? 10. If known samples are submitted with the unknowns, who prepares the known (spiked) samples? Rev. 2-89