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CONOCO CHEMICALS - ABERDEEN PVC PLANT DOSIMETRY CARD (A)
SAMPLE NS
Hazard: VCM </) Name Department
Load ( ) Noise < )
< ) Date jLirtg
S. S. # tot'iC. 3a7J Shift _a_
0927*
Analyst:
Hazard VCM Noise Lead (Mlcrogrems)!
PEL: 1 PPM
Over ! ) TOT:.
Under ( ) PEL:
IIBdBA Per M3
TWA Exposure
^0*1 PPM
% of PEL Per M3
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-+
CQNOCOCHEMICALS - ABERDEEN PVC PLANT DOSIMETRY DATA CARD (B)
*****
SAMPLE NS 0927*
Hazard: VCM {^j Lead ( ) Noise ( )
( I Date
Time Clock (Lead
AMI > PMIX)
AMlfcj PM( )
List areas you spent most time in and estimate amount of time (nearest hour is sufficient! spent.
Area
^yL r i
bTime,
Area
Timesbi a
List most likely causes of possible overexposure to the hazard.
1.
2. 3.
Check respiratory protection you used:
I^X^None
) Dust Mask
) Air-line Respirator
{ ) Scott Air-pak
Signature
Please complete and return to guard
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