Tier I Working Group 3rd Quarter FY 2010

August 23, 2010

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Overview

Rollup of 3rd Quarter FY 2010 Tier I Inspection Findings

Latest Status on Maximo Upgrade and Timetable for Common Database

Finalize Tier I List of Categories and Subcategories Open Discussion (Issues & Good Practices)

3

Rollup of 3rd Quarter FY 2010 Tier I Inspection Findings

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Data Roll-up and ReviewTier I Findings by Fiscal Year

(Q3)

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200

400

600

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1000

WED ESD ESE HK WEP CG WT CSL CSS FS OGIH ESP OT RS EM PPE MH MS CSU UP SECBH GS

Findin

gs

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Data Roll-up and ReviewTier 1 Findings By Category

Fiscal Year=2010, Quarter=Q3

WED 814ESD 431ESE 407HK 394WEP 304CG 257WT 223CSL 179CSS 147FS 120OG 72IH 66ESP 60OT 52RS 40EM 39PPE 34MH 30MS 27CSU 26UP 9SEC 5BH 1

SecurityBiohazards

EnvironmentalPersonal Protective EquipmentMaterial Handling and Equipment Machine Shop SafetyChemical Safety: UseUnsafe Practices

Fire SafetyOutside and GroundsIndustrial Hygiene IssuesElectrical Safety: ProgrammaticOtherRadiation Safety

HousekeepingWorking Environment: PlantCompressed Gas/CryogenicsWasteChemical Safety: LabelingChemical Safety: Storage

Working Environment: DepartmentElectrical Safety: DistributionElectrical Safety: Equipment

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Data Roll-up and ReviewTier I Directorate Findings

Fiscal Year=2010, Quarter=Q3

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200

400

600

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Light Sources Basic Energy Sciences

Nuclear and ParticlePhysics

Life Sciences

GARS F&O

Science & Tech. ESH&Q

ERP Human Resources

Finance Director's Office

CEGPA

Fin

din

gs

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Data Roll-up and ReviewTier 1 Top 7 Findings By Category

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200

400

600

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2005 2006 2007 2008 2009

CSSESDESEHKOGWEDWEPCGWTCSL

Fiscal Year

WED 814

ESD 431

ESE 407

HK 394

WEP 304

CG 257

WT 223Waste

Electrical Safety: Equipment

Housekeeping

Working Environment: Plant

Compressed Gas/Cryogenics

Working Environment: Department

Electrical Safety: Distribution

0

200

400

600

800

1000

2005 2006 2007 2008 2009 2010

CSSESDESEHKOGWEDWEPCGWTCSL

Fiscal Year (Q3)

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Latest Status on Maximo Upgrade and Timetable for Common Database

New Tier 1 Database

Upgrade Still in process• Upgrade complicated by different interface with PeopleSoft• Should be completed in time for the new fiscal year

Plan for Tier 1 database completion• New term programmer retained for other work• Frees up Maximo-trained programmer to complete

database

Swag at completion is 4/2011• BSD hopes to complete it earlier

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Finalize Tier 1 List of Categories and Subcategories

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I. Biohazards

1. No IACUC (Institutional Animal Care and Use Committee) or IRB (Institutional Review Board) approval as required

2. No labeling

3. No storage posting as required

4. Proper procedures not followed

5. Other

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II. Chemical Safety: Labeling

1. Chemical contents/hazards not identified on labels or illegible labels

2. No CMS (Chemical Management System) Bar Coding/Static Inventory

3. Particularly Hazardous Substances (PHS) not labeled

4. Peroxide-forming chemicals not tested and not date-labeled

5. Other

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III. Chemical Safety: Storage1. Chemicals storage in fume hood not kept to a minimum [1]

2. Container not in good condition

3. Corrosives not stored below eye-level

4. Designated area (e.g. Carcinogen/Nanomaterial/Reproductive hazard) not posted

5. Excessive materials accumulated in laboratory hoods or on work benches

6. Legacy storage of chemicals no longer used/needed (outdated)

7. No explosion proof or flammable cabinet/refrigerator/freezer as required

8. No Secondary Containment (e.g. trays) for hazardous liquids

9. No segregation of incompatibles

10. Nanomaterials are not stored properly in sealed containers when not in use

11. Eyewash/shower not available (if corrosives present)

12. Containers storing nanomaterials are not labeled properly with the “Caution: Nanomaterial” label

13. Other

 [1] What does this mean?

14

IV. Chemical Safety: Use

1. Carcinogen reproductive hazard and/or acute toxin requirements not met

2. Hood sash not kept at proper height

3. No substitution of less hazardous chemical [1] 

4. Work area cluttered or dirty

5. Work area not appropriate for level of hazard [2]  (e.g. use of a solvent outside of an exhaust hood, use of a Biohazardous material outside of a BSL designated area)

6. Work area not appropriate for chemical type

7. Other

 [1] Is “No review of less hazardous chemical substitute” better? [2] Group, what does this mean? The parenthetical was provided by S. Ferrone.

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V. Compressed Gas/Cryogens1. Cylinders on carts when not in use (valve protection caps not installed)

2. Cylinders do not have status tags

3. Cylinders not capped when not in use

4. Cylinders not secured

5. Equipment/piping not appropriate for cryogen use

6. Flammable Gas Storage not posted

7. Improper storage and handling of cylinders

8. Piping not labeled or secured if over 10 ft or through wall penetration

9. In-service monitors/gauges not properly calibrated as appropriate and used (e.g., CO2, flammable gas meters)

10. No required ODH posting

11. Oxidizers not separated from flammables (20 ft/fire wall)

12. PPE for cryogen transfer not available or not used

13. Static posting for cylinders not current/complete

14. Other

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VI. Electrical Safety: Distribution

1. Arc flash labels missing on equipment

2. Breakers or disconnects not labeled

3. Cable trays overloaded (guidance > 50%)

4. Electrical distribution panels blocked

5. Electrical distribution panels not labeled

6. Electrical distribution panels: inadequate working space (i.e., ~36-42” deep [depending on voltage] x 30” wide x 6.5’ high) unless working space limitations sticker is affixed

7. Emergency disconnect switches not labeled

8. Exposed conductors (bare wires)

9. Flexible cords used as permanent wiring

10. Ground Fault Circuit Interrupter (GFCI) protection not within 6 ft. of sinks/wet areas

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VI. Electrical Safety: Distribution (Cont.)

11. Improper grounding

12. Junction boxes not secured

13. LO/TO tags: outdated, not durable, illegible, not completely filled out

14. Loose or missing covers on panels, raceways or outlets

15. Missing knockouts

16. Other

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VII. Electrical Safety: Equipment

1. Daisy chaining of extension cords/power strips

2. Electrical plugs not grounded

3. Frayed power cords, extension cords, or heater tapes

4. Hand tools not grounded or not double insulated

5. Inappropriate use of extension cord

6. Lack of strain relief

7. Missing covers/exposed wires

8. Not UL listed or EEI inspected

9. Panel/disconnects blocked by programmatic equipment/material, < 36” in front

10. GFCI does not trip

11. Screws missing, unplugged openings

12. Other

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VIII. Electrical Safety: Programmatic

1. Imminent danger electrical items

2. LO/TO non-compliance

3. Wiring in hazardous areas not reviewed or not in compliance

4. Working on or near exposed conductor violations

5. Other

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IX. Environmental

1. Article 12 non-compliance, e.g., Tank inspection forms, tank labels missing, overfill alarm not functioning

2. Environmental monitoring equipment non-functioning/maintained/calibrated

3. Evidence of spills; not properly cleaned up

4. Faucets not equipped with vacuum breakers/equivalent backflow prevention device

5. Hazardous materials by sinks/floor drains

6. Hoses hanging below sink rim without anti-siphon device

7. Improper air emissions

8. Leaking chemical containers or piping

9. Mold or stains not removed (i.e., ceiling tiles)

10. No secondary containment for storage of hazardous liquid materials (e.g. fuel, hydraulic oils, and paint)

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IX. Environmental (Cont.)

11. No sink disposal posting for allowable/pre-approved sanitary discharges

12. Non-compliance with air emissions permits (e.g. logs are not up-to-date, emissions not on permit)

13. Unlabeled/unknown chemical containers

14. Vehicles and equipment not parked on paved or stone-covered areas

15. Other

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X. Fire Safety

1. Cutting and welding areas: no current permit

2. Emergency exit doors malfunctioning

3. Emergency lighting inoperable

4. Emergency lighting not located where required [1] 

5. Emergency planning postings (i.e., Local Emergency Plan, Shelter-in-Place, Indoor Assembly Area) missing or not current (i.e. postings list individuals who are no longer in the building)

6. EXIT signs missing, not posted appropriately, not illuminated if required

7. Fire doors non-operable, not inspected, or not labeled [2] 

8. Fire extinguishers blocked, incorrect type, incorrect placement, poor condition

9. Fire extinguisher sign if needed is missing

10. Fire wall penetrations not sealed

[1] Provide guidance[2] How is this checked on a Tier I?

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X. Fire Safety (Cont.)

11. Flammable/combustible materials block or impede egress path or access to exits

12. Missing ceiling tiles (> 10% of room size)

13. Non-availability, improper use or location of approved flammable liquids or storage cabinets

14. Shelves in flammable liquid cabinets have been modified

15. Sprinkler heads not free of obstruction (18” clearance), inadequate placement

16. Tone Alert Radio missing, non operable, or not placed in common unlocked area

17. Welding splatter or slag present in a non-welding area

18. Other

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XI. Housekeeping

1. Areas not free of insects, rodents, pests

2. Custodial issues (i.e., cleaning floors, emptying trash) not addressed

3. Egress paths not kept clear, i.e., floors, aisles, emergency egress [1] 

4. Floors not dry or free of debris

5. General Housekeeping

6. Handrails and treads not adequate or in poor condition

7. Improper or excessive storage of materials/equipment/heavy equipment

8. Non-industrial and non-lab areas (i.e., locker rooms, wash rooms, toilets, drinking fountains, kitchens, conference, and common areas) not maintained in a safe, sanitary and clutter-free condition

9. PPE not stored in a clean and sanitary manner

10. Proper width of aisles and corridors not maintained [2] 

 [1] Group, Should this go under Fire Safety? [2] Provide guidance or criteria on proper width

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XI. Housekeeping (Cont.)11. Shelved items placed in disorderly manner causing potential for item to fall when nearby items are being retrieved

12. Stairways, hallways, passageways/aisles and access to emergency exits not free of obstruction or inadequately lit

13. Storage cabinets, freezers, and refrigerators contain un-needed material [3] 

14. Un-needed materials, chemicals, and equipment have not been excessed or disposed of

15. Unoccupied storage buildings/areas not maintained, cluttered, or not used to the best advantage

16. Unsanitary conditions of eating food prep areas

17. Recyclable waste containers inadequate in size and design or overflowing

18. Containers not provided for recyclable paper, recyclable cans/bottles, [4] , and trash

19. Work areas (inside or out) not returned to clean and orderly condition upon completion of maintenance or repair work

20. Other

 [3] Who decides this? [4] Steve Ferrone took out “sharps”

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XII. Industrial Hygiene Issues 1. Ergonomic concerns not addressed

2. Hazard assessments not completed where required

3. Hazard placards missing

4. High-noise areas not assessed or posted

5. Indoor air quality issues not addressed by Industrial Hygiene/Safety and Health Services Division Rep [1] 

6. Laser-controlled area interlock not tested within last 6 months

7. Laser Standard Operating Procedure not reviewed within the last year

8. Surface contamination from hazardous metals

9. Required hazard-specific monitoring not completed, documented, or communicated

10. Other

 [1] How do you know this upon inspection?

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XIII. Machine Shop Safety

1. Anti restart devices not installed on machines

2. Machine guarding non-compliant

3. Machines not secured (i.e. to floor, table)

4. PPE not available, stored, or used appropriately

5. Other

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XIV. Material Handling and Equipment Safety

1. Autoclave warning not posted

2. Forklift unsafe or not inspected

3. Ladder non-compliant [1] 

4. Material-handling equipment – improper operation or maintenance, overdue inspection (i.e. cranes, hoists, slings)

5. Pressure or compressed gas system not reviewed [2] 

6. Scaffolding not properly installed, secured, and maintained

7. Other

 [1] How? Rungs damaged? Feet missing? [2] How is this known upon inspection? Label? Posting?

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XV. Outside and Grounds 1. Unsecured/free access to buildings during off-hours [1]

2. Steps to building not available or damaged

3. Automatic door opener buttons for handicapped accessibility non-functional

4. Building Manager placard missing, displays inaccurate information

5. Butt stops of non-approved type, not emptied

6. Refuse collection containers (recyclable metal/cardboard/C&D debris, trash) not present, inadequate in size or design or are overflowing

7. Exterior lighting not provided, inadequate, or non-functional

8. Grounds/roofs not free of waste and debris

9. Handicapped/ADA parking requirements not met (if required)

10. Leaves, tall grass, and weeds near doors or walkways not removed

11. Modular building/trailer skirts not intact

12. Outside areas not maintained clear of un-necessary materials & equipment [2]

 [1] Group, what does this mean? “access to buildings added” [2] The dept fixes

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XV. Outside and Grounds (Cont.)

13. Outside areas not maintained clear of rubbish, leaves, weeds, or snow/ice. [3 ]

14. Pest/rodent/wildlife issue (i.e. animal or insect nests observed)

15. Poor condition of stairs, ramps, walkways outside the building

16, Trees/shrubs near sidewalks, parking lot, road not trimmed or damaged

17. Trenches, pits, or sumps not covered, barricaded, or otherwise protected (i.e., to prevent slips/trips/falls) and free of any liquid accumulation

18. Snow plow damage

19. Concrete walkways in disrepair

20. Damage from lawn mower

21. Other

 [3 ] F&O fixes

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XVI. Personal Protective Equipment (PPE)

1. Appropriate protective clothing in hazard areas not available, not sanitary, or in poor condition (e.g. Electrical arc face shield, gloves, cotton shirt) [1] 

2. Eye protection not used, unavailable, or in poor condition

3. Face shield and gloves for cryogens not worn, unavailable, or in poor condition

4. Gloves not used, unavailable, or in poor condition

5. Hard hat and safety shoes required but not posted or used as required

6. Hearing protection not used, unavailable, or in poor condition

7. Improper selection of respirator

8. Minimum PPE requirements not met

9. PPE improperly stored

10. Proper footwear in Labs/Industrial areas not worn

11. Lab coats/uniform not worn when required

12. Other

 [1] Group, what is the issue? Steve Ferrone added the parenthetical phrase.

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XVII. Radiation Safety

1. Access not controlled where required

2. Not wearing TLD badge or dosimeter when required (potential PAAA) [1]

3. Area posting(s) not current or incorrect

4. Calibration of survey and dosimetry equipment not current

5. Custodian not assigned (Radiological Materials Area [RMA] sealed source, etc.)

6. Fixed contamination not properly identified or labeled

7. Improper storage or labeling of sources and rad materials

8. Radiation survey levels not updated or incorrect

9. Radiation Work Permits not current, posted or used

10. Sealed source log not current as to location/usage of sources

11. X-ray compliance – not posted, interlock, log

12. Other

[1] This was moved from Unsafe Practices.

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XVIII. Security

1. Door locks malfunctioning where required

2. Doors with self-closing features not closing properly

3. Personnel not wearing ID Badge

4. Property Protection Area postings not current and logbooks not up to date

5. Other

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XIX. Unsafe Practices

1. Imminent danger - climbing without fall protection

2. Imminent danger - failure to tie down ladders or using cable tray for climbing

3. Not wearing PPE during hazardous work

4. Parking in no-parking areas

5. Using broken or damaged tools or ladders

6. Other

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XX. Waste: 90-Day Hazardous Waste Accumulation Area

1. Secondary containment is inadequate - does not hold: 10% of total volume/100% of the largest container (larger of the two volumes is required) or does not hold 30% of total volume (if total volume exceeds 250 gallons). 

2. Area is not inspected on a weekly basis using an SBMS or SME-approved weekly checklist

3. Base of the secondary containment is not sloped or the waste containers are NOT elevated in order to prevent container contact with spilled liquid

4. Haz Waste Contingency Plan is not posted inside room and in nearby location, or is not current

5. Incompatible wastes are not separated

6. Labels missing or incomplete description (e.g. no chemical name)

7. PCB labels are not present on room entrance and on container (if PCB wastes are present)

8. 90-Day Rules postings not present

9. Sinks/floor drains located in the area are not plugged/covered

10. Waste(s) accumulation start dates is not present or is >90 days

11. Waste container(s) not in good condition (damaged or is leaking)

12. Waste container(s) not tightly-securely closed

13. Wastes not protected from the elements (extreme heat/cold)

14. Other

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XXI. Waste: Rad Waste Accumulation Area

1. Area not being inspected on a monthly basis and/or checklist not being completed

2. Area postings not present (90-Day Rules postings and RCD area postings)

3. Damaged/leaking container/bag

4. Liquid wastes do not have adequate secondary containment (see Haz Waste section for details)

5. Rad inventory sheet not present

6. Unlabeled container/bag

7. Wastes not properly segregated (liquids vs. solids, Decay-in-Storage with long-lived, compactibles vs. non-compactibles, etc.)

8. Waste staged >90 days

9. Other

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XXII. Waste: Regulated Medical Waste

1. Abandoned Regulated Medical Waste present

2. Open sharps box/sharps sticking out of container

3. Sharps box contains more than two-thirds of total capacity

4. Biohazardous symbol not present on Regulated Medical Waste container

5. Use of a non-biohazardous bag

6. Use of a non-sturdy, non-approved red sharps container

7. Other

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XXIII. Waste: Satellite Accumulation Area (Hazardous Waste)

1. Abandoned wastes present

2. Secondary containment not present or inadequate for liquid wastes (does not hold: 10% of total volume of all contaners or 100% of the largest container—whichever larger)

3. Container not closed

4. Container not properly labeled (MISSING red haz waste label and/or MISSING/illegible chemical descriptions – chemical symbols/secret formulas used)

5. Container dated (date required only when inside a 90-day Accumulation Area

6. Full container present (transfer to 90-day Accumulation Area)

7. Haz waste container next to non-waste container(s), putrescribles/recyclables

8. Incompatible wastes being stored together

9. Nanomaterial liquid waste: missing container, missing label, or improper label (Note: Use “Caution: Nanomaterials” label and red hazardous waste label that specifies the chemical or identifying name)

10. Nanomaterial solid waste (i.e., gloves, chem. wipes, etc.): missing container, not securely containerized to prevent dispersal, improper labels (see above) (Note: Use “Caution: Nanomaterials” label and red hazardous waste label that specifies the chemical or identifying name)

11. Other

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XXIV. Waste: Solder

1. Solder beads are not inside a container

2. Solder container does not have ‘Solder Scrap for Recycling’ label

3. Other

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XXV. Waste: Used Oil/ Non-hazardous Waste

1. Used oil is near a floor drain or is uncontained

2. Waste not containerized or container is not covered

3. Waste container does not have proper description (“Used Oil”)

4. Waste container is in poor condition/leaking

5. Other

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XXVI. Waste: Universal Waste Batteries/Fluorescent Light Bulbs

1. Battery types mixed together (e.g. Lead-acid vs. NiCd) and terminals are not taped to prevent shorts

2. Fluorescent Light Bulbs not stored to prevent breakage and container is open

3. Container not closed and not compatible with battery type

4. Leaking electrolyte from battery present (call WM)

5. Universal Waste posting missing

6. Universal waste containers not properly labeled as “UNIVERSAL WASTES” including type (e.g. Mercury/Nickel-Cadmium/Lithium battery or mercury containing fluorescent bulb), and not dated when first piece went inside container (cannot exceed 6 months)

7. Other

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XXVII. Working Environment: Department

1. Eyewash/shower pathways not obstructed, no tepid water delivery, travel distance > 10 seconds and > 100 feet, not well maintained

2. Eyewash tags not completed with proper dates

3. Dirt present in and around eyewash or covers on eyewash fountains

4. Fixed and portable ladders non-compliant

5. Fume hoods not inspected, labeled or used

6. Hazard Information Placards missing, incorrect, incomplete, or out of date. (Note: These placards have to be updated annually.)

7. Piping not labeled

8. Refrigerators/freezers not labeled, malfunctioning, or storing non-food items with food

9. Safety signs & postings illegible, in poor condition

10. Work area barricades (when applicable) not in place and not maintained in good condition

11. Other

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XXVIII. Working Environment: Plant

1. Access to safety/emergency equipment (i.e., fire extinguishers, eyewashes, safety showers) and electric panel boxes is obstructed

2. Broken hardware on doors, windows or machines (other than security)

3. Emergency shower/eye wash inspections not done annually

4. Exposed building insulation

5. Floor load ratings not posted or incorrect

6. Improper (non-compliant) handrails or tread, or no anti-tread on stairs

7. Improper use or unavailability of floor covering mats

8. Inadequate general ventilation, heat and/or AC

9. Inadequate lighting in work area

10. Lack of toe-boards or missing or improper railings

44

XXVIII. Working Environment: Plant (Cont.)

11. Leaks (i.e., roofs, basements) causing potential safety issues are not properly contained or repaired

12. Missing floor or ceiling tiles (> 10%)

13. Out of date or missing inspection certificates in elevators

14. Uneven walking surfaces not identified or posted

15. Utility lines not labeled

16. Walking and Working Surfaces not kept clean and free of debris

17. Portable ladders not secured when not in use

18. Gaskets leaking on the floor

19. Pipe flow is not identified

20. Other

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XXIX. Other

1. Other environmental, safety, health, security or quality issues that cannot be otherwise categorized

Open Discussion (Issues & Good Practices)

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