Subcontractor Construction Job Safety Analysis (jsa) Form

	Activity & Training Authorization	ATA: EARL CAUSTIN	Date, Revision: April 12, 2011
Department/Group Name AARD	Resident Buildings or Areas: 104D, 222, 223, 225, 407, 128, 129, 062	Buildings or Areas with off-shift or annual releases (if applicable). End Station B (b.062, 128, 129)	ATA Duration (if < 12 months) (not to exceed 12 months)
Activities	Basic Hazards	Basic Controls, including boundary conditions (engineering, procedural or PPE)	ESH Training, Qualifications, Skills, Certifications, etc.
Unescorted access into accelerator areas	Radiation, both prompt and residual.	Wear personal dosimeter on upper torso Boundaries: Remain at least 1 foot away from magnets	Course 219 – Employee Orientation to ES&H Course 115 – General Employee Radiological Training
Work in a PPA laboratory environment. Electrical – use DVMs and oscilloscopes to test electronic instruments Chemical – use small quantities of solvents to clean vacuum parts and optical components Vacuum – be present during system venting and pump down ODH – be present during system venting	Startle hazard from electrical hazards below 50 V, 10 A, 10J stored energy Chemical burns and blindness resulting from chemical exposure Cuts and lacerations resulting from implosion of a vacuum window Asphyxiation resulting from oxygen displacement by nitrogen boiloff	Electrical Hazards Engineering controls: Equipment covers. Administrative controls: signage. PPE: none. Boundaries: Do not operate electronic equipment with the protective covers removed. Chemical Hazards Engineering controls: Equipment covers. Administrative controls: signage. PPE: nitrile or latex gloves and goggles or face shield Boundaries: Use restricted to Isopropanol, Methanol, Ethanol, and Acetone in 1 Liter point-of-use bottles only. Vacuum Hazards Engineering controls: Experimental chamber cannot be pressurized Administrative controls: Avoid contact with all glass vacuum windows. PPE: none required Boundaries: do not pressurize any vacuum system under any circumstance. Oxygen Deficiency Hazards Engineering controls: ODM and shut-off valve in LN line Administrative controls: Personal ODM placed near point of most probable ODH PPE: none. Boundaries: Use only the plumbed-in LN system. Do not bring dewars into the accelerator housings.	Course 110 – Lab Safety for Particle Experimentalists =OR= Course 239 – General Electrical Safety =AND= Course 251 – Electrical and General Safety for R & D” =AND= Course 170 – Cryogen and ODH Safety
Soldering	Burns Inhalation of fumes	Use protective holder to store heated iron. Properly dispose of solder dross Use in well ventilated areas	None.
Climb ladders. Climbing on machines and equipment.	Falling Head injury People run into ladder	Don’t stand on steps not designed for standing (usually the top step and top of ladder) Inspect ladders before use. Do not use damaged ladders. Zone off area if there is a potential of falling objects to personnel below. Require use of hardhats if your work may potentially drop something below on workers. Have someone hold ladder if it will provide more support Use barricades or signs to warn of presence of ladder Do not position ladder in front of closed door that can open into the ladder. Use the right ladder for the job. For example, do not use an “A” frame ladder to lean against a building…use an extension ladder. Store ladders so they will not block exits in the event of an earthquake. Boundaries: Elevated surface work (unguarded elevated surfaces 4 feet or more above the surroundings) is not allowed.	Course 293 – Stairway and Ladder Safety is highly recommended.
Stack or handle lead Limits working with lead to 30 minutes/day Excludes cutting, drilling, or machining lead, grinding.	Exposure to hazardous materials (lungs, skin, eyes) Contamination of equipment and environment	Limit daily activity to 30 minutes Wear gloves. Store gloves in marked zip lock baggie for future use or dispose of as “lead contaminated debris” Containerize (sealed bag) all waste, properly label, and request disposal(example below) The words “hazardous waste-Lead contaminated debris” The word “poison” Date Name and phone extension/pager number Training Hazardous Waste Management (Course 105) required if you will generate hazardous waste	Stack or handle lead Limits working with lead to 30 minutes/day Excludes cutting, drilling, or machining lead, grinding.
Working in tight spaces	Bumping into things with body or head Trip hazards Getting in each others’ way	avoid rushing wear hard hat/ wear bump hat practice good housekeeping be aware of your surroundings Boundaries: Entry into Confined Spaces is not allowed.	None.

I will maintain compliance with my STA training requirements, including staying current with recertifications. I understand the type of activities, including boundary conditions, which I am authorized to perform, and the hazards and controls associated with such activities.

Worker Name (please print) Signature Date

R. Joel England


I have reviewed the basic steps, hazards, controls & boundary conditions described in this ATA with all workers listed above. Workers listed above possess the skills, knowledge, training & qualifications to perform work as described in this ATA and are therefore authorized to carry out such work. Workers are also released to carry out such work in their resident work area, as defined in this ATA.
Eric R. Colby

Supervisor Name Signature Date

I acknowledge the extension of the Resident Work Area to include End Station B and adjoining buildings. All yellow work in ESB must be released at the 9:30am daily operations meeting.
Carsten Hast

Test Facilities Head Signature Date

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