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 1.   Is there silica in the workplace that can be released into the workplace air?   Yes___   No___
 2.   If "yes", have you made a written determination that states whether any employee may be exposed to airborne concentrations of silica?   Yes___   No___
 3.   If "yes" to 2, does the written determination include at least the following:
a.   Any information, observations, or calculations that would indicate employee exposure?   Yes___   No___
b.   If employees are exposed to toxic material, statement that exposure is at or above the Permissible Exposure Limit for crystalline quartz?   Yes___   No___
c.   Any employee complaints of symptoms attributable to exposures? If "yes", go to symptoms list.   Yes___   No___
d.   Date of determination, work being performed, location within the worksite, identification of employees possibly exposed?   Yes___   No___
e.   Any concentration measurements (area or personal) taken?   Yes___   No___
f.   Any comments from medical examinations that may point to possible exposures?   Yes___   No___
 4.   Is there any reasonable possibility of any employee being exposed above the Permissible Exposure Limit according to the written determination?   Yes___   No___
 5.   If "yes", have you measured the exposure of the employee (s) most likely to have the greatest exposure (maximum risk employees)?   Yes___   No___
 6.   If "no", have you repeated Step 2 and succeeding steps each time there has been a change in production, process, or control measures that could result in an increase in airborne concentrations of any material in Step 2?   Yes___   No___
 7.   If any exposure measurement indicates exposure above the Permissible Exposure Limit, have you:
a.   Identified all employees so exposed?   Yes___   No___
b.   Sampled those employees so identified?   Yes___   No___
c.   Classified all employees according to noncompliance exposure, possible overexposure, or compliance exposure?   Yes___   No___
 8.   Have you taken the following actions, depending on employee classification:
a.   Resampled employees with noncompliance exposures within 1 month and decided whether controls are to be instituted?   Yes___   No___
b.   Resampled employees with possible overexposures within 2 months and reclassified them if appropriate?   Yes___   No___
c.   Resampled employees with compliance exposures every 2 months (or if changes occurred in the operation) and reclassified them if appropriate?   Yes___   No___
 9.   Have employees with exposures exceeding Federal standards been informed?   Yes___   No___
10.   Have all employee exposure measurements been properly recorded and filed?   Yes___   No___
11.   Have you instituted appropriate controls for those exposed employees needing them?   Yes___   No___
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