| 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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