103

ERHMS
71. lnLegrauon of Lxposure AssessmenL, 8esponder AcuvlLy
uocumenLauon, and ConLrols lnLo L8PMS
Contents:
1. CSnA Deepwater nor|zon ersona| rotecnve Lqu|pment (L) Matr|x
2. Inc|dent Safety and nea|th Management nandbook
3. Nk1 Iat|gue Management k|sk Assessment 1oo|
4. NICSn Deepwater nor|zon Stag|ng Area Safety Informanon Check||st
S. NICSn nea|th nazard Lva|uanon rogram Worker Cbservanon Iorm (Lxposure Assessment Data
Co||ect|on 1emp|ate)
6. NICSn Deepwater nor|zon Cn Shore Lxposure Assessment Data Co||ecnon Iorm
CSnA Deepwater nor|zon ersona| rotect|ve Lqu|pment Matr|x
hLLp://www.osha.gov/ollspllls/gulf-operaLlons-ppe-maLrlx.pdf
MaLrlx creaLed for Lhe ueepwaLer Porlzon 8esponse Lo qulckly ldenufy mlnlmum L requlremenLs and
addluonal conslderauons for selecLed Lasks boLh on- and o-shore.
AInA Inc|dent Safety and nea|th Management nandbook
hLLps://webporLal.alha.org/urchase/roducLueLall.aspx?roducL_code=2d99f67d-4778-de11-96b0-
0030368361fd
1hls Pandbook ls avallable from Lhe Amerlcan lndusLrlal Pyglene Assoclauon (AlPA) webslLe. lL provldes
Lhe followlng:
1. An lmmedlaLe and fleld-expedlenL gulde Lo lncldenL SafeLy Cfflcers or Lhelr sLaffs
2. A sLrucLured safeLy and healLh plannlng and execuLlon process ln order Lo lnLegraLe safeLy funcLlons
lnLo an esLabllshed lncldenL command sLrucLure
3. ShorL Lechnlcal reference lnformaLlon for lncldenL SafeLy Cfflcers or Lhelr sLaff on lssues such as
alr monlLorlng, resplraLory proLecLlon, and personal proLecLlve equlpmenL selecLlon, ln order Lo
develop good plans and acLlons
Nk1 Iangue Management k|sk Assessment 1oo|
hLLp://nrL.org/producLlon/n81/n81Web.nsf/AllALLachmenLs8y1lLle/SA-10491Aullnal/$llle/1Auflnal.
pdf?CpenLlemenL
1hls Lool ls avallable from Lhe naLlonal 8esponse 1eam webslLe and ls Appendlx A of Lhe ColJooce fot
Moooqloq wotket lotlqoe Jotloq ulsostet Opetotloos. 1hls Lool for evaluaLlng rlsk facLors and quanLlfylng rlsk
can be used Lo asslsL ln developlng Lhe plans and procedures and ldenLlfylng Lhe resources each organlzaLlon
should have ln place ln anLlclpaLlon of a ma[or emergency response. As noLed prevlously, Lhls documenL
and Lool are prlmarlly for use durlng Lhe posL-rescue phase of a long-Lerm emergency response operaLlon.
1he Lool ldenues rlsk facLors" and sLressors" wlLhln each rlsk facLor" uslng Lhe concepL of Cperauonal
8lsk ManagemenL and aspecLs of rlsk assessmenL Lools used by ueparLmenL of uefense (uCu) agencles and
Lhe unlLed SLaLes CoasL Cuard (uSCC). 1he laugue ManagemenL 8lsk AssessmenL 1ool ls loosely based on
Lhe uSCC Creen-Amber-8ed (CA8) AssessmenL Model. lnsLead of Lhe sLandard elemenLs of CA8, faugue
106
ERHMS
rlsk facLors or sLressors have been ldenued. 1hese ve (3) ma[or facLors LhaL conLrlbuLe Lo or are aecLed
by faugue and Lhelr assoclaLed sub-facLors, or sLressors," are ldenued ln Lhe research on faugue and
exLended work hours.
1he rlsk facLors or sLressors lnclude:
Ma[or lacLor A - 1lme - Sub-facLors: long hours (more Lhan 8 hours/day), exLended hours per week (greaLer
Lhan 40 hours per week), and exLended weeks (more Lhan Lwo weeks)
Ma[or lacLor 8 - Llvlng Condluons - Sub-facLors: quarLers, food, sanlLauon, and recreauon/lelsure
opporLunlues
Ma[or lacLor C- naLure of Work - Sub-facLors: phase (rescue, response, or demoblllzauon), acuvlLy, level of
L, shl work, securlLy, famlllarlLy wlLh area, and famlllarlLy wlLh emergency and dlsasLer work
Ma[or lacLor u - SlLe Condluons - Sub-facLors: chemlcal hazards, mulu-chemlcal hazards, lonlzlng radlauon,
and oLher WMu
Ma[or lacLor L - Lmouonal SLress - Sub-facLors: poLenual for encounLerlng casualues (wounded or deceased)
and people who have losL relauves, frlends, properLy, peLs, eLc.

ERHMS
NICSn Deepwater nor|zon Stag|ng Area Safety Informat|on Check||st
Staging Area Information Check List

1

Staging Location:
(Insert County/Parish,
State)

Date:


NIOSH Personnel:


Number of Workers:


Type of Workers:
VOO, On-shore, Off-shore

Number of collected
surveys:

Describe Work Tasks:




Workshift time/duration:




Module Training required


Personal Protective
Equipment Required





Safety Concerns observed:


Top Safety Concerns
observed by Safety Officer

(Identify Safety Officers)




Decon in Use


Describe Medical Support

Heat Stress Coordinator

ERHMS
Staging Area Information Check List

2

Heat Stress Program
Details

(Shade provided, time
on/off)




Hot Zones


Hot Zone Markings



Safety Briefings ( yes/no
when





Specific Messages during
briefing





Hygiene Logistics
(hand washing stations,
etc)





Consumables provided to
workforce at staging
area?
(food, water, Gatorade,
etc.)



Workforce Organization
(buddy system, etc.)




Pre-employee medical
screening




109
ERHMS
Staging Area Information Check List

3







Description of Site



















Issues Observed: vlslL 1exL:

ERHMS
NICSn nea|th nazard Lva|uat|on rogram Worker Cbservat|on Iorm (Lxposure Assessment
Data Co||ect|on 1emp|ate)
GENERAL NFORMATON
Name: Job title:
Process description: Length of process:
Dept: Line: Location:
3peoito tasks:
Potential exposures:
Sampling conducted: . Air . Noise . Heat stress . Dermal/surface . Other:
W
O
R
K
E
R


O
B
S
E
R
V
A
T
I
O
N


F
O
R
M
HETA #
Date:
Sequence #
P
a
g
e

1


(
S
e
e

B
a
c
k
)
RESPRATORY PROTECTON
1ype (half-mask, eto.): Mnf: Model:
1ype of oartridge or tlter:
Respirator use:
. Mandatory . Voluntary
Is employee in a written respiratory protection program?
. Yes . No . Uon't know
Correct type of respirator for
exposures?
. Yes . No Worn correctly? . Yes . No
Respirator condition
(valves, seal, oleanliness, eto.):
Frequency of use: Changeout frequency
(for respirator or oartridge):
Employees judgment of
effectiveness:

Company name:
Completed by:
Air SAmpling informAtion
(Uraw arrows to link samples for 1wA oaloulation. 0ray is required)
Sample #
Sampling media
Pump #
Type . PBL . Area . PBL . Area . PBL . Area . PBL . Area
Agent(s)
1ask (if task
based)
Start time
(military)
Stop time
(military)
Pump time (min)
Avg. tow (LPM)
Cono.
Averaging time
(8hr, 15min, eto.)

ERHMS
NICSn nea|th nazard Lva|uat|on rogram Worker Cbservat|on Iorm (Lxposure Assessment
Data Co||ect|on 1emp|ate)
protective clothing / gloveS
Type (gloves,
coveralls, etc)
Mnf
Model
Material
Available but not
worn
. . .
Changeout freq.
Condition . Good . Fair . Poor . Good . Fair . Poor . Good . Fair . Poor
Description
Other PPE . 0lasses . ard hat . 3teel 1oe Boots . 0ther:

Uncovered skin
(Check all that
apply)
. Arms . Hands . Wrist . Neck
. Face . Legs . Other:

notes



P
a
g
e

2
W
O
R
K
E
R


O
B
S
E
R
V
A
T
I
O
N


F
O
R
M
enGIneerInG controls
Task/Process
Type (LEV,
enclosure,
etc)
Mnf
Model
Description
Judgment of
effectiveness
. Effective . Ineffective . Effective . Ineffective . Effective . Ineffective
If ineffective,
why?
Further
evaluation
needed?
. Yes . No . Yes . No . Yes . No
HearInG protectIon
Type: . Plugs . Muffs . Both . Available but not worn
Mnf: Model: NRR:
Use: . Mandatory . Voluntary Worn correctly? . Yes . No
Is employee in a written hearing conservation program? . Yes . No . Dont know

ERHMS
NICSn Deepwater nor|zon Cn Shore Lxposure Assessment Data Co||ect|on Iorm




IH observer Date (mm/dd/yy)
Worksite information Time
St ate County Division

Command Center (Division Name)

Site Location

Nature of operation (check one)
shoreline/marsh cleanup equipment decon wildlife decon waste mgmt
other, specify
Date operation began (mm/dd/yy) No. workers

Day or night operation? Day Night

Oil Contamination: Heavy Moderate light None Temp F RH %
Job/task information
Describe
Does the task involve any of the following? Check all t hat apply
heavy lift ing high pressure water/cleaner power hand t ools
awkward postures repetitive motions diesel-powered equipment
Chemical hazards
Is there evidence of oil or chemicals on employees' work clothes? No Yes
Is there evidence of unprotect ed skin contact with chemicals or oil? No Yes
Is there evidence of unpleasant odors? No Yes
Chemical form
solid
liquid/ pour
liquid/ spray
Ot her
inhalation
potential
hi
med
low
Dermal
Pot ential
hi
Med
lo
duration
(hrs/ day)
if indoors,
ventilat ion:
none
general
local exhaust
Comments
Oil


Dispersant


Cleaner


other
(Specify)

ERHMS








Personal protective equipment observed in use

Other
PPE Type In use? Replacement
Frequency
Type Ot her Info Provided by Use is

Safety
glasses
No
Yes
As nec Daily
Task Other
Employer
Employee
Required
Voluntary
Goggles
No
Yes
As nec Daily
Task Other
Employer
Employee
Required
Voluntary
Gloves
No
Yes
As nec Daily
Task Other

Short Long Employer
Employee
Required
Voluntary
Respirator
No
Yes
As nec Daily
Task Other
Employer
Employee
Required
Voluntary
Safety
shoes
No
Yes
As nec Daily
Task Other
Employer
Employee
Required
Voluntary
Hard hat
No
Yes
As nec Daily
Task Other
Employer
Employee
Required
Voluntary
Hearing
Protection
No
Yes
As nec Daily
Task Other
Employer
Employee
Required
Voluntary
Face
Shield
No
Yes
As nec Daily
Task Other
Employer
Employee
Required
Voluntary
Tyvek or
Tychem
No
Yes
As nec Daily
Task Other
Employer
Employee
Required
Voluntary
Rubber
Boot s
No
Yes
As nec Daily
Task Other
Employer
Employee
Required
Voluntary
Slicker
Suit (rain)
No
Yes
As nec Daily
Task Other
Employer
Employee
Required
Voluntary
Ot her
No
Yes
As nec Daily
Task Other
Employer
Employee
Required
Voluntary
Clothing No Yes Type
Shirt
No Yes Long sleeve Short sleeve
Pant s
No Yes Long Short
Head covering
No Yes

Protective sleeves
No Yes

Apron
No Yes

Waders
No Yes

ERHMS




Other preventive measures
It em No Yes Comments
Shower facilities on site

Handwash facilities onsite

Emergency eyewash onsite

Adequate sanit ary facilit ies

Access t o air condition area for breaks

Shaded work area

Shaded break area

Do workers eat , drink, or smoke in work area?

Adequate wat er provided?

MSDS readily available
non-English, as needed

Unlabelled chemical cont ainers?

Facilities for first aid?

Procedures for medical emergencies?

Decon of clothing

Decon of t ools?

Other
What is t he average number of hours worked per day?
What is t he maximum number of hours worked per day?
Is there a work/rest regimen? No Yes minutes on minutes off

Check if any evidence of the following.
snakes wild animals mosquit oes ticks alligators
Comments
113
ERHMS
lCS lorm 214 AcLlvlLy Log
1. Incident Name 2. Date Prepared 3. Time Prepared
4. Unit Name/Designators 5. Unit Leader (Name and Position) 6. Operational Period (Date/Time)
7. Personnel Roster Assigned
NAME ICS POSITION HOME BASE
8. ACTIVITY LOG (CONTINUE ON REVERSE)
TIME MAJOR EVENTS
9. Prepared By:
116
ERHMS
lCS lorm 204 AsslgnmenL LlsLs
ICS 204 8/96
3. Incident Name 4. Operational Period (Date/Time)
1. Branch 2. Division/Group
5. Operations Personnel
6. Resources Assigned This Period
Strike Team/Task Force/Resource
Identifier
Leader Phone
# of
Pers.

Drop Off
Point/Time
Pick Up
Point/Time
7. Assignments
8. Special Instructions/Safety Message
11. Approved By: (Planning Section Chief) Date/Time Approved Prepared By
Div./Group/Unit
Tactical
Command
Local
Repeat
Function Freq. System Chan.
Support
Local
Repeat
Function Freq. System Chan.
Ground-To-Air
117
ERHMS
lCS lorm 208 SlLe SafeLy and ConLrol lan
ICS 208 HM Page 1 3/98
SITE SAFETY AND
CONTROL PLAN
ICS 208 HM
1. Incident Name:
2. Date Prepared:
3. Operational Period:
Time:
Section I. Site Information
4. Incident Location:
Section II. Organization
5. Incident Commander: 6. HM Group Supervisor: 7. Tech. Specialist - HM Reference:
8. Safety Officer: 9. Entry Leader: 10. Site Access Control Leader:
11. Asst. Safety Officer - HM: 12. Decontamination Leader: 13. Safe Refuge Area Mgr:
14. Environmental Health: 15. 16.
17. Entry Team: (Buddy System)
Name: PPE Level
18. Decontamination Element:
Name: PPE Level
Entry 1 Decon 1
Entry 2 Decon 2
Entry 3 Decon 3
Entry 4 Decon 4
Section III. Hazard/Risk Analysis
19. Material: Container
type
Qty. Phys.
State
pH IDLH F.P. I.T. V.P. V.D. S.G. LEL UEL
Comment:
Section IV. Hazard Monitoring
20. LEL Instrument(s): 21. O
2
Instrument(s):
22. Toxicity/PPM Instrument(s): 23. Radiological Instrument(s):
Comment:
Section V. Decontamination Procedures
24. Standard Decontamination Procedures: YES: NO:
Comment:
Section VI. Site Communications
25. Command Frequency: 26. Tactical Frequency: 27. Entry Frequency:
Section VII. Medical Assistance
28. Medical Monitoring: YES: NO: 29. Medical Treatment and Transport In-place: YES: NO:
Comment: