TITLE:	ES&H Manual
DOCUMENT ID:	3120 Appendix H Checklists for Experiment Preparation

Please use the following checklists for each experiment, as appropriate:

• Hazard Identification Checklist
• Beam Requirements List
• Experiment Installation Checklist
• Issue/Concern Checklist
• Experiment Readiness Clearance Checklist

Hazard Identification Checklist

Experiment #

(Check all items for which there is anticipated need) Address anything requiring unusual handling or disposition in items 1 and 2 at the end of the table.
Cryogenics beamline magnets analysis magnets target type: flow rate: capacity:	Electrical Equipment cryo/electrical devices capacitor banks high voltage exposed equipment If applicable, special Waste Disposition:	Radioactive/Hazardous Materials List any radioactive or hazardous/toxic materials planned for use: If applicable, special Waste Disposition:
Pressure Vessels inside diameter operating pressure window material window thickness	Flammable Gas or Liquids: Target type: flow rate: capacity: Drift Chambers type: flow rate: capacity:	Solid Target Materials Beryllium (Be) Lithium (Li) Mercury (Hg) Lead (Pb) Tungsten (W) Uranium (U) other (list below) If applicable, special Waste Disposition: Special Concerns - Usage:
Vacuum Vessels inside diameter operating pressure window material window thickness	Radioactive Sources Use: permanent installation temporary use type: strength:	Large Mechanical Structure/ System lifting devices/carriages motion controllers scaffolding or elevated platforms
Lasers type: wattage: class: Installation: permanent temporary Use: calibration alignment	Hazardous Chemicals cyanide plating materials scintillation oil PCBs methane TMAE TEA photographic developers other (list below) If applicable, special Waste Disposition: Special Concerns - Usage:	General: Experiment Class: Base Equipment Temp. Mod. to Base Equipment Permanent Mod. to Base Equipment Major New Apparatus Other:

Hazard Identification Checklist

Experiment #

1. Are there any actions that could involve environmental permit issues such as requiring advance authorizations?	Yes, if yes, describe concern below No
2. Briefly describe unusual actions/activities (such as from unique materials or waste products) that could present hazards to personnel or the environment. (Specific descriptions and practices to be implemented shall be documented in the experimental COO.)

Beam Requirements List

Experiment #

List all combinations of anticipated targets and beam conditions required to execute the experiment. (This list will form the primary basis for the RSAD calculations that must be performed for each experiment).

Condition#

Beam Energy (GeV)

Beam Current (μA)

Polarization and other special requirements

Target Material (use multiple rows for complex targets - e.g. w/ windows)

Target Material Thickness (mg/cm2)

Experiment Installation Checklist

Experiment #

(To be developed by E²RC, with possible additions from other reviews, and to be completed by Physics Division EH&S Staff together with the assigned Physics Division Liaison prior to issuance of the Experiment Readiness Clearance.)

Item#	Description	Review that requested installation check	Installation Check
			Date	Signature

Issue/Concern Checklist

Experiment #

(To be reviewed by the Division Safety Officer and then included with the documents submitted to the AD for Physics prior to issuance or Experiment Readiness Clearance.)

Item #	(I)ssue or (C)oncern	Description	Review that raised issue or concern	Resolution
				Date	Signature

Reviewed by Physics Division Safety Officer:

Signature Date

Experiment Readiness Clearance Checklist

Experiment #

Document	Review(s)*	Certification	Signature	Date
Proposal w/ EH&S Hazard Identification Checklist	TAC & PAC	Jefferson Lab Director