TITLE:	ES&H Manual
DOCUMENT ID:	3310 Appendix T2 Operational Safety Procedure Form

		Serial Number:
						(Assigned by ESH&Q Document Control x7277)
			OSP		TOSP
		*Attach the Task Hazard Analysis (THA) related to this procedure
		Issue Date:						Expiration Date:
		(No more than three years from Issue Date except TOSP which is three months from issue date)
		Title:
		Location:
		Risk classification (See ESH&Q Manual Chapter 3210 Appendix T3 Risk Code Assignment.)								Without mitigation measures (3 or 4):
										With mitigation measures in place (0, 1, or 2):
		Document Owner(s):									Date:
Supplemental Technical Validations:
		Hazard Reviewed (per ES&H Manual 2410-T1):							Subject Matter Experts Signature:					Date:
Approval Signatures:							Print Signature								Date:
		Division Safety Officer:
		Department or Group Head:
		Safety Warden of Area:
		Other Approval(s):
Document History:
	Revision:			Reason for revision or update:								Serial number of superseded document

Distribution: Copies to: affected area, authors, Division Safety Officer, ESH&Q Document Control

After expiration: Forward original and log sheet of trained personnel to ESH&Q Document Control.

1. Purpose of the Procedure
2. Scope – include operations, people, and/or areas where procedure applies
3. Description of the Facility: (include floor plans and layout of a typical experiment or operation)
4. Authority and Responsibility:
	4.1 Who has authority to implement/terminate
	4.2 Who is responsible for key tasks
5. Who analyzes the special or unusual hazards (See ES&H Manual Chapter 3210 Appendix T1 Work Planning, Control, and Authorization Procedure)
6. Personal and environmental hazard controls including:
	6.1 Shielding
	6.2 Interlocks
	6.3 Other
7. Monitoring systems
8. Ventilation
9. List of safety equipment (i.e: personal protective equipment or special tools)
10. Associated administrative procedures
11. Operating guidelines
12. Notification of Affected Personnel (How and Who)
13. List of steps required to execute the procedure from start to finish.
14. Back out procedures, i.e., steps necessary to restore the equipment/area to a safe level.
15. Special environmental control requirements:
16. Environmental Impacts (See EMP-04 Project/Activity/Experiment Environmental Review
17. Abatement Steps – Secondary Containment, or Special Packaging requirements
18. Training requirements
19. Unusual/Emergency procedures e.g., Injury, Fire, Loss of power
20. Instrument calibration requirements, e.g., safety system/device recertification, RF probe calibration
21. Inspection schedules
22. References/Associated Documentation
23. List of Records Generated (Include Location / Review and Approved procedure)

Authorized/Trained Individuals

Print Name/Signature	Date

ISSUING AUTHORITY	APPENDIX AUTHOR	APPROVAL DATE	EFFECTIVE DATE	EXPIRATION DATE	REV.
ESH&Q Division	Harry Fanning	10/05/09	01/01/10	10/05012	0

This document is controlled as an on line file. It may be printed but the print copy is not a controlled document. It is the user’s responsibility to ensure that the document is the same revision as the current on line file. This copy was printed on 10/16/2009.