8012T1 Proposed Construction Act Info Checklist;


POTENTIAL ENVIRONMENTAL EFFECTS CHECKLIST [Consider all activities that will be part of or necessary in support of this project. Include work to be performed by subcontractors.]
1. ACTIVITY: The primary and related activities for this project would be:
Yes	No	Unc	Activity	Explanation
			Indoor Bench-Scale Research
			Indoor Pilot-Scale Research
			Outdoor Research
			Technology Development
			Technology Demonstration
			Chemical/Physical Analysis
			Maintenance/Modification
			Fabrication
			Production
			Routine Operation
			Non-routine Operation
			Renovation Indoors
			New Construction
			Transportation On-site
			Transportation Off Site
			Clearing/Removal of Vegetation
			Other


2. INDUSTRIAL SAFETY: Would activities (during construction or during operations) involve any of the following:
Yes No Uncertain
Explain:
Yes	No	Unc	Activity	Explanation
			Excavation/Trenching/Clearing [indicate total area affected]
			Utilities Lockout/Tagout
			Crane Operations
			Welding/Cutting
			Confined Space Entry
			Blocking Roads
			Use of Scaffolds
			Use of Fall Protection
			Use of Explosives
			Use of Corrosives
			Use of Incompatible Chemicals
			Use of Compressed Gas Cylinders
			High Operating Pressures
			X-Rays
			Radiation Protection
			Other


3. INDUSTRIAL HYGIENE PROTECTION:
Yes No Uncertain Not Applicable
Yes	No	Unc	Activity	Explanation
			High Noise Level
			Extreme Temperature
			Non-ionizing Radiation
			Ionizing Radiation [refer to #10]
			Ergonomic Situations
			Respirator or Other Air Purifying Device
			Anti-contamination Protective Clothes
			Confined Space
			Sanitation
			Other


4. RESPIRATORY PROTECTION:
Yes No Uncertain Not Applicable
Yes	No	Unc	Activity	Explanation
			Abrasive Blasting
			Acid or Alkali Cleaning of Metals
			Degreasing
			Decontamination
			Use of Coolant and Cutting Fluids
			Welding, Cutting, or Brazing
			Grinding, Polishing, or Brazing
			Metal Thermal Spraying
			Painting
			Electroplating
			Heat Treatment of Metal Alloys
			Boiler Deslagging
			Furnaces
			Hoods
			Respirator or Other Air Purifying Devices
			Other, including work with radioactive materials


5. MATERIALS: Would any of the following be encountered (E), handled (H), stored (S), or used (U) or disposed (D) during any phase of the project?
Yes	No	Unc	Activity	Explanation
			Fissionable Materials
			Radioactive Materials
			Hazardous Materials
			Mixed Materials (Haz & Rad)
			Toxic Materials
			PCBs
			Oils
			Asbestos
			Fibrous Insulation
			Organic Chemicals
			Heavy Metals
			Compressed Gases
			Pesticides/Herbicides
			Petroleum
			Other


6. EQUIPMENT: Would any of the following types of oil-containing equipment be used during any phase of the project?
Yes	No	Unc	Activity	Explanation
			Transformers
			Capacitors
			Hydraulic Presses
			Other Hydraulic Equipment
			Large Light Ballasts
			Vacuum Pumps
			Other


7. LIQUID WASTES: Would the project involve disposal or discharge of liquid wastes into any collection and/or treatment systems? What and how much?
Yes	No	Unc	Activity	Explanation
			Sanitary Wastewater
			Low-Level Rad Waste
			Process Waste
			Other Liquid Waste, e.g. sump discharges
			Discharge to Soil
			Storm Sewer / Surface Water
			Other


8. SINKS/DRAINS: would any of the following be present in the project area? What and how much?
Yes	No	Unc	Activity	Explanation
			Sinks
			Sumps
			Floor Drains
			Fume Hood Drains
			Storm Drains
			Other


9. SOLID WASTES: Would solid wastes be generated (G), stored (S), or disposed (D) of as a result of this project? What, how much, and characteristics, if known?
Yes	No	Unc	Activity	Explanation
			Asbestos
			Radioactive
			RCRA Hazardous
			Mixed
			Non-hazardous
			Radioactively Contaminated Wipes
			Contaminated Wipes
			Biohazard Wastes
			Oily Wastes
			Other


10. AIRBORNE EMISSIONS: Would the project generate airborne emissions?
Yes	No	Unc	Activity	Explanation
			Radioactive [provide dose levels to workers/public]
			Hazardous or Toxic
			Mixed
			Other


11. POLLUTION PREVENTION (P2): Would any of the following waste minimization & P2 methods be applicable and considered for use for the proposed project?
Yes	No	Unc	Activity (Accel. & Physics Div practices)	Explanation
			P2 Practices
			Waste Volume Reduction
			Waste Toxicity Reduction
			Waste Segregation
			Equipment Reuse
			Materials Recycling
			Product/Materials Substitution
			Inventory Control
			Energy Conservation
			Other


12. OUTDOOR STORAGE: Would the project utilize tank, drum, bottle, or other storage materials?
Yes No Uncertain Not Applicable
Yes	No	Unc	Activity	Explanation
			Radioactive
			Hazardous or Toxic
			Mixed
			Flammable Materials
			Reactive Materials
			Corrosive Materials
			Explosive Materials
			Shelf Chemicals
			Old Chemicals
			Oil
			Pesticides/Herbicides
			Petroleum
			Other


13. CHEMICAL OR BIOLOGICAL AGENT USE: Will this project result in the storage and/or use of chemicals or biochemical agents in the workplace?
Yes No Uncertain Not Applicable
Explain:
Activity	Chemical & Quantity	Storage Method


14. ACCUMULATION, TREATMENT, OR RECYCLE AREAS: Would the project involve any of the following? Describe and quantify.
Yes No Uncertain Not Applicable
Yes	No	Unc	Activity	Explanation
			RCRA Satellite Areas
			RCRA Central Accumulation Area
			Laundry Recycle
			Radioactive Material Storage
			Radioactive Waste Storage
			Other


	15. BELOW GROUND STORAGE: Would the project utilize ground equipment or tanks for storage, control, or transport of materials?
	Yes No Uncertain Not Applicable


16. RADIOLOGICAL AREAS: Would the project be performed in any of the following radiological areas? Indicate locations, if appropriate.
Yes No Uncertain Not Applicable
Yes	No	Unc	Activity	Explanation
			Low-Level Radiation Source Area
			High Radiation Area
			Regulated Area
			Airborne Activity Area
			Radiation Area
			Very High Radiation Area
			Contamination Area
			Respirator Area
			Other


17. RADIATION PROTECTION CONTROLS: Would any of the following protective or administrative controls be involved with the project? Will the project result in any exposure of workers or the public to radiation? If so, indicate dose levels.
Yes No Uncertain Not Applicable
Yes	No	Unc	Activity	Explanation
			Radiation Work Permit
			Radiation Worker Training
			Respirator or Other Air Purifying Device
			Anti-contamination Protective Clothes
			Supplementary Dosimetry
			Other


18. RADIATION SOURCES: Would the project involve the use or storage of any radiation sources?
Yes No Uncertain Not Applicable
Yes	No	Unc	Activity	Explanation
			X-Ray Machine / Generator
			Sealed Radioactive Material
			Accelerator
			Unsealed Radioactive Material
			Ultraviolet Light Sources
			Other


19. OPERATIONAL READINESS: Would the activity involve one or more of the following?
Yes No Uncertain Not Applicable
Yes	No	Unc	Activity	Explanation
			Safety Review
			Safety Class Items
			Items under Configuration Control
			Glove Boxes
			Other


	20. UNCONTROLLED RELEASES: Would measures be in place to manage possible uncontrolled emissions, discharge, or spills during any phase of the project?
	Yes No Uncertain Not Applicable
	Explain:


21. EMERGENCY RESPONSE: In the event of a release, would the following be readily available in the work area?
Yes	No	Unc	Activity	Explanation
			MSDS Information
			Spill Control and Containment Materials
			Phone numbers
			Portable Fire Extinguishers
			Warning Signs
			Other


22. PERMITTING: Would the project/activity require application for or modification of any of the following permits?
Yes	No	Unc	Activity	Explanation
			Excavation/Penetration
			Burning Permit
			Radiation Work Permit
			Safety Work Procedure
			Air Permit
			Fugitive Emissions Permit
			Existing VPDES Permit
			Permit for Groundwater Dewatering
			RCRA
			Corps of Engineers
			NESHAPs
			Stormwater Management
			Stormwater During Construction Activities
			Other


23. GROUNDWATER PROTECTION: Does the proposed project have any of the following existing or planned features or conditions? Will this project result in any activation of soil or groundwater?
Yes No Uncertain Not Applicable
Yes	No	Unc	Activity	Explanation
			Existing Wells or Boreholes
			Existing Contaminated Groundwater
			Excavations requiring Dewatering during Construction
			Devices that could alter Groundwater Levels
			New Monitoring Wells
			New Soil Borings


	24. PLANT/ANIMAL SPECIES: Has the project area been surveyed for plants (or habitats of plants) or animals (or habitats) listed as follows?
	Yes No Uncertain Not Applicable
	Explain:


	25. AQUATIC SPECIES: Have waters in the project area been surveyed for aquatic species listed as follows?
	Yes No Uncertain Not Applicable


		26. HISTORICAL/ARCHEOLOGICAL: Has the proposed site been surveyed for objects of historical/archeological significance?
		Yes No Uncertain Not Applicable
		Explain:


		27. FLOODPLAIN: Would the project encroach upon or take place within a floodplain?
		Yes No Uncertain Not Applicable
		Explain:


		28. WETLANDS: Are the following conditions present at any proposed site? Note: Wetlands are not limited to standing water. Areas such as forest, sedge meadows, and stream banks may qualify.
		Yes No Uncertain Not Applicable

		TITLE:	ES&H Manual

DOCUMENT ID:	8012 Appendix T1 Proposed Construction Activity Information Checklist


	PROPOSED ACTION TITLE:

	NEPA Action Managers:
	NEPA Action Funding:
	Total Estimated Cost:
	Estimated Activity Start Date:
	Information Compiled by:

	GENERAL INFORMATION:
	Are the actions described part or parts of an ongoing EA or other NEPA activity?
	Yes No					Explain:
	Are any extraordinary circumstances related to these actions?
	Yes No					Explain:
	Are actions connected to other actions with potentially significant impacts?
	Yes No					Explain:
	Location for the Proposed Action:


	DESCRIPTION OF THE PROPOSED ACTION
	Provide a narrative description of the physical activities involved in setting up and/or performing the proposed activities. Include construction and operations and primary equipment to be used. Address timeframes. Describe the magnitude of the activity. Provide as much quantitative information as possible relevant to the overall impact of the project on the environment

	*Activities (sample)* Installation of Erosion and Control measures as necessary. Removal of asphalt Excavation of foundations Concrete work Erection of building Removal of all debris to off site location Jefferson Lab use of building for storing lead
	JUSTIFICATION AND NEED FOR THE PROPOSED ACTION/PROJECT
	What problem is this action intended to solve, and how will this action solve it? What alternative solutions to this particular problem exist? Are there different technologies or techniques that could also solve the problem? If so, why were they rejected? Were alternative sites for this project considered? If so, why were they rejected? What would be the consequence(s) of taking NO ACTION toward the problem?

	DESCRIPTION OF THE AFFECTED ENVIRONMENT AND SAFETY AND HEALTH ISSUES
	Would any part of this activity involve work outside existing buildings? If YES, provide a general description of the affected area and the geographic location. Indicate the entire extent of the project on the appropriate map. Has the affected area ever been used as a chemical dispensing area, waste or product storage area, or been the site of any chemical spills? If so, describe. Consider below ground effects, surface effects, and above ground effects.