Appendix 22 CF#3Report Template

ISM Core Function Teams Assessment Plan

January 2008

Appendix 22–CF#3Report Template

Assessment Title / ISM Core Function #3 (Develop and Implement Controls) Independent Assessment (Cycle I)
Date / February 8, 2008 / Assessment # / IA-2008-05
(obtained from QA/CI)
Purpose & Scope:
The purpose of this assessment was to evaluate the effectiveness and identify opportunities for improvement for Core Function #3 – Develop and Implement Controls - of the Integrated Safety Management System. The expectations for criteria to be evaluated and activities to be conducted to perform the evaluation for this assessment are summarized below.
Inspection Criteria:

Management systems for work control are developed and effectively implemented for work activities that ensure development of adequate hazard controls for performing the work safely and mitigating environmental impact.
Line management has established processes for identifying and tailoring controls for hazards associated with all facilities, operations, and work activities.
Hazard controls are established based on an analysis of hazards, vulnerabilities, and risks in the work environment (e.g., radiological, chemical. industrial, physical, and natural phenomena).

Inspection Activities:

Review work planning and control processes and procedures. Interviewpersonnel including project personnel, group leaders, subject matterexperts, managers, work control managers, foremen, supervisors, environmental, safety andhealth support personnel, and operations/technician personnel.
Review selected safety requirements, hazard control plans, samplingresults, permits (radiological work permits, industrial hygiene/industrial safety), workdocuments, procedures, pollution prevention opportunity assessments, and monitoring protocols.Observe work activities.
Interview facility managers, projectleaders/supervisors, workers, and ES&H personnel.

This assessment was performed in accordance with the assessment plan titled: Jefferson Laboratory, ISM Core Function Teams Assessment Plan (Cycle I) during the period: January 14, 2008 through February 8, 2008
The following personnel participated in the assessment

Summary of Assessment:
Provide a narrative summary of areas assessed. Description is to include adequate details to enable an independent reviewer to comprehend the depth and breadth of the assessment. Details to include key elements of the assessed activity or process and the status of their acceptability. When applicable, define the status of implementation of actions related to previous issues relevant to the assessed area.
Results:
Define the issues (findings, observations, noteworthy practices) identified during the assessment. All findings require corrective action to eliminate the non-conformance. Cognizant management will decide whether or not to pursue corrective actions for observations. Issues with corrective actions should be documented on a Corrective Action Form (Attachment D) and entered into CATS; the CATS identification number should be included in the report. Identify the status of each issue (open, pending or closed), issue owner, and estimated completion of required corrective and/or preventive actions. Clearly state all required follow-up actions with due dates and owners.

Are standardized hazard controls developed and used in an appropriately graded approachbased on project/work complexity and risk, performance frequency, and hazard analysisresults?

Yes / No / Partially / Not Observed/
Evaluated
FEL
Accelerator
Facilities & Logistics
Engineering
Physics – Hall A
Physics – Hall B
Physics – Hall C
12 Gev
ESH&Q

Do controls encompass each phase of work performance and all aspects of the work,including potentially abnormal or emergency situations?

Yes / No / Partially / Not Observed/
Evaluated
FEL
Accelerator
Facilities & Logistics
Engineering
Physics – Hall A
Physics – Hall B
Physics – Hall C
12 Gev
ESH&Q

Are the knowledge, skills, and abilities of the work force considered when selecting the formof controls?

Yes / No / Partially / Not Observed/
Evaluated
FEL
Accelerator
Facilities & Logistics
Engineering
Physics – Hall A
Physics – Hall B
Physics – Hall C
12 Gev
ESH&Q

Are the types of controls (engineering, administrative, and personal protection equipment)applied in the correct sequence and with an appropriate technical basis?