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Work and Safety Coordination Plan (WSCP)

Name Role/Title

Owner D.Phan ESS Accelerator Safety Engineer

Authors D.PhanE.Sargsyan

ESS Accelerator Safety EngineerESS Accelerator Installation Planning Coordinator

Reviewers N.GazisM.ConlonE.MalmstedtA.JohannessonB.Winer

ESS Accelerator Installation ManagerESS Accelerator Quality EngineerESS Accelerator System EngineerSEC HS Lead/Occupational Safety EngineerESS ES&H Safety Representative

Approvers Mats LindroosJohn WeisendPeter RadahlJohn HainesPeter Jacobsson

ESS Accelerator Division HeadESS Accelerator Project LeaderESS Installation ManagerESS Project LeaderESS ES&H Division Head

Diffusion list (for information): ESS AD Group Leaders, ESS AD WP leaders, Roland Garoby, Tobias Lexholm, Hector Novella, Meredith Shirey, Andreas Lundstrom, Linus Meck, Lisa Arthursson, Jesper Blucher, Kieran Deasy, Jorgen Larsson, Ralf Trant

Template: Chess Controlled Core Word (ESS-0060903 Rev: 1, Active date: Sep 22, 2015)

Document Type Document Template Date Sep 22, 2015Document Number ESS-0060903 State ReleasedRevision 1 Confidentiality Level Interna

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Work and Safety Coordination Plan (WSCP)

ESS ACCELERATOR INSTALLATION - INDICATE MAIN ACTIVITY OF THE CONTRACT

Purpose:This Work and Safety Coordination Plan (WSCP) is the contractual binder document and shall be implemented by the ESS staff, their relevant In-Kind Contribution (IKC) partners and/or contractors.

The main purpose of that document is to identify the list of preparatory and organizational measures required prior to the start-up of the installation activity to be carried out by the contractor, as well as the list of associated hazards and safety control measures to be implemented.

The WSCP shall be subject to adjustments and updates adapting to the on-going ESS accelerator installation activity.

TRACEABILITY

Role Signature Date

Group Leader(Last/First Name, Division/Group)

yyyy/mm/dd

Area Supervisor(Last/First Name, Division/Group)

yyyy/mm/dd

ESS Safety Representative(s)(Last/First Name, Division/Group)

yyyy/mm/dd

ESS System Leader(Last/First Name, Division/Group)Contractor Representative(Last/First Name, Company/Institute)

yyyy/mm/dd

yyyy/mm/dd

Distribution list:The ESS System Leader is responsible for the redaction of the WSCP, its update relevant to the system of his/her responsibility, and its distribution to the signatories of this document.

The ESS System Leader shall also archive and update this WSCP in CHESS1.1 ESS Document Management System (https://chess.esss.lu.se/).

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The Contractor Representative is responsible for the distribution of this WSCP:

to the Health and Safety responsible of his company/institute; to his sub-contractors; to all relevant bodies that the company/institute shall report to.

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At the initiative of ESS ERIC and in order to ensure coordination and safe execution of the contract or activity, this WSCP is established:

Between:

ESS ERIC

Address: Box 176, 221 00 Lund, Sweden

Represented by: Last/First NameDivision/Group: fill inActing as: Group Leader on behalf of the Division Head

Tel: (+46 46 888 xxxx)Mobile: (+46 72 179 xxxx)E-mail: (FirstName.LastName@esss.se)

ESS System Leader: Last/First NameTel: (+46 46 888 xxxx)Mobile: (+46 72 179 xxxx)E-mail: (FirstName.LastName@esss.se)

Area supervisor(s) Last/First Name(To be repeated if different areas are involved)

Tel: (+46 46 888 xxxx)Mobile: (+46 72 179 xxxx)E-mail: (FirstName.LastName@esss.se)

And:

Contractor fill in

Address: fill in

Represented by: Last/First NameTitle: fill in

Tel: fill inFax: fill inE-mail: fill in

Safety representative of the contractor: Last/First NameTel: fill inFax: fill inE-mail: fill in

Contract/Agreement: number or reference

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Template: Chess Controlled Core Word (ESS-0060903 Rev: 1, Active date: Sep 22, 2015)

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TABLE OF CONTENT PAGE

1. INTRODUCTION............................................................................................5

2. COMMITMENT.............................................................................................5

3. APPLICABLE DOCUMENTATION AND REGULATORY FRAMEWORK..............5

4. WORK COORDINATION PLAN.......................................................................6

4.1. General information.................................................................................64.1.1. General information regarding the activity...........................................6

4.2. Preparatory measures..............................................................................7

4.3. Organizational measures during the working activity..............................8

5. SAFETY COORDINATION PLAN...................................................................12

5.1. Assessment of occupational hazards and control measures..................12

5.2. Arrangements for information and training of personnel......................14

5.3. Provisions for special medical surveillance.............................................15

5.4. Site map (worksite/area layout).............................................................15

5.5. Reporting in case of an accident.............................................................16

6. ANNEX 1 - SITE MAP (WORKSITE/AREA LAYOUT/DRAWING)...................17

7. ANNEX 2 – AREA HAZARD ANALYSIS (AHA)...............................................18

8. ANNEX 3 – JOB HAZARD ANALYSIS (JHA)...................................................22

9. ANNEX 4 – COMPLEMENTARY INFORMATION..........................................24

10. ANNEX 5 – INSTRUCTIONS IN CASE OF AN EMERGENCY.........................26

11. REFERENCES.............................................................................................27

12. DOCUMENT REVISION HISTORY...............................................................27

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1. INTRODUCTION

The term Safety used in the document covers all health and safety related aspects, including radiation and environmental protection.

European Directives & Regulations, Swedish national regulations as well as ESS ERIC Safety rules apply on the entire site of the ESS facility and shall be respected by the contractors and In-Kind Contributors (IKC). For easiness of use, in the current document the term contractor shall refer to contractors, IKC or any other ESS collaborating party.

The present Work and Safety Coordination Plan is prepared in accordance with the applicable ESS safety rules for the coordination of Safety aspects and is specific to the contract mentioned at the front page.

2. PURPOSE

This WSCP is the contractual binder document and shall be implemented by the ESS staff, their relevant In-Kind Contribution (IKC) partners and/or contractors.

The main purpose of that document is to identify the list of preparatory and organizational measures required prior to the start-up of the installation activity to be carried out by the contractor, as well as the list of associated hazards and safety control measures to be implemented.

The WSCP shall be subject to adjustments and updates adapting to the on-going ESS accelerator installation activity.

3. COMMITMENT

The Contractor Representative, signatory of this document, is committed to:

enforce the application of the provisions of this document by its personnel; justify in writing that its staff has been trained in all of these provisions;

forward this WSCP and all related documents, for application, to all its subcontractors and any person or entity intervening on his behalf on the ESS site in the context of the contract subject of this document;

collaborate in the Safety process within the framework of the implementation of the contract on the ESS site by:- informing the ESS System Leader of any changes in operating methods

associated with the contract/activity; participating in regular meetings related to the contract/activity;

- enforcing specific requirements notified through amendments or joint inspection visits;

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- reporting Safety issues rendering inoperative the provisions of this document; promptly reporting accidents and/or near misses;

- contributing to the updating of this document as often as necessary.

4. APPLICABLE DOCUMENTATION AND REGULATORY FRAMEWORK

In addition to the present WSCP, the following regulations and documents related to Safety in the context of the contract execution on the ESS site by the contractor shall be followed:

Swedish Work Environment Act (AML), Reference No.: SFS 1977:1160. Translation in English is available at: http://www.government.se/government-policy/labour-law-and-work-environment/19771160-work-environment-act-arbetsmiljolagen/

Swedish Work Environment Regulations (AFS). Provisions and general recommendations in English is available at: https://www.av.se/en/work-environment-work-and-inspections/publications/foreskrifter/;

Swedish Posting of Workers Act, Reference No.: SFS 1999:678. Translation in English is available at: http://www.government.se/government-policy/labour-law-and-work-environment/1999678-posting-of-workers-act/ ;

Building and Civil Engineering work (AFS 1999:3). Translation in English is available at:https://www.av.se/en/work-environment-work-and-inspections/publications/foreskrifter/building-and-civil-engineering-work-afs1999-3eng-provisions/

ESS-Skanksa Health and Safety Plan [1]; ESS-Skanksa Guidelines for ESS Stakeholder Access [2]; General conduct and safety rules ESS – Conventional Facilities Worksite [3]; Procedure for Authorizing Work in ESS workspaces [4].

5. WORK COORDINATION PLAN

5.1. General information5.1.1. General information regarding the activity

Start date of the activity: yyyy/mm/dd

Description of the activity (summary): to be completed

Produce a detailed summary of the information in the tender including:

1. Scope2. Material List

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3. Installation processes 4. Milestones 5. Deliverables.

Duration of the contract/activity: to be completed

Working hours: to be completed

Arrangements for organizing the work outside normal working hours: to be completed

Note: Normal working hours on the ESS site -08.00 to17.00 from Monday to Friday - working days.

When working outside of these hours and during holidays, a notice of performing works outside normal working hours and working days shall be completed and addressed to the area supervisor.

5.1.2. Installation/implantation map

The installation/implantation map shall be available (and up-to-date) by the contractor, after the approval of the System Leader.

The installation/implantation map shall include patterns and detailed information for the drilled holes/threaded inserts or other fixations of the system with the floor, with its exact location with respect to the physical plant (walls etc.).

The alignment strategy of the contractor, including the relevant fiducialization procedure of the components (when applicable), shall include the verification of the installation/implantation map.

5.1.3. Information concerning the contractor

All the information* concerning the contractor, its sub-contractors can be found in Annex 4 of this document.

* Such as personnel list, operational procedures, provisions for training, etc.

5.1.4. Sub-contractors

Will the contractor sub-contract any activities? YES NO

If yes, the ESS System Leader shall issue an approval of ESS - attach a copy in Annex 2.

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Table 1 - List and type of sub-contracted work

Sub-contractor name and

contact information

Start and end dates of

works

Personnel*

Working hours

Work sub-contracted

Contact person on site/ tel.

fill in date to date number fill in fill in fill infill in date to date number fill in fill in fill infill in date to date number fill in fill in fill in

* Personnel list in Annex 3.

5.2. Preparatory measures5.2.1. Pre-work visits

A pre-work visit of workplaces, facilities and equipment made available to the contractors and their sub-contractors is carried out prior to the execution of the work in the presence of all the intervening stakeholders.

Minimum participation: ESS System Leader and contractor representative, Area Supervisor, Work Leader(s)/Supervisor(s) (if any) and Safety Representative(s).

To be completed with:

1. Dates 2. Participants3. Main findings4. Mitigations 5. References to the minutes of preparatory meeting(s).)

5.2.2. Declaration of works and services

Certain types of works and services are subject to a request for authorization before the intervention. The work and services can be realized only after obtaining all the necessary signatures. It is important to note that in all sectors (such as the Accelerator Tunnel (AT), Klystron Gallery (KG), Target area, etc.) the access is subject to specific access procedures and regulations.

5.3. Organizational measures during the working activity

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5.3.1. General organizational measuresTable 2 - General organizational measures

Item Description Action

WorkplacesIdentification of area of intervention - attach site map and worksite/area layout/drawing in Annex 1.Description of means used to delimit the area of intervention.Description of access roads to the area of intervention - pedestrians and vehicles.

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

Concurrent risk areasIdentification of these areas.Materialization of these areas.Means to be implemented.

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

Storage areasIdentification of locations.Description of the access route.Means for marking storage areas.

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

Waste managementDescription of the means.Location of dumpsters.Dumpsters management mode.

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

Connecting to networksLocation, conditions.Electricity, voltages.Water, compressed air, gas, etc.Drainage.

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

Equipment or machines usedDesignation.Place of depot and who provides.Prior checks.Maintenance state.

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

Other to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

REMINDERAny modification of general organization shall be reported immediately to the ESS System Leader and Area Supervisor.

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5.3.2. Participation of ESS to the workTable 3 - Participation/provisions of ESS to the work

Item Description Service/contact

Provision of servicesElectricity.Water.Drainage.Snow removal.

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

Provision of equipmentDesignation.Place of depot and who provides.Prior checks.Maintenance state.

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

Provision of staffConditions/what works?Qualifications.Terms of command.

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

Maintenance and breakdown assistance

Services and equipment provided by ESS.

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

Other measures to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

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Item Description Service/contact

REMINDERAny modification of the participation of ESS to the work shall be valid only with written agreement by the ESS System Leader and the Contractor Representative.

5.3.3. Preliminary measures taken/to be taken by ESSTable 4 - Preliminary measures taken/to be taken by ESS

Task Action Service/contact

Worksite safety measuresLock-out/tag-out of electricity, water, gas, cryogenic fluids, etc.Lock-out/tag-out of mechanical installations.Verification of atmosphere, working environment.

to be filled-in by the Area Supervisor and ESS System Leader

to be filled-in by the Area Supervisor and ESS System Leader

Preparatory workEvacuation of equipment, area delimitations, signage, etc.

to be filled-in by the Area Supervisor and ESS System Leader

to be filled-in by the Area Supervisor and ESS System Leader

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5.3.4. Provisions for personnel rooms and hygieneTable 5 - Personnel rooms and hygiene

Provided by Location Terms of use Maintained by

Changing rooms

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

Toilets

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

Canteen/ Cafeteria

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

Showers

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

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6. SAFETY COORDINATION PLAN

6.1. Assessment of occupational hazards and control measuresThe risk assessment shall identify the work situations that are dangerous and/or likely to cause interference between activities, facilities and equipment.

6.1.1. Hazards related to the work environment, facilities and activities of ESS (Area Hazard Analysis)

Hazards inherent to the work environment, facilities and activities of ESS as well as compensatory measures are to be identified and evaluated prior to the start-up of the work activity. This Area Hazard Analysis (AHA) [4] shall be included in Annex 2 of the present document.

Note: It is requested that the contractor staff is able to identify the hazards associated with facilities and activities of ESS through the signage on site.

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6.1.2. Hazards related to the interference of activities (co-activity/succession of activities leaving behind hazards)

Table 6 - Hazards related to the interference of activities

Interference type Identified hazard Decided/set preventive measure Action

Overlapping works to be filled-in by the Area Supervisor

to be filled-in by the Area Supervisor to be filled-in by the Area Supervisor

Adjacent works

to be filled-in by the Area Supervisor

to be filled-in by the Area Supervisor to be filled-in by the Area Supervisor

Transport/handling

to be filled-in by the Area Supervisor

to be filled-in by the Area Supervisor to be filled-in by the Area Supervisor

Sharing of specific access/passages

to be filled-in by the Area Supervisor

to be filled-in by the Area Supervisor to be filled-in by the Area Supervisor

Other types of interference(To be completed according to the installation activity)

to be filled-in by the Area Supervisor

to be filled-in by the Area Supervisor to be filled-in by the Area Supervisor

Other worksites

Respect the signage put in place by others intervening entities.Do not cross the boundaries of areas or sites work.Access to other work sites, not subject of this Work and Safety Coordination Plan can only be done after a pre-work visit

to be filled-in by the Area Supervisor

If cases of co-activity other than the ones mentioned in the AHA [4] are revealed during the works, the contractor shall:

temporarily stop the activity, immediately report the unplanned co-activity to the ESS System Leader.

The ESS System Leader shall, in collaboration with the contractor and the other intervening coactivity entities, decide on additional measures to implement.

Each intervening entity shall bear the protections or the measures to be put in place to minimize the risks it generates by its activities with respect to other intervening entities.

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If necessary, an amendment to this document will be drafted by the ESS System Leader.

6.1.3. Hazards related to the work activities of the contractor

6.1.3.1. Job Hazard Analysis (JHA) provided by the contractor

Hazards inherent to the contractor’s work activities as well as compensatory measures are to be identified and evaluated prior to the start-up of the work. This Job Hazard Analysis (JHA) [4] shall be included in Annex 3 of the present document.

6.1.3.2. Specific supplements and ESS requirements following the analysis of the activity of the contractor

To be completed or specified that there are no additional requirements.

6.1.4. Control documents to be submitted to the contractor

Control documents required to perform the work will be provided by the ESS System Leader to the contractor representative.

YES NO Tick all appropriate boxes below

Lock-out/tag-out permit: electrical, mechanical, fluids, etc.

Fire permit

Confined space work procedure

Procedure for alarm inhibition

Work authorization

Welders certificate

Authorization for the use of lifting equipment

Other: fill in, if any

6.2. Arrangements for information and training of personnel6.2.1. Safety awareness related to the activities of ESS

The contractor must continuously ensure that its personnel working on the ESS site has followed appropriate ESS Safety training and awareness as well as associated refresher courses.

Regardless of its activity, and before working on the ESS site, each member of the contractor personnel must follow the awareness sessions mentioned below:

ESS Safety inductionSafety at ESS

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In addition, the staff of the contractor* must follow specific awareness sessions depending on the areas that it must access: (Check from boxes below)

RadioprotectionElectrical Safety - AwarenessPortable ODH MonitorCryogenic Safety – AwarenessInterventions in confined spacesWork at heightHot workOther: (fill in)

* These provisions also apply to sub-contractors of the contractor as well as to any person intervening on a temporary or ad hoc basis.

6.2.2. First aid training

It is requested by ESS that the minimum number of first aiders at worksite corresponds to the tenth of the total staff of the contractor on site, including subcontractor’s staff.

6.2.3. Provisions for training and information of staff of the contractor

See Annex 4.

6.3. Provisions for special medical surveillanceWorks and services and/or locations involving special hazards requiring special medical surveillance under the applicable regulations in Sweden, shall be identified.

Table 7 - Special medical surveillance

Works and services/locations Special medical surveillance

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

to be filled-in by the Area Supervisor and ESS System Leader (with Contractor Representative)

The list of exposed personnel, including sub-contractors, is mentioned in Annex 4.

6.4. Site map (worksite/area layout)A site map prepared by the Area Supervisor shall be provided to the contractor prior to the start-up of the work. The site map shall contain at least the following information:

perimeter of the activity to be carried out; location of the emergency exits and assembly points; location of the fire extinguishers, first-aid kits, etc;

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location of entrances/exits for personnel and equipment; location of utilities (e.g. waste container, toilets, etc.); access routes for personnel and equipment.

6.5. Reporting in case of an accident Any accident that caused bodily injury with or without work interruption on the ESS site, including when traveling on the ESS site, shall be immediately reported to the ESS System Leader.

This reporting shall be made in written.

The document shall be completed by the contractor, addressed to the national authority and the insurance company of the victim.

The ESS System Leader shall notify the ESS ES&H Division with an internal accident report including relevant documentation provided by the contractor as attachment.

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7. ANNEX 1 - SITE MAP (WORKSITE/AREA LAYOUT/DRAWING)

Template: Chess Controlled Core Word (ESS-0060903 Rev: 1, Active date: Sep 22, 2015)

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8. ANNEX 2 – AREA HAZARD ANALYSIS (AHA)

Work Area: specifiy the location

Brief description of activities to be authorized for this work area: provide a detailed description of the installation activity to be performed

Approvers Name Date Signature Phone No.

Work Area leader Last/First Name yyyy/mm/dd Phone No.

Line Manager Last/First Name yyyy/mm/dd Phone No.

ES&H Division or designated Safety Committee Rep.

Last/First Name yyyy/mm/dd Phone No.

Division Head Last/First Name yyyy/mm/dd Phone No.

Hazard Identification

Please mark with a cross any potential hazards that could be present in the work area:

Potential Hazard Present in Area?

Present in adjacent

work area?

HAZARD Description including applicable regulations, licenses, and permits

Biological SafetyBiological agentsLegionellaChemical SafetyAsbestosCMRCorrosiveDangerous for the environmentExplosiveFlammableHarmfulIrritantOxidizingToxicCryogenic Safety and Oxygen Deficiency Hazards

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Potential Hazard Present in Area?

Present in adjacent

work area?

HAZARD Description including applicable regulations, licenses, and permits

Cryogenic fluidInert gasesElectrical and Electromagnetic SafetyElectricityMagnetic fieldStatic electricityIonizing radiationOpen sourcesClosed sourcesActivated materialRadioactive wasteParticle beamNon ionizing radiationLaser (class to be specified)Microwaves (300 MHz-30 GHz)Radio frequency (1MHz-300MHz)UV LightMechanical SafetyLifting equipmentMachineryMechanical energy (moving parts)Mechanical properties (sharp, rough, slippery)PressureSurface temperatureVacuumWorkplaceConfined spacesDustFall from heightFalling objectsFall on the same levelLone workingObstruction in passagewaysTrafficWorking at heightStructural SafetyStructures (inadequate design

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Potential Hazard Present in Area?

Present in adjacent

work area?

HAZARD Description including applicable regulations, licenses, and permits

or condition)ErgonomicsAir qualityLightingManual handlingMental overloadMoistureNoiseRepetitive activityTemperatureVDU work (Visual Display Unit)VibrationsWorksiteCo-activityHot work (welding, flame cutting, brazing, sparks, etc.)EnvironmentConsumption of resourcesDischarge of effluents to the site drainageDischarge of effluents to sewageEmission of noise harmful for the environmentEmission of substances into the atmosphereGeneration of vibrations harmful for the environmentHistorical site pollution (chemical)OdorsSoil activation (radioactive)Use/storage of potentially polluting substances (gases, liquids, solids)Waste generationOthers

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Access control measures based on hazards in the work area or adjacent work areas (these requirements should be clearly posted at all entrances to the work area):

PERSONAL PROTECTIVE EQUIPMENT (PPE) TO CONSIDERA

Safety gloves (EN

388, EN 420)

B

Safety helmet

(EN 812, EN 397, EN 14052 or

EN 13087)

C

Safety shoes (EN 345, EN 346 or EN

347)

D

Ear protection(EN 352)

E

Face protection(EN 166)

F

Eye protection (EN 166)

G

Safety overall

H

Respiratory

protection

(EN 149)

I Other, please specify :

[specify PPE and associated standard]

Training required to access the area (may be waived if escorted by authorized workers):

Provide the list of mandatory training(s) to access the area

Note: Job specific PPE and training, along with licenses, permits, procedures or any other control or mitigation measures required to deal with specific hazards are addressed in the Job Hazards Analysis for specific work activities.

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9. ANNEX 3 – JOB HAZARD ANALYSIS (JHA)

Note: The JHA shall be regularly reviewed and updated if necessary as indicated in [4]. A copy of this JHA shall be kept in the location at the premises where the job shall be performed.

Job: specifiy the name of the job to be performed

Number of people performing the job: specifiy the number of workers

Start date: yyyy/mm/dd End date: yyyy/mm/dd

Location/Work Area: specifiy the location

Approvers Name Date Signature Phone No.

Work Area leader:

System owner:

Last/First Name yyyy/mm/dd

Phone No.

If work is considered to be hazardous or new

ES&H Div or designated Safety Committee Rep:

Division Head:

Last/First Name yyyy/mm/dd

Phone No.

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Work Tasks/StepsIdentify work steps/tasks in sequence when such sequencing contributes to safety, security, and/or environmental protection.

Associated HazardsIdentify activity hazards for each step.

Controls, Preventive Measures, and ActionsSpecify compensating measure for each hazard

Time estimationSpecify the time estimated to perform each task/step of the work activity

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10. ANNEX 4 – COMPLEMENTARY INFORMATION

1. Service termsContractor: fill in

Subcontractor: YES NO Health and Safety representative of the contractor: (Last/First Name and contact information)

2. Provisions for the information and training of personnel Provide detailed description of the provisions of the contractor for the Safety training of his/her personnel and possible temporary workers.

3. Provisions for maintaining and adapting preventive measures Provide detailed description of the means provided by the contractor to ensure control of the condition of equipment used, worksite cleanliness and usage of appropriate personal protection equipment.)

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4. Personnel list of the contractor

Last/First Name Role Certification/ Authorization

First aiderYES/NO*

Special medical

surveillance

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

to be filled-in by the Contractor Representative

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11. ANNEX 5 – INSTRUCTIONS IN CASE OF AN EMERGENCY

IN CASE OF EMERGENCY CALL 112

REPORT THE CIRCUMSTANCES OF THE EMERGENCY

IN CASE OF ACCIDENT, REPORT THE ACCIDENT BY NATURE AND LOCATION, NUMBER AND STATE OF THE INJURED PEOPLE AND OTHER TYPE OF INFORMATION THAT COULD BE OF

USE FOR THE RESPOND/RESCUE TEAM.

REPORT IMMEDIATELY TO THE ESS SYSTEM LEADER (SPECIFY NAME AND PHONE NUMBER)

REPORT IMMEDIATELY TO THE AREA SUPERVISOR (SPECIFY NAME AND PHONE NUMBER)

AND CONTRACTOR REPRESENTATIVE (SPECIFY NAME AND PHONE NUMBER)

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12. REFERENCES

[1] «Health and Safety Plan,» ESS-0020522.

[2] «Guidelines for ESS Stakeholder Access,» ESS-0062090.

[3] «General conduct and safety rules - ESS Conventional Facilities Worksite,» ESS-0063375.

[4] «Procedure for authorizing work in ESS workspaces,» ESS-0064035.

13. DOCUMENT REVISION HISTORY

Revision

Reason for and description of change Authors Date

1 First issue D.Phan, E.Sargsyan 2016-12-01

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