IX Silica Final Report

• Job Name

• Prepared by

• Conducted on

  Date

Summary Report

• A survey was conducted on

  Date

• At the

• In

• The purpose of the survey was to evaluate the potential exposures to respirable dust, total dust, & crystalline silica for the employee group listed below, compare the results to the applicable permissible exposure limits (PEL) as necessary, and make recommendations for their control.

Agent/PEL/Action Level

• Agent:
  Respirable dust & respirable silica
  

• PEL:
  50 ug/m3

• Action Level:
  25 ug/m3
  (Micrograms of silica per cubic meter of air)

Sample 1

• GROUP

• Worker 1:

• RESULTS

• ug/m3

• COMMENTS

Sample 2

• GROUP

• Worker 1:

• RESULTS

• ug/m3

• COMMENTS

Sample 3

• GROUP

• Worker 1:

• RESULTS

• ug/m3

• COMMENTS

• As seen above, the results were _________ the OSHA action Level.

  Above

  Below

• The results above were ____________ OSHA's permissible exposure limit.

  Above

  Below

Sampling Method

• Workers sampled were instructed to follow the normal procedures for their task which includes;

• All sampling pumps were calibrated prior to their use in accordance with manufacturer specifications using a _______________ calibration device.

• Samples were taken using ___________; attached to ___________ using the appropriate hose.

• Respirable dust and respirable silica sampling incorporated a __________ with _________ media and was placed in the workers breathing zone for the entire sampled time. Pump numbers, sample times, flow rate, and air volume are listed below.

Pump Info:

• Pump #

• Minutes sampled

• Pump Flow Rate (LPM)

• Air Volume (liters)

Pump Info:

• Pump #

• Minutes sampled

• Pump Flow Rate (LPM)

• Air Volume (liters)

Pump Info:

• Pump #

• Minutes sampled

• Pump Flow Rate (LPM)

• Air Volume (liters)

Weather

• The temperature at the start of the sampling was _____ Rising to _____ Fahrenheit by the end of the sampling period.

• The Humidity was _____% with winds out of the _____ at _______ MPH.

• _____ minutes of precipitation and _______ inches of rainfall.

Activity Log

• Pump #:

• Task:

• Time

• Activity

• Weather (Temp, Wind, Humidity)

Activity Log

• Pump #:

• Task:

• Time

• Activity

• Weather (Temp, Wind, Humidity)

Activity Log

• Pump #:

• Task:

• Time

• Activity

• Weather (Temp, Wind, Humidity)

Activity Log

• Pump #:

• Task:

• Time

• Activity

• Weather (Temp, Wind, Humidity)

Media

• Add media

  Media

• Add media

  Media

• Add media

  Media

• Add media

  Media