SAFETY, HEALTH DEFICIENCY REPORT (ESHDR) Ref: 5090.54 'bl rt (sefg?g?de?iotiiei) Shop 99 nag/323$: Potential Employee Exposure to High Airborne Chlorine Levels During Processing of Waste Water in Building 1109 Title (summarize the problem with a brief title) Event Date I Responsible Party POC Phone Time 02/04/2012 (Superintendent or M. lrby 476 2688 Area/Location Building 1109 This ESHDR issued for administrative purposes. A 0th Id t'eror omments (I app Mb 9) problem notification has been submitted to Code 2006!. Name Shop/Code Phone Employee Identifying Deficiency Judd King Code 10522 476-4361 ESHDR Prepared By Jeff Cizek Code 106.22 476?9683 ESH Pro ram Industrial iene ESH Process I S-o? no .- I. 0 QPS LINE ITEM CODE BRIEF PROBLEM DESCRIPTION AND ACTIONS REQUIRED (1, 2, 3. etc.) Safety and Health: This is a level 2 event IAW NAVSEA letter SSIC of 08 Sep 2010. paragraph 2.n. (See ESHTG 3-10-40?99-for safety severity level paragraph.) Deficiency Description: 1 OSHSO1 During processing of cyanide waste water from Building 873. the chlorine detector in Building 1109 alarmed and the Fire Department was called to respond. Just prior to the alarm, one of the Shop 99 employees reported he had his breath taken away on the upper level adjacent to the tank where the processing was taken place. Subsequent monitoring by the fire department identified high levels of chlorine adjacent to the tank and in the pit. Immediate Corrective Actions Taken: Shop 99 secured pumps and put process in a safe condition. Building was evacuated, secured and danger taped. Employees were instructed by Code 106 to report possible chlorine exposure to dispensary. Shop 99 submitted a Problem Notification to Code 2000. QPS Responsible Party: Shop 99 Responsible Party IMPORTANT - PLEASE READ - This item will also be input to QPS for informational purposes and Response Due Date (no later CATS for the purpose of tracking to completion. Please use the ESHDR Response Form for than 15 working days from date responding to this item but utilize CATS for closure signatures and requesting an extension if of submittal) necessary. I A Responsible Issuing Party or QPS Severity Level designated representative Signature Date (1 or 2) ReviewiConcurrence Signature - Level Jeff Cizek 03/07/2012 2 Critia ue Determination POST-RESPONSE ACCEP ANCEIREJECTION and FINAL CLOSU WILL BE DENOTED IN CATS. WILL BE: (1) E-mailed to appropriate parties (follow Distribution List established). (2) Entered into QPS and CATS. 50901258 (Rev. 5-11) (Front) CATS NIA