Permissible exposure limit (PEL):

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1 Toxic & Hazardous Substances Compliance Program Purpose The purpose of this program is to inform interested persons, including employees, that Company Name at the What work site/project does this compliance program cover? (Insert designation for individual site.) is complying with the following chemical-specific regulation(s): Regulation: This is a complex regulation(s) covering a particularly hazardous chemical(s). Due to the nature of the chemical(s), OSHA has specified regulatory limits for exposure to them: Action level (AL): Permissible exposure limit (PEL): Excursion limit/short-term exposure limit (STEL): Company Name ensures that no employee is exposed to a chemical at concentrations greater than its permissible exposure limit (PEL) over an eight-hour period. Our company also ensures that if an employee is exposed to a chemical for more than eight hours in any work day, the employee s allowable exposure, as a time-weighted-average (TWA) for that day, must be reduced according to the chemical-specific regulation. Administrative duties Who is responsible for developing and maintaining this written program? (Enter name/title of person responsible.) is the program coordinator/manager who is responsible for developing and maintaining this written program. Copies of this program may be obtained at Where are copies of this written program kept? (Insert building/room, etc.). operations The following company operations emit the corresponding chemicals listed: Operation name and brief description: How exposure to chemical occurs in operation: Operating practices/job procedures for jobs with contact with chemical: Monitoring data Our company understands that it is required to determine if any employee may be exposed to a chemical(s) at or above the action level as an eight-hour time-weighted average. We chose the following method(s) of monitoring and analysis for our initial exposure determination: Initial employee exposure determination was based on: Method of monitoring and analysis for initial exposure determination was: Method chosen provides the following level of accuracy:

2 Our initial determination for the following area(s)/operation(s) revealed that employee exposure is: Above action level (AL): Above PEL: Above STEL: Subsequent monitoring is performed as follows: Subsequent monitoring frequency: When can subsequent monitoring discontinue? Has subsequent monitoring been completed? (yes/no) We also understand that, after our initial determination, if changes in production, process, control, or personnel occur, we must determine if employees are exposed to higher concentrations of the chemical(s). Our procedure(s) for monitoring for change and initiating additional monitoring is: Procedure for monitoring change: Our company notifies each employee in writing of the results that represent that employee s exposure. Our procedure for this notification process is: Notification procedure (including who is responsible for doing it and how many days after completing exposure determination that person notifies each employee): Other monitoring information includes: Other monitoring information: Engineering and work practice controls We use the following engineering, administrative, and work practice controls to reduce and maintain employee exposure to the chemical(s) to or below the permissible exposure limit to achieve compliance: Control Measure: Schedule for implementing control measure: The engineering plans and studies used to determine methods selected for controlling exposure to the chemical(s) are specified in the table below:

3 Engineering plans and studies used to select control methods: In meeting the PEL, we considered the following technology: Technology considered: Maintenance plays an important role in meeting the PEL. Our maintenance schedules are as follows: Maintenance activity: Schedule (frequency): Personal Protective Equipment (PPE) Our engineering and work practice controls are sufficient enough to reduce exposures to at or below the PEL without the use of respirators. Therefore, unless an employee specifically requests a respirator, respiratory protection is not used at this work site. We provide personal protective equipment to supplement our engineering and work practice controls: PPE and clothing: Procedures for cleaning, laundering, replacing, repairing, and disposing of PPE and clothing: We provide personal protective equipment as interim protection for exposed employees during exposure determination, treating employees as if they were exposed above the PEL (or to any quantity, if the chemical is one of the 13 carcinogens). This means we provide the following: Specific types of protection provided during the initial exposure determination period: Inspections Work areas, materials, and equipment are inspected as follows: Responsible inspector: Inspection frequency: Check:

4 Emergency Situations Our company procedures for a chemical emergency situation involving the substantial release of a chemical are as follows: Emergency procedures: Employees not essential to correcting the emergency situation are restricted from the area and normal operations are halted in that area until the emergency is abated. These persons are trained and responsible for correcting the emergency situation: Names of those responsible for abating an emergency situation: See our written Emergency Action Plan attached to this written program for more details. Also see our written Fire Prevention Plan attached to this written program for more details. Medical Surveillance With its medical surveillance program, Company Name monitors and maintains appropriate levels of employee occupational exposure to hazardous substances or physical agents. To determine which employees need medical surveillance because of occupational exposure to chemicals, we have identified the operations where employees may have contact. This exposure determination is made without regard to the use of personal protective equipment (i.e., employees are considered to be exposed even if they wear personal protective equipment). This exposure determination lists all job classifications/tasks in which all or some employees may be expected to incur such occupational exposure, regardless of frequency. At this site, the following job classifications/tasks is in this category: A. B. Job classifications where all employees have occupational exposure: C. Job classifications where some employees have occupational exposure: D. Tasks/procedures where occupational exposure occurs in job classifications listed in column C: Our examinations are performed under the supervision of a licensed physician, without cost to the employee, without loss of pay, and at a reasonable time and place. We provide the opportunity for medical attention and evaluation both when an employee experiences signs or symptoms of exposure and when they are routinely exposed to hazardous substances or physical agents above the action level or the PEL (whichever is the OSHA requirement). The processes we use to provide those opportunities is as follows: Process for providing medical attention when employees experience signs and symptoms: Process and frequency for providing medical attention when employees are routinely exposed above OSHA limits:

5 When an emergency occurs during operations exposing an employee to a hazardous substance or physical agent used in the workplace, we provide him/her opportunity for medical attention and evaluation. We use the following process to provide this opportunity: Process for providing medical attention and evaluation for emergencies: Our examining physician plays an important role in our medical monitoring program. Therefore, the following person provides all necessary documentation to the physician: Information provided to physician: Who provides information: At our site, we keep detailed records of medical monitoring. These include: Medical surveillance records: The medical records for our site are kept Where do you maintain medical surveillance records? (These records must be kept confidential. Enter office, department, building, etc. where records are kept.). Access is limited to Who do you limit these medical surveillance records to? (Enter name/position of person responsible.). Other relevant data Other relevant data and information: Program evaluation This written program is revised and updated according to the table below: Name/Position of reviewer: Review frequency: Appendices The following documents have been attached to this written program:

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