Form HARP "Hazard Assessment and Recognition Plan" - Montana

What Is Form HARP?

This is a legal form that was released by the Montana Department of Justice - a government authority operating within Montana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2005;
  • The latest edition provided by the Montana Department of Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form HARP by clicking the link below or browse more documents and templates provided by the Montana Department of Justice.

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Download Form HARP "Hazard Assessment and Recognition Plan" - Montana

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MONTANA DEPARTMENT OF JUSTICE – DIVISION OF CRIMINAL INVESTIGATION
HAZARD ASSESSMENT AND RECOGNITION PLAN
A. FILE INFORMATION
DIVISION
OFFICE
DATE SEIZED
CASE NO.
SITE SAFETY OFFICER (Name)
AFFILIATION (if other than DOJ, enter Agency name)
)
AFFILIATION (if other than DOJ, enter Agency name
CHEMIST (Name)
B. LABORATORY TYPE AND HAZARDS
LABORATORY TYPE (Check)
POTENTIAL CHEMICAL HAZARDS (Check)
OTHER POTENTIAL HAZARDS (Check)
Methamphetamine
Amphetamine
Respiratory Tox.
Flammables
Comp Gas Cylinder
Slip/Trip/Fall Hazard
Cocaine
Fentanyl
Systemic Tox.
Explosives
Heat Stress
Electrical Shock
P2P
PCP
External Tox.
Oxidizers
Cold Stress
Burn Hazard
LSD
Carcinogens
Pyrophorics
Confined Space
Leaking Containers
Other (Specify)
Corrosives
Water Reactives
Limited Egress
Damaged Structure
Poor Visibility
Excavation
Production Method:
Specific High Hazard Chemical:
Other:
C. SITE DESCRIPTION
LAB ADDRESS
SITE LOCATION & DESCRIPTION
NAME OF OWNER / OCCUPANT
STRUCTURE DESCRIPTION
HOW LONG WAS LAB ACTIVE? (Approximately)
WEATHER CONDITIONS:
Wind Direction & Velocity
Temperature
Rain
Snow
Humidity
ESTIMATED TIME:
ESTIMATED LAB SIZE:
Entry:
Sec/Min
Assessment:
Min/Hr
Processing: Min/Hr
Small
Medium
Large
D. OTHER AGENCY FIELD SUPPORT
NAME
(Include jurisdiction
FIELD
TELEPHONE
OFFICIAL CONTACTED
NOTIFIED
by City, State or
SUPPORT
NUMBER
STANDBY LOCATION
(Name)
Date
/
Time
County)
Fire Dept.
/
Ambulance
/
Medivac
/
Helicopter
Health
/
Dept.
Hospital
Address
/
Emergency Room
Disposal
/
Company
Other
/
E. TEAM MEMBER ASSIGNMENTS
TEAM MEMBERS (Include Name, Affiliation & check Assignment box:
TEAM MEMBERS (Include Name, Affiliation & check Assignment box:
E = Entry; A = Assessment; P = Processing)
E
A
P
E = Entry; A = Assessment, P = Processing)
E
A
P
DRAFT FORM HARP (09/05)
Page 1 of 4
MONTANA DEPARTMENT OF JUSTICE – DIVISION OF CRIMINAL INVESTIGATION
HAZARD ASSESSMENT AND RECOGNITION PLAN
A. FILE INFORMATION
DIVISION
OFFICE
DATE SEIZED
CASE NO.
SITE SAFETY OFFICER (Name)
AFFILIATION (if other than DOJ, enter Agency name)
)
AFFILIATION (if other than DOJ, enter Agency name
CHEMIST (Name)
B. LABORATORY TYPE AND HAZARDS
LABORATORY TYPE (Check)
POTENTIAL CHEMICAL HAZARDS (Check)
OTHER POTENTIAL HAZARDS (Check)
Methamphetamine
Amphetamine
Respiratory Tox.
Flammables
Comp Gas Cylinder
Slip/Trip/Fall Hazard
Cocaine
Fentanyl
Systemic Tox.
Explosives
Heat Stress
Electrical Shock
P2P
PCP
External Tox.
Oxidizers
Cold Stress
Burn Hazard
LSD
Carcinogens
Pyrophorics
Confined Space
Leaking Containers
Other (Specify)
Corrosives
Water Reactives
Limited Egress
Damaged Structure
Poor Visibility
Excavation
Production Method:
Specific High Hazard Chemical:
Other:
C. SITE DESCRIPTION
LAB ADDRESS
SITE LOCATION & DESCRIPTION
NAME OF OWNER / OCCUPANT
STRUCTURE DESCRIPTION
HOW LONG WAS LAB ACTIVE? (Approximately)
WEATHER CONDITIONS:
Wind Direction & Velocity
Temperature
Rain
Snow
Humidity
ESTIMATED TIME:
ESTIMATED LAB SIZE:
Entry:
Sec/Min
Assessment:
Min/Hr
Processing: Min/Hr
Small
Medium
Large
D. OTHER AGENCY FIELD SUPPORT
NAME
(Include jurisdiction
FIELD
TELEPHONE
OFFICIAL CONTACTED
NOTIFIED
by City, State or
SUPPORT
NUMBER
STANDBY LOCATION
(Name)
Date
/
Time
County)
Fire Dept.
/
Ambulance
/
Medivac
/
Helicopter
Health
/
Dept.
Hospital
Address
/
Emergency Room
Disposal
/
Company
Other
/
E. TEAM MEMBER ASSIGNMENTS
TEAM MEMBERS (Include Name, Affiliation & check Assignment box:
TEAM MEMBERS (Include Name, Affiliation & check Assignment box:
E = Entry; A = Assessment; P = Processing)
E
A
P
E = Entry; A = Assessment, P = Processing)
E
A
P
DRAFT FORM HARP (09/05)
Page 1 of 4
EQUIPMENT
F. TRUCK CHECKLIST
G. STAGES OF RAID
REQUIREMENTS
ENTRY
ASSESSMENT
PROCESSING
H.
Reference
Video Camera
Primary Hazard
Primary Hazard
Primary Hazard
NO.
Visqueen Plastic
TSP/Cleaner
OF
Duct Tape
Extension Cord
Check box under
Duration
Duration
Duration
ITEMS
Traffic Cones
SCBA Bottles
either Required or
5 gl bucket/brush
Cartridges OV/AM
USED
Standby column in
Personnel
Personnel
Personnel
Hand Cleaner/Rags
Tyvek Suit
each stage of raid to
Disinfectant
Saranex Suit
indicate equipment
Exhaust Fan
Poly Tyvek Suit
Level of Protection
Level of Protection
Level of Protection
Generator
PVC Suit
requirement.
Gas Can
PVC Booties
Required
Standby
Required
Standby
Required
Standby
Gas Tech 1314
Nitrile Gloves
SCBA
Draeger Kit/Tubes
PVC Gloves
Extra Bottles
Bung Wrench
Neoprene Gloves
Wading Pool
Polyvinyl Liners
Air Purifying Resp.
Pump Sprayer
Shower/Eye Wash
Cartridge – OV/AG
Wind Indicator
First Aid Kit
– AM/MA
Plastic Bags
Fire Extinguisher
Tyvek Suit
Sample Kit
Drinking Water
Saranex Suit
Water Hose
Polyethylene Tyvek Suit
Other (Specify):
Nomex Suit
PVC Suit, Med. Wt.
Field Boots
Neoprene Boots
PVC Booties
Nitrile (Green) Gloves
PVC Gloves
Neoprene Gloves
Silver Shield Gloves
Polyvinyl Liners/Gloves
Hard Hat
Safety Goggles/Glasses
Face Shield
I. HAZARD ASSESSMENT FINDINGS
LEL
% OXYGEN
PPM
LOCATION IN LAB
DRAEGER TUBES
RESULTS
Conversion = Adjusted
Maximum
(check all used/tested)
(check)
COLOR (changed to)
LEVEL
PPM X
Factor
Reading
Value
Acetic Acid – 5/a
+
-
Acetone – 100/b
+
-
Benzene - .5/a
+
-
Carbon disulfide - .04
+
-
Ethyl Acetate – 200/a
+
-
Formic Acid – 1/a
+
-
Hydrocyanic – 5/a
+
-
Methanol – 50/a
+
-
O-Toluidine – 1/a
+
-
Trichloroethane – 50/d
+
-
Triethylamine – 5/a
+
-
J. NARRATIVE OF LOCATIONS OF POSSIBLE CONTAMINATION. (1) insert digital photos and descriptions on
following page and (2) attach or Fax HazMat manifest
SITE SAFETY OFFICER (signature & date)
CASE AGENT (signature & date)
REGIONAL AGENT IN CHARGE (signature &
date)
DRAFT FORM HARP (09/05)
Page 2 of 4
J. Continued - NARRATIVE OF LOCATIONS OF POSSIBLE CONTAMINATION. (1) insert digital photos and
descriptions on following page and (2) attach or Fax HazMat manifest
Insert Digital Photos: Draft Note: May not be able to insert photos into form. If this cannot be done, photos may
be inserted into a Word document and attached to this form.
Photo 1
Photo 2
Photo 1 Description:
Photo 2 Description:
Photo 3
Photo 4
Photo 3 Description:
Photo 4 Description:
DRAFT FORM HARP (09/05)
Page 3 of 4
HAZARD ASSESSMENT AND RECOGNITION PLAN
INSTRUCTIONS FOR HARP FORM
GENERAL:
(1) Prepare an Original for retention in case file. (2) For compliance with MCA §75-10-1306(1) submit via Email to address on website
www.deq.mt.gov
or Fax to __________________________.
SECTION INSTRUCTIONS
SECTION A - FILE INFORMATION – Self-explanatory.
SECTION B - LABORATORY TYPE AND HAZARDS
Laboratory Type. Check the appropriate box for known or suspected lab type. Write in the production method if known or suspected
(example: methamphetamine via red phosphorous/hydriodic acid).
Potential Chemical Hazards. Check all boxes indicating known or suspected hazards. List any specific high hazard chemicals known or
suspected of being present (example: ether, thionyl chloride, red phosphorous, etc.).
Other Potential Hazards. Check all boxes indicating known or suspected hazards. List any other hazards known or suspected of being
present (example: low overhead, unstable container storage, booby traps, etc.).
SECTION C - SITE DESCRIPTION
Laboratory Address. Self-explanatory.
Site Location and Description. Description and location of lab at the address. (Example: detached garage 10 yards from house, outside
storage shed near rear door of main building.)
Structure Description. Physical description, i.e., size, shape, type, condition, etc. (Example: 10 x 10 wood barn, no windows; small
warehouse, fire damaged with opposing roll up doors.)
Weather Conditions. Enter the best estimate of conditions at anticipated time of entry/seizure.
Estimated Time: Enter the estimated duration of each phase of the lab seizure (entry, assessment, processing).
Estimated Lab Size. Check appropriate box based on best estimate of size.
SECTION D - OTHER AGENCY FIELD SUPPORT – Self-explanatory.
SECTION E - TEAM MEMBER ASSIGNMENTS – Self-explanatory.
SECTION F - TRUCK CHECKLIST – Check inventory of safety equipment on truck (available for use at lab site). List any additional equipment needed.
SECTION G - STAGES OF RAID – For each stage of the raid note the following information.
Primary Hazard: Example: Flammable atmosphere, cyanide gas, etc.
Duration: The actual time of work. (Example: assessment – 15 minutes)
Personnel: Enter the numbers corresponding to team members in Section E.
Level of Protection: Write in the letter designation. Example: “B” (i.e., Level B Protection).
Equipment Requirements: For each stage of the raid, mark all required (R) and standby (S) equipment specified by the Site Safety Officer.
(Example: Entry – SCBA (S); Nomex Suit (R); Field Boots (R); Goggles (R).
SECTION H - INVENTORY OF EQUIPMENT USED. List the total number of disposable items used at the conclusion of the raid. (Example: tyvek suit – 8)
SECTION I - HAZARD ASSESSMENT FINDINGS. During initial assessment, measure and record finding as indicated.
LEL (Lower Explosive Level). (Example: 1%, 15%, etc.)
% Oxygen (percent oxygen). (Example: 21%, 18%, etc.)
PPM (Parts Per Million). (Example: 100 ppm, 350 ppm)
Location in the lab – Describe each location where qa series of three measurements were taken. (Example: front door; southeast corner of
bathroom, etc.).
Draeger Tubes – See the Clandestine Laboratory Hazard Assessment Protection guide (CLHAP) to determine which Draeger Tubes to
use/test.
Check name of each tube to be used/tested.
After the test, check + for color change, and check – for no color change.
Describe color change (Example: dark brown, etc.)
Record the ppm level calculated following the manufacturer’s instructions for each individual tube.
Write in the conversion factor if listed in the CLHAP Guide for the individual Draeger Tubes specified by lab type and production method.
(Example: 2, 3, 4).
Calculate an adjusted reading, i.e., ppm x conversion factor. (Example: 100 ppm x 2 = 200 ppm)
Compare the adjusted reading to the maximum value listed in the CLHAP Guide for individual Draeger Tubes specified by lab type and
production method.
SECTION J - NARRATIVE. Include new hazards observed, injuries/near misses, equipment failures, recommendations, locations of possible
contamination, etc. Insert digital photos and corresponding descriptions of photos. Attach or Fax HazMat manifest.
DRAFT FORM HARP (09/05)
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