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ENVIRONMENTAL ACTIVITY_IMPACT WORKSHEET by malj

VIEWS: 143 PAGES: 7

									NOAA -                               EMS                           Date issues & revised: 8-12-03 R 1/25/05
MOC                               FORM 004.01                      Reference: EMS 004

ENVIRONMENTAL ACTIVITY/IMPACT WORKSHEET
Forms, checklists and sample documents should be reviewed and critiqued for application at the facility. Use care when adopting
formats to ensure all facility specific EMS issues and topics are covered and where applicable integrated into companion documents
and formats. Expand on format information wherever applicable to maximize the EMS effectiveness and efficiency.

Activity                                               Worksheet Completed by:                                    Date:
 Aspects of                                            Environmental Impacts (3)                    Priority (4)                                    Management (5)
 Activity (1)                          Environmental                                            Low – Medium - High
                       Condition (2)




                                                                                                                   Stewardship




                                                                                                                                      Operational
                                                                Community




                                                                            Materials




                                                                                                                                      Controls
                                       Media




                                                                                        Legal




                                                                                                           Risk
                                                                                                     Ref




                                                                                                                                 P2




                                                                                                                                                           P2
Each column reflects the following. Create worksheet in Excel file.
1. Aspects of Activity: Elements within the overall activity that have or have the potential to impact the environment.

2. Condition: Normal, Emergency or Abnormal and Maintenance

3. Environmental Impacts are identified for the following areas:
Environmental Media Impact
                          Air emission
                          Water Quality (fresh, ocean, marshland)
                          Wastewater including sewage and storm-water
                          Land
                          Natural Resources (energy, water, natural gas use)
                          Hazardous Waste
                          Special Waste (waste requiring special management practices, but not classified as hazardous)
                          Solid Waste
                          Medical Waste
                          Marine Mammal and Endangered Species (inclusive of flora and fauna)
Community Impact
                          Cultural Resources
                          Historical Resources
                          Noise and Light
                          Drinking Water
Materials Impact
                          Hazardous Material and Explosives
                          Radioactive Material
                          Pesticides
                          Petroleum, Oil & Lubricant
                          Toxic Substances (PCBs, Asbestos, Radon, Lead-based Paint)
                          Storage Tanks
                          Operations Support (budget, acquisition and use associated with equipment, parts, supplies, and non-hazardous
                           materials)




           "NOT CONTROLLED" UNLESS VIEWED VIA NOAA INTRANET OR DISTRIBUTED HARDCOPY BY MOC ECO
NOAA -                      EMS                     Date issues & revised: 8-12-03 R 1/25/05
MOC                      FORM 004.01                Reference: EMS 004


Environmental Activity/Impact Worksheet, continued

4.
  Criteria                                                                          Rating
                                        Low                                      Medium                                      High
 Regulation              No regulation or applicable legal      Regulation or legal requirement              Regulation or other legal requirement
 (Regulatory or          requirement, no other requirement      applicable, but facility activity/impact     is applicable. Other requirement
 other requirement)      applicable.                            is exempt. No other requirement              applicable.
                                                                applicable.
 Risk                    No potential risk to human health      Some risk to human health, community        High risk to human health, community
 (Risk, financial,       or community. Risk to                  or environment, and/or                      or environment, and/or
 environmental           environment low, and/ or
 liability and/or
 cost)                   Cost less than $10,000                 Cost from $10,001 to $50,000                Cost exceeding $50,000

 Stewardship &           No affect on natural resource use      Affects wise use of natural resources       Sustainability of natural resources
 Operations              and/or sustainability.                 and/or facility operations.                 greatly affected and/or significantly
 (Environmental                                                                                             affects facility ability to maintain
 Stewardship &                                                                                              operations.
 NOAA Operations)
                         No public concern, not an issue.       Some public concern.                        High public concern.


 Pollution               No      pollution        prevention    Pollution prevention opportunities          Pollution prevention opportunities
 Prevention              opportunities.                         known but not considered priority due       possible but requires formal priority
 (Pollution                                                     to low risk and cost effectiveness.         assessment.
 prevention
 opportunity)                                                                                               Pollution prevention opportunities
                                                                                                            known and can be implemented.

                                                                                                            Pollution prevention will help attain
                                                                                                            goals and objectives including
                                                                                                            elimination or reduction of toxic
                                                                                                            pollutants.
Ref – Reference refers the citation of the legal requirement. This information is identified on the Compliance Assurance Program.

5. These columns are used to identify specific management elements for the activity and environmental impact. Operational controls and
Environmental Improvement Activities are usually referenced.




             "NOT CONTROLLED" UNLESS VIEWED VIA NOAA INTRANET OR DISTRIBUTED HARDCOPY BY MOC ECO
      NOAA -                   EMS                Date issues & revised: 8-12-03 R 1/25/05
      MOC                   FORM 004.01           Reference: EMS 004

Process:                                                 Completed by:                               Date:                      Page___of___
 Aspects of Activity, Department   What are the environmental impacts?                       Condition of    Comments: Operational Controls, Records, P2 ideas etc
 or Function                                                                                 operation




                                                                                              




               "NOT CONTROLLED" UNLESS VIEWED VIA NOAA INTRANET OR DISTRIBUTED HARDCOPY BY MOC ECO
NOAA -                               EMS                           Date issues & revised: 8-12-03 1/24/05
MOC                               FORM 004.01                      Reference: EMS 004

ENVIRONMENTAL ACTIVITY/IMPACT WORKSHEET
Forms, checklists and sample documents should be reviewed and critiqued for application at the facility. Use care when adopting formats to ensure all facility
specific EMS issues and topics are covered and where applicable integrated into companion documents and formats. Expand on format information
wherever applicable to maximize the EMS effectiveness and efficiency.

Activity: _________________________Worksheet Completed by: _______________ Date: _________
 Process (1)                                           Environmental Impacts (3)                     Priority (4)                                        Management (5)
                                                                                                 Low – Medium - High
                                       Environmental
                       Condition (2)




                                                                                                                        Stewardship




                                                                                                                                           Operational
                                                                Community




                                                                                                      Ref: CAP
                                                                            Materials




                                                                                                                                           Controls
                                       Media




                                                                                         Legal




                                                                                                                 Risk




                                                                                                                                      P2




                                                                                                                                                                P2
Follow the directions below to complete each worksheet. Create worksheet in an Excel file.
1. Process: Elements or actions within the overall activity that have or can have the potential to impact (change) the environment (air, water, land, flora , fauna, natural
resources and human interrelations).

2. Condition: Process operations under Normal (N), Emergency or Abnormal (E) and Maintenance (M).

3. Environmental Impacts are identified using the following environmental management (aspect) categories. These EMS management categories: 1) align with the
categories used to identify and organize regulations in the Compliance Assurance Plan (CAP) and 2) align with the NOAA Regulatory Compliance Audit checklists. A
process can have more than one impact. Directions: Identify the specific EMS Management (aspect) category and the impact. For example: Air Emission – VOCs
emission from solvent tank (quantify an impact whenever possible) Caution: Do not put more than one impact on a line – if more than one impact is identified on a line
you can not determine which impact your are ranking in area #4.
                                                              ENVIRONMENTAL IMPACT
EMS Management (Aspect) Category                       Further Breakdown of general management category in accordance with NOAA Compliance
Media                                                  Audit Assessment Category and/or EMS CAP
Air emission                                           1.1           Steam Generators
                                                       1.2           Gas Turbines
                                                       1.3           Misc. Incinerators
                                                       1.4           Medical Waste Incinerator
                                                       1.5           Printing Presses & Graphic Arts
                                                       1.6           Fugitive Emissions
                                                       1.7           CFCs & Halon
                                                       1.8           Degreasing Operation
                                                       1.9           Alternative Fuel Vehicles
                                                       1.10          Vessel Air Emissions
Water Quality (fresh, ocean, marshland)                14.1          Public Water Supply
                                                       14.2          Community Water Supply
                                                       14.3          Non-Community Water Supply
                                                       14.4          Non-transient/non-community (NTNC) water system
                                                       14.5          Transient Non-Community Water Supply
                                                       14.6          Sole Source Aquifer
                                                       14.7          Non-Community Water
                                                       14.8          Potable Water
                                                       7.6           Wetlands




          "NOT CONTROLLED" UNLESS VIEWED VIA NOAA INTRANET OR DISTRIBUTED HARDCOPY BY MOC ECO
NOAA -                      EMS                      Date issues & revised: 8-12-03 1/24/05
MOC                      FORM 004.01                 Reference: EMS 004

Environmental Activity/Impact Worksheet, continued
EMS Management (Aspect) Category                      Further Breakdown of general management category in accordance with NOAA Compliance
Media                                                 Audit Assessment Category and/or EMS CAP EMS Management (Aspect) Category Media
Wastewater including sewage and storm-water           13.1          NPDES Permit
                                                      13.2          Discharge to POTWFOTW
                                                      13.3          Steam Electric Generating Sources Effluent Limitation
                                                      13.4          Electroplating Effluent Limitation
                                                      13.5          Metal Finishing Effluent Limitation
                                                      13.6          Photo Lab Effluent Limitation
                                                      13.7          Armed Forces Vessel Discharge (Sewage & Gray Water Discharge at Sea)
                                                      13.8          Sludge Management & Application
Natural Resources (energy, water, natural gas use)    6.1           Dredging
                                                      6.3           Wildlife
                                                      6.4           Sustainability
Land                                                  6.2           Land Management

Hazardous Waste                                       5.1           All Generators
                                                      5.2           CESQG
                                                      5.3           SQG
                                                      5.4           LQG
                                                      5.5           HW Transportation
                                                      5.6           Mixed Waste
                                                      5.7           TSDF
                                                      5.8           HW Export/Import
                                                      5.9           HW on Public Vessels
                                                      5.10          SQ UW Handler
                                                      5.11          LQ UW Handler
                                                      5.12          UW Transporter
                                                      5.13          UW Destination Facility
Special Waste (waste requiring special                5.1
management practices, but not classified as
hazardous)
Solid Waste                                           10.1          Storage/Collection of Solid Waste
                                                      10.2          Recycling
                                                      10.3          Non-MSWLF & Facilities
                                                      10.4          Thermal Processing Facilities
                                                      10.5          Disposal of Refuse from Outside US
                                                      10.7          Solid Waste From Ships
Medical Waste – Land                                  10.6          Medical Waste
Medical Waste - Sea                                   10.8          Disposal of Medical Waste at Sea
Marine Mammal and Endangered Species                  7.5           Threatened & Endangered Species
(inclusive of flora and fauna)
EMS Management Category
Community
Cultural Resources                                    2.2           Religious Heritage Access
                                                      2.3           Archaeological/Indian
                                                      2.4           Collection Management & Curation
Historical Resource                                   2.1           Historical Preservation
Noise and Light                                       7.2           Environmental Noise
Drinking Water (in buildings)                         14.0




          "NOT CONTROLLED" UNLESS VIEWED VIA NOAA INTRANET OR DISTRIBUTED HARDCOPY BY MOC ECO
NOAA -                    EMS                     Date issues & revised: 8-12-03 1/24/05
MOC                    FORM 004.01                Reference: EMS 004

Environmental Activity/Impact Worksheet, continued
EMS Management Category
Materials
Hazardous Material and Explosives                  4.1        Personal Training
                                                   4.2        HM in Laboratories
                                                   4.3        Releases of HM
                                                   4.4        EPCRA
                                                   4.5        Right-to-Know
                                                   4.6        Flammable/Combustible Storage
                                                   4.7        Compressed Gas Storage
                                                   4.8        HM Transportation
                                                   4.9        HM Transfer to/from Vessels
                                                   4.10       HM Transfer Operation/Fixed Facility
                                                   4.11       HM Storage/Floating Plants
                                                   4.12       HM on Tank Vessels
                                                   4.13       HM on Cargo & Misc. Vessels
                                                   4.15       HM on Vessels
Radioactive Material                               4.14       Radioactive Materials
Pesticides                                         8.1        Pesticide Applicators
                                                   8.2        Pesticide Application
                                                   8.3        Storage, Mixing & Handling
Petroleum, Oil & Lubricant                         9.1        Spill Plan >1,320 gal
                                                   9.2        Response Plan >1,000,000 gal
                                                   9.3        Discharge/Spills
                                                   9.4        Oil Waste Handling & Discharge at Sea
                                                   9.5        POL Storage
                                                   9.6        POL Storage on Vessels/Ships
                                                   9.7        POL Storage on Tank Vessels
                                                   9.10       Service Stations
                                                   9.11       POL Loading & Unloading (Oil Transfer)
                                                   9.12       Used Oil
                                                   9.13       Used Oil Transport
                                                   9.14       Used Oil Burners
Toxic Substances (PCBs, Asbestos, Radon, Lead-     12.1       PCB
based Paint)                                       12.2       Asbestos
                                                   12.3       Radon
                                                   12.4       Lead Based Paint
Storage Tanks                                      11.1       AST
                                                   11.2       Emissions From POL Storage Vessels
                                                   11.3       UST
                                                   11.4       HW Storage Tanks (SQG & TSDF)
                                                   11.5       Flammable/Combustible Liquid
                                                   11.6       Used Oil
                                                   11.7       Marine Portable Tanks
                                                   11.8       Storage Tanks on Ships
                                                   11.9       Ballast Tank on Vessels
Operations Support (budget, acquisition and use    7.1        NEPA
associated with equipment, parts, supplies, and    7.3        Installation restoration Program
non-hazardous materials)                           7.7        Real Property Acquisition & Disposition
                                                   3.1        Management Commitment
                                                   3.2        Compliance Assurance & Pollution Prevention
                                                   3.3        Enabling Systems
                                                   3.4        Performance and Accountability
                                                   3.5        Measurement and Improvement




          "NOT CONTROLLED" UNLESS VIEWED VIA NOAA INTRANET OR DISTRIBUTED HARDCOPY BY MOC ECO
NOAA -                      EMS                      Date issues & revised: 8-12-03 1/24/05
MOC                      FORM 004.01                 Reference: EMS 004

Environmental Activity/Impact Worksheet, continued
4. Priority: Rank each process and its related impact to determine its significance. Use the ranking table below to prioritize your facility activity processes and their
environmental impacts.
  Criteria                                                                               Rating
                                        Low                                     Medium                                              High
  Regulation            No regulation or applicable legal      Regulation or legal requirement               Regulation or other legal requirement is
  (Regulatory or        requirement, no other requirement      applicable, but facility activity/impact      applicable. Other requirement applicable.
  other requirement)    applicable.                            is exempt. No other requirement
                                                               applicable.
  Risk                  No potential risk to human health      Some risk to human health, community         High risk to human health, community or
  (Risk, financial,     or community. Risk to                  or environment, and/or                       environment, and/or
  environmental         environment low, and/ or
  liability and/or
  cost)                 Cost less than $10,000                 Cost from $10,001 to $50,000                 Cost exceeding $50,000

 Stewardship &           No affect on natural resource use       Affects wise use of natural resources        Sustainability of natural resources greatly
 Operations              and/or sustainability.                  and/or facility operations.                  affected and/or significantly affects facility
 (Environmental                                                                                               ability to maintain operations.
 Stewardship &
 NOAA Operations)                                                                                             High public concern.
                         No public concern, not an issue.        Some public concern.


 Pollution               No      pollution        prevention     Pollution prevention opportunities          Pollution prevention opportunities possible but
 Prevention              opportunities.                          known but not considered priority due       requires formal priority assessment.
 (Pollution                                                      to low risk and cost effectiveness.
 prevention                                                                                                  Pollution prevention opportunities known and can
 opportunity)                                                                                                be implemented.

                                                                                                            Pollution prevention will help attain goals and
                                                                                                            objectives including elimination or reduction of
                                                                                                            toxic pollutants.
Ref – Reference refers the citation of the legal requirement. This information is identified on the Compliance Assurance Program.

All impacts ranked “High” are considered significant. Those ranked “Medium” may be considered for significance. A “Low” ranking identifies a not significant
activity process and its related impact.

5. Management: These columns are used to identify specific management elements for the activity process and environmental impact. Operational controls and
Environmental Improvement Activities are usually referenced




          "NOT CONTROLLED" UNLESS VIEWED VIA NOAA INTRANET OR DISTRIBUTED HARDCOPY BY MOC ECO

								
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