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  • 7/28/2019 IMS ChecklistsampleXYZ

    1/5

    Doc. No. :

    Date of Effectivity:

    IMS CHECKLIST FORM

    XYZ Plant Page of

    Department/Areas:Q.C. Laboratory

    Audited by/ Date:

    Activities/Areas:Sampling : Collection and preparation of samples, Distribution of Samples, Storage of samples for dailycomposite, Disposal of Excess Samples

    Clause Requirement Y/N/NA Findings

    4.2, 4.3.1, 4.3.3,4.3.2, 5.3,5.4.1, 7.1,

    7.4, 8.3, 6.4, 7.5.5,8.2.3

    4.4.3, 4.4.6, 4.4.7,4.4.2, 6.2.2, 7.1, 7.4,

    8.3, 7.5.5, 8.2.3

    4.5.1, 4.5.2, 8.2.3,7.5.5

    4.5.3,4.5.3.1/4.5.3.2,8.5.1, 8.5.2

    A1. Collection ofsample at different

    sampling point areclearly defined in theprocedure as well as thepreparation of samplefor analysis.

    -QESH Risks clearlyidentified

    2. Samplers properly

    trained on the procedureof sampling and aware

    of the QESH Risks ofthe activity?

    What about samplers

    under Contractor?

    3. Requiredperformance evaluation

    of samplers to ensurethat sampling procedureis carried out correctly?

    Verify if HIRADC wasconducted?

    4. Create procedure of

    sampling at differentsampling point.

    Create HIRADC for thesampling of material atdifferent sampling

    point.

    Evaluate the samplersby letting them perform

    the actual sampling vs.the procedure.

  • 7/28/2019 IMS ChecklistsampleXYZ

    2/5

    Doc. No. :

    Date of Effectivity:

    IMS CHECKLIST FORM

    XYZ Plant Page of

    Department/Areas:Q.C. Laboratory

    Audited by/ Date:

    Activities/Areas:Sampling : Collection and preparation of samples, Distribution of Samples, Storage of samples for dailycomposite, Disposal of Excess Samples

    Clause Requirement Y/N/NA Findings

    4.2, 4.3.1, 4.3.3,4.3.2, 5.3,5.4.1, 7.1,

    7.4, 8.3, 6.4, 7.5.5,8.2.3

    4.4.3, 4.4.6, 4.4.7,4.4.2, 6.2.2, 7.1, 7.4,8.3, 7.5.5, 8.2.3

    4.5.1, 4.5.2, 8.2.3,7.5.5

    4.5.3,4.5.3.1/4.5.3.2,8.5.1, 8.5.2

    B1. Samples foranalysis at different

    section are properlylabeled and with propercontainers?

    2. Proper labeling ofsample containers

    done?

    3. Visual Inspection of

    sample containers withthe appropriate samples

    inside.

    4. Samples should beplaced in different

    containers and properly

    labeled.

  • 7/28/2019 IMS ChecklistsampleXYZ

    3/5

    Doc. No. :

    Date of Effectivity:

    IMS CHECKLIST FORM

    XYZ Plant Page of

    Department/Areas:Q.C. Laboratory

    Audited by/ Date:

    Activities/Areas:Sampling : Collection and preparation of samples, Distribution of Samples, Storage of samples for dailycomposite, Disposal of Excess Samples

    Clause Requirement Y/N/NA Findings

    4.2, 4.3.1, 4.3.3,4.3.2, 5.3,5.4.1, 7.1,

    7.4, 8.3, 6.4, 7.5.5,8.2.3

    4.4.3, 4.4.6, 4.4.7,4.4.2, 6.2.2, 7.1, 7.4,

    8.3, 7.5.5, 8.2.3

    4.5.1, 4.5.2, 8.2.3,7.5.5

    4.5.3,4.5.3.1/4.5.3.2,8.5.1, 8.5.2

    C1. Proper labeling andstorage of samples for

    daily composite

    2. Daily compositesamples are well

    segregated andcollected?

    3.Packaging andstorage of dailycomposite samples

    4. Composite samplesare collected,

    segregated and storedproperly for future

    analysis.

  • 7/28/2019 IMS ChecklistsampleXYZ

    4/5

    Doc. No. :

    Date of Effectivity:

    IMS CHECKLIST FORM

    XYZ Plant Page of

    Department/Areas:Q.C. Laboratory

    Audited by/ Date:

    Activities/Areas:Sampling : Collection and preparation of samples, Distribution of Samples, Storage of samples for dailycomposite, Disposal of Excess Samples

    Clause Requirement Y/N/NA Findings

    4.2, 4.3.1, 4.3.3,4.3.2, 5.3,5.4.1, 7.1,

    7.4, 8.3, 6.4, 7.5.5,8.2.3

    4.4.3, 4.4.6, 4.4.7,4.4.2, 6.2.2, 7.1, 7.4,

    8.3, 7.5.5, 8.2.3

    4.5.1, 4.5.2, 8.2.3,7.5.5

    4.5.3,4.5.3.1/4.5.3.2,8.5.1, 8.5.2

    D1. -Proper disposal ofsamples are defined in

    the procedure?-Environmental ImpactIdentified?-Volume of disposedwastes with regular

    monitoring?

    2. -Samplers aware ofthe procedure on proper

    disposal of wastes?-Environmental Aspects

    and Impact AssessmentIn Placed?-Record Monitoring ofWastes Disposal

    3. Areas where theexcess samples are to be

    disposed?- Records of wastesdisposal available?-EAIA

    4. Disposal area should

    be clearly defined in theprocedure.

    Increase awareness of

    the samplers of thedisposal area for the

    excess

  • 7/28/2019 IMS ChecklistsampleXYZ

    5/5

    Doc. No. :

    Date of Effectivity:

    IMS CHECKLIST FORM

    XYZ Plant Page of

    Department/Areas:Q.C. Laboratory

    Audited by/ Date:

    Activities/Areas:Sampling : Collection and preparation of samples, Distribution of Samples, Storage of samples for dailycomposite, Disposal of Excess Samples

    Clause Requirement Y/N/NA Findings

    4.2, 4.3.1, 4.3.3,4.3.2, 5.3,5.4.1, 7.1,

    7.4, 8.3, 6.4, 7.5.5,8.2.3

    4.4.3, 4.4.6, 4.4.7,4.4.2, 6.2.2, 7.1, 7.4,

    8.3, 7.5.5, 8.2.3

    4.5.1, 4.5.2, 8.2.3,7.5.5

    4.5.3,4.5.3.1/4.5.3.2,8.5.1, 8.5.2

    1. Collection of sampleat different sampling

    point are clearly definedin the procedure as wellas the preparation ofsample for analysis.-QESH Risks clearly

    identified

    2. Samplers properlytrained on the procedure

    of sampling and awareof the QESH Risks of

    the activity?

    What about samplersunder Contractor?

    3. Requiredperformance evaluationof samplers to ensure

    that sampling procedureis carried out correctly?

    Verify if HIRADC was

    conducted?

    4. Create procedure ofsampling at different

    sampling point.

    Create HIRADC for the

    sampling of material atdifferent sampling

    point.

    Evaluate the samplersby letting them performthe actual sampling vs.

    the procedure.