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EMERGENCY SAFETY AND RESPONSE PLAN (ICS-208-CG SSP-A) Purpose: The Emergency Safety and Response Plan provides the Safety Officer and ICS personnel a plan for safeguarding personnel during the initial emergency phase of the response. It is only used during the emergency phase of the response, which is defined as a situation involving an uncontrolled release. It is also intended to meet the requirements of the Hazardous Waste Operations and Emergency Response (HAZWOPER) regulation, Title 29 Code of Federal Regulations Part 1910.120. Preparation: The Safety Officer or his/her designated staff starts the Emergency Site Safety and Response Plan. They initially address the hazards common to all operations involved in the response (initial site characterization). Outside support organizations must be contacted to ensure the plan is consistent with other plans (local, state, other federal plans). Form ICS-208-CG SSP-G need not be completed if this form is used. When the operation proceeds into the post-emergency phase (site stabilized and cleanup operations begun) forms ICS-208-CG SSP-B and ICS-208-CG SSP-G should be used. For large incidents, the Emergency Site Safety and Response Plan complements the Incident Action Plan. For smaller incidents, the Emergency Site Safety and Response Plan complements ICS-201. Distribution: The Emergency Safety and Response Plan completed by the Safety Officer is forwarded to the Planning Section Chief. Copies are made and attached to the Assignment List(s) (ICS Form 204). The Operations Section Chief, Directors, Supervisors or Leaders get a copy of the plan. They must ensure it is available on site for all personnel to review. The Safety Officer is responsible for ensuring that the Emergency Site Safety and Response Plan properly addresses the hazards of the operation. The Safety Officer accomplishes this through on site enforcement and feedback to the operational units. Instructions: Item# Item Title Instructions 1 Incident Name Print the name assigned to the incident. 2 Date/Time Prepared Enter date (month, day, year)prepared. 3 Operational Period Enter the time interval for which the assignment applies. 4 Attachments Enter attachments. Material Safety Data Sheets are mandatory under 1910.120. Safe Work Practices may also be attached. 5 Organization List the personnel responsible for these positions. IC and Safety Officer are mandatory. 6 Physical Hazards & Check off the physical hazards at the site. Identify the major tasks involved in the response (skimming, Protection lightering, overpacking, etc.). Check off the controls that would be used to safeguard workers from the physical hazards for each major task. 7 Chemical/Agent List the chemicals involved in the response. Chemicals may be listed numerically. Check off the hazards, potential health effects,pathway of dispersion, and exposure route of the chemical. Numbers corresponding to the chemical may be entered into the check blocks to differentiate. Check off the PPE to be used. Identify the type of PPE selected for example: loves: butyl rubber). 8 Instruments Indicate the instruments being used for monitoring. List the action levels adjacent to the instruments being used. Identify the chemicals being monitored(2). List the physical parameters of the chemicals. Use a separate form for additional chemicals monitored.