Doc. No.

: Date of Effectivity: IMS CHECKLIST FORM XYZ Plant

Page of

Department/Areas: Q.C. Laboratory Activities/Areas:

Audited by/ Date:

Sampling : Collection and preparation of samples, Distribution of Samples, Storage of samples for daily composite, Disposal of Excess Samples

Clause
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

Requirement
A1. Collection of sample at different sampling point are clearly defined in the procedure as well as the preparation of sample for analysis. -QESH Risks clearly identified 2. Samplers properly trained on the procedure of sampling and aware of the QESH Risks of the activity? What about samplers under Contractor?

Y/N/NA

Findings

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

3. Required performance evaluation of samplers to ensure that sampling procedure is carried out correctly? Verify if HIRADC was conducted?

4.5.3, 4.5.3.1/4.5.3.2, 8.5.1, 8.5.2

4. Create procedure of sampling at different sampling point. Create HIRADC for the sampling of material at different sampling point. Evaluate the samplers by letting them perform the actual sampling vs. the procedure.

Doc. No. : Date of Effectivity: IMS CHECKLIST FORM XYZ Plant

Page of

Department/Areas: Q.C. Laboratory Activities/Areas:

Audited by/ Date:

Sampling : Collection and preparation of samples, Distribution of Samples, Storage of samples for daily composite, Disposal of Excess Samples

Clause
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

Requirement
B1. Samples for analysis at different section are properly labeled and with proper containers?

Y/N/NA

Findings

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

2. Proper labeling of sample containers done?

4.5.1, 4.5.2, 8.2.3, 7.5.5

3. Visual Inspection of sample containers with the appropriate samples inside.

4.5.3, 4.5.3.1/4.5.3.2, 8.5.1, 8.5.2

4. Samples should be placed in different containers and properly labeled.

Doc. No. : Date of Effectivity: IMS CHECKLIST FORM XYZ Plant

Page of

Department/Areas: Q.C. Laboratory Activities/Areas:

Audited by/ Date:

Sampling : Collection and preparation of samples, Distribution of Samples, Storage of samples for daily composite, Disposal of Excess Samples

Clause
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

Requirement
C1. Proper labeling and storage of samples for daily composite

Y/N/NA

Findings

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

2. Daily composite samples are well segregated and collected?

4.5.1, 4.5.2, 8.2.3, 7.5.5

3. Packaging and storage of daily composite samples

4.5.3, 4.5.3.1/4.5.3.2, 8.5.1, 8.5.2

4. Composite samples are collected, segregated and stored properly for future analysis.

Doc. No. : Date of Effectivity: IMS CHECKLIST FORM XYZ Plant

Page of

Department/Areas: Q.C. Laboratory Activities/Areas:

Audited by/ Date:

Sampling : Collection and preparation of samples, Distribution of Samples, Storage of samples for daily composite, Disposal of Excess Samples

Clause
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

Requirement
D1. -Proper disposal of samples are defined in the procedure? -Environmental Impact Identified? -Volume of disposed wastes with regular monitoring? 2. -Samplers aware of the procedure on proper disposal of wastes? -Environmental Aspects and Impact Assessment In Placed? -Record Monitoring of Wastes Disposal 3. Areas where the excess samples are to be disposed? - Records of wastes disposal available? -EAIA 4. Disposal area should be clearly defined in the procedure. Increase awareness of the samplers of the disposal area for the excess

Y/N/NA

Findings

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

Doc. No. : Date of Effectivity: IMS CHECKLIST FORM XYZ Plant

Page of

Department/Areas: Q.C. Laboratory Activities/Areas:

Audited by/ Date:

Sampling : Collection and preparation of samples, Distribution of Samples, Storage of samples for daily composite, Disposal of Excess Samples

Clause
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

Requirement
1. Collection of sample at different sampling point are clearly defined in the procedure as well as the preparation of sample for analysis. -QESH Risks clearly identified 2. Samplers properly trained on the procedure of sampling and aware of the QESH Risks of the activity? What about samplers under Contractor?

Y/N/NA

Findings

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

3. Required performance evaluation of samplers to ensure that sampling procedure is carried out correctly? Verify if HIRADC was conducted?

4.5.3, 4.5.3.1/4.5.3.2, 8.5.1, 8.5.2

4. Create procedure of sampling at different sampling point. Create HIRADC for the sampling of material at different sampling point. Evaluate the samplers by letting them perform the actual sampling vs. the procedure.