2013 ChemECar_National JSA - with logo Page 1 of 8

Job Safety Assessment Form

Chem-E-Car
2013 National Competition Updated January 2013

University: ehi!le Name"
JSA A#thor Conta!t Name: A#thor Email"
Fa!#lty S#pervisor" S#pervisor Email"
$evision %: $evision &ate:

'#rpose of E(periment ) E*#ipment" Briefly describe your Chem-E-Cars design, intended mode
for operation (source of power), intended mode for control (stopping), and major haards and their
control!
"escribe your cars design:




#ower source:




$topping mechanism:




%aards inherent in design:





$afety measures:







E(pe!te+ ,peratin- Con+itions"




2013 ChemECar_National JSA - with logo Page 2 of 8
.emperat#re 'ress#re
&ormal: &ormal:
'inimum: 'inimum:
'a(imum: 'a(imum:
)his page applies to your home institution * not the competition site! #lease attach a floor diagram
of the laboratory where you will be building and testing your +ehicle! ,ist the location of a+ailable
safety e-uipment and spill response supplies on this diagram!

'ersonal 'rote!tive E*#ipment /''E0" Chec. all ##E worn during operation of this Chem-E-Car!
"o not list these in the procedure section!
,ong #ants $afety /lasses %ard %at 0pron
,ong $lee+es $plash /oggles 1nsulated /lo+es Ear #rotection
&on-porous $hoes 2ace $hield Chemical /lo+es 3ther:


Available Safety E*#ipment * #ro+ide the location of each item shown below at your home
institution where your +ehicle will be operated and tested! $how the location of this e-uipment on
your pro+ided floor plan! 1f not a+ailable, type 4&05 in the field!
1tem 2o!ation
2ire E(tinguisher:
Eyewash:
$afety $hower:
)elephone:
2irst 0id 6it:
$pill Containment
3ther:


Spill $esponse S#pplies - #ro+ide the location of each item shown below at your home institution
where your +ehicle will be operated and tested! $how the location of this e-uipment on the
attached floor plan! 1f not a+ailable, type 4&05 in the field!
1tem 2o!ation
$pill 6it:
2loor-"ri:
$pill "i.es:
$odium Bicarbonate:
"rain #lugs:
$pill #illows:
'ercury $pill 6it:
3ther:
3ther:





2013 ChemECar_National JSA - with logo Page 3 of 8
&isallo3e+ A!tivities" 0ll acti+ities listed below are not allowed and will result in a dis-ualification
of your uni+ersity from ChemE car competition and possible fines!
1tem
(a) &o transport of chemicals in pri+ate, uni+ersity or rental +ehicles either to or from the
competition!
(b) Chemicals must not be stored in hotel rooms or other facilities not rated for chemical storage!
0ppro+ed chemical storage will be pro+ided at the host site!
(c) &o +ehicle testing in hotel or dorm hallways, warehouses, or other facilities that are not
designed for chemical handling! )his includes your uni+ersity and the competition site!
(d) &o improper disposal of chemicals at the conclusion of the competition! 0ll chemicals shipped
to the competition site must be disposed of in a safe and en+ironmental fashion following all
local, state and national regulatory measures! Chemical disposal will normally be pro+ided by the
host site!

&isallo3e+ ehi!les" 0ll of the items listed below are not allowed!
1tem E(planation
(a) 2lames and7or smo.e Both inside and outside the +ehicle, e(cept for commercial internal
combustion engines! $ee ChemE car rules for using commercial
internal combustion engines!
(b) ,i-uid "ischarge ,i-uid may not be discharged under normal operating conditions!
(c) 3pen and7or
improperly
secured containers
Containing chemicals ha+ing a /lobally %armonied $ystem
of Classification and ,abeling of Chemicals (/%$) rating of 8 or
greater! &o open containers allowed at the starting line or during
the operation of your +ehicle! 0ll containers with these chemicals
must ha+e secure lids and must be secured to the +ehicle! 0ll
containers brought to the starting line must ha+e lids, be properly
labeled, and proper personal protecti+e e-uipment must be used!
(d) Chemical pouring at
starting line
0ny chemicals with an &2#0 rating of 8 or greater! 9se a holding
+essel on +ehicle, with +al+e, to load starting chemicals!
(e) :egulated Chemicals 0 number of chemicals are listed by 3$%0 as a special haard! $ee
list below! 3$%0 has a special regulation for each chemical! $ee
www!osha!go+ for details!
(f) %ighly :eacti+e 7
9nstable Chemicals
0ny chemical, raw material, intermediate or product with an &2#0
reacti+ity 7 instability rating of ;!
(g) %ydrogen pero(ide %ydrogen pero(ide at concentrations of greater than <=> are not
allowed!

$e-#late+ !hemi!als" asbestos, coal tar pitch +olatiles, ;-nitrobiphenyl, alpha-napthylamine,
methyl chloromethyl ether, <,<?-dichlorobenidine, bis-chloromethyl ether,
beta-naphthylamine, benidine, ;-aminodiphenyl, ethyleneimine, beta-propiolactone,
8-acetylaminofluorene, ;-dimethylaminoao-beneene, n-nitrosodimethylamine, +inyl chloride,
inorganic arsenic, benene, @,8-dibromo-<-chloropropane, acrylonitrile, ethylene o(ide,
formaldehyde, ;,;?-'ethylenedianiline, @,<-butadiene, methylene chloride!




2013 ChemECar_National JSA - with logo Page 4 of 8
ehi!le 'rimary 4a5ar+s Che!6list" Chec. the left hand column bo( if the haards listed below e(ist
on the +ehicle! )hen chec. the applicable means of control for each haard!
4a5ar+
/!he!6 if present0
Control
(a) #ressure 0nything greater than @ psigA 7#st meet all re*#irements belo3"
#ressure gauge (must read to 8( ma(! operating pressure)
Emergency relief de+ice set to no more than @!@ times ma(! operating
pressure! :elief siing calculations must be pro+ided!
Emergency relief de+ice in proper location!
#ressure certification * see #ressure Bessel )esting #rotocol
#roper management system to pre+ent o+er or mis-charging!
0ll car components e(posed to pressure must be certified to operate at
that pressure! #ro+ide manufacturers pressure specifications!
&o #BC, c#BC or polyethylene terephthalate (#E)E or #E)) plastics in
pressure ser+ice
7#st have meas#rements or !al!#lations to prove ma(im#m operatin-
press#re8
See ChemE !ar r#les for more +etails on these re*#irements8
(b) )o(ic 0ny chemicals with /%$ to(icity of 8 or greaterA
"oubly contained and handled properly!
(c) 2lammable 0ny chemicals with/%$ flammability rating of 8 or higherA
"oubly contained and handled properly
(d) :eacti+e 0ny chemicals with /%$ instability 7 reacti+ity rating of 8 or <A
Chemi!als 3ith a 9 ratin- are not allo3e+8
"oubly contained and handled properly!
(e)
)emperature
0ny e(posed surface greater than CDEC or under =ECA
1nsulation or barrier to pre+ent contact!
(f) Electrical E(posed wiring and electrically energied components are ignition,
electrocution, and a shorting 7 fire haard! 0lligator clips and twisted wire
connections are not allowed * use binding posts or banana plugs for a more
secure connection!
#roper electrical insulation and connections pro+ided!
(g) 'echanical 0ny fast mo+ing parts (meshing gears, belts or chains) that are pinch
haardsA
/uards present and ade-uate!
(h) 3(ygen

0ll components e(posed to o(ygen must be
certified for o(ygen ser+ice!
thoroughly cleaned of contaminants as per instructions in rules!
not used pre+iously for other types of ser+ice!
(i) Biohaards

&o biohaards greater than biohaard le+el @ either during the design,
de+elopment, preparation or competition phases of your car!




2013 ChemECar_National JSA - with logo Page 5 of 8
Fabri!ation : ,peration A++itional 4a5ar+ &etail Che!6 2ist" Chec. all haards that are li.ely to be encountered during your Chem!-Car
construction and operation! ,ist the major source(s) of the haard and describe how the haard(s) will be controlled! 1f both construction and
haard columns are chec.ed in an indi+idual row, then the haards should be identified separately for both the construction and operation!

4a5ar+ 'resent &#rin- Control 7etho+/s0
1
''E $e*#ire+
1

Constr#!tion; ,peration;
#ressure
)o(icity
2lammability
:eacti+ity 7 1nstability
%ot $urfaces7 %igh )emp
F CDEC

Cold $urfaces7 ,ow )emp G
=EC

Electrical
0rc welding
/as welding
,athe
'illing machine
%andheld power tools
"rill press
3ther mechanical haards
#aint spraying
1oniing radiation
,aser radiation
0sphy(iates
3pen flames
#otential $pills
Biohaards:
3ther:
3ther:




2013 ChemECar_National JSA - with logo Page 6 of 8
Chemi!al 1nformation 'a-e

2ill in as much data below as a+ailable! 1f data are not a+ailable, lea+e the field blan.!

Chemi!al <#antities" ,ist below the chemical names, concentrations, and total -uantity of chemical re-uired for the competition!

Chemi!al Name
Chemi!al State
Soli+= 2i*#i+= >as
Con!entration $e*#ire+
?e s#re to list #nits@
.otal <#antity $e*#ire+ for Competition
?e s#re to list the #nits@








Chemi!al 'roperties an+ 4a5ar+s for A22 C4E71CA2S= in!l#+in- rea!tants= interme+iates an+ pro+#!ts8

Chemi!al Name

'hysi!al
State
S= 2= >

>4S $atin-s
A
1n!ompatible Chemi!als
,ist chemicals present within the laboratory, and
any others that may come in contact!
Flash
'oint
.emp8
Flammability
2imits
4 F S Sp8 2F2 UF2








>4S $atin-s" 4 * %ealth, F * 2lammability, S * $tability, Sp8 * $pecial





2013 ChemECar_National JSA - with logo Page 7 of 8

Chemi!al .o(i!olo-y= $e-#lation an+ &isposal" ,ist the same chemicals that appear abo+e, in the same order!


Chemi!al Name
.o(i!olo-y 4a5ar+o#s
Baste
N#mber

,S4A
$e-#late+;


'ersonal 'rote!tive E*#ipment
Spe!ifi! to this Chemi!al
.BA 'E2 ,ther










Chemi!al $ea!tions" #ro+ide details below on any chemical reaction(s) that occur in your process! #lease show the species in+ol+ed, the
stoichiometry and the heat of reaction, if a+ailable! 0lso list side reactions and any other reactions that may impact safety!


?ioha5ar+s" #ro+ide details below on any biological haards that may occur during the design, de+elopment, preparation or competition phases of
your car! #lease list the biological haards, the biohaard le+el, and a description of how these agents will be safety handled!





2013 ChemECar_National JSA - with logo Page 8 of 8
Job Safety Assessment Form
Safe ,peratin- 'ro!e+#res 'a-e

#ro+ide step-by-step details for each of the sections shown below! 1dentify the haards, the control methods and the personal protecti+e
e-uipment (##E) re-uired! #ro+ide ade-uate detail so that the re+iewers of this document will ha+e ade-uate understanding of your procedure to
pass judgment on the safety of your +ehicle!

)he Emer-en!y Sh#t+o3n section should ha+e only one or two steps re-uired to stop your +ehicle and bring it to a safe state!
)he Start-Up 'ro!e+#re section should list all the steps re-uired to prepare your chemicals and +ehicle!
)he $#n .ime 'ro!e+#re should describe all steps to operate your +ehicle at the starting line of the competition!
)he Sh#t+o3n 'ro!e+#re should describe the steps normally ta.en to shutdown your +ehicle at the end of your competiti+e run!
)he Clean#p ) Baste &isposal section should list all the steps re-uired to clean your +ehicle of all chemicals and proper chemical disposal!


Se*#en!e of Steps

'otential 4a5ar+s

'ro!e+#re to Control 4a5ar+
''E or E*#ipment
$e*#ire+
Emer-en!y Sh#t+o3n

Start-#p 'ro!e+#re

$#n .ime 'ro!e+#re

Sh#t+o3n 'ro!e+#re

Clean#p ) Baste &isposal


Usef#l 2in6s"
http:77www!unece!org7fileadmin7"0'7trans7danger7publi7ghs7ghsHre+=;7English7$)-$/-0C@=-<=-:e+;e!pdf
http:77www8!unitar!org7cwm7publications7cw7ghs7/%$HCompanionH/uideHfinalHIune8=@=!pdf
http:77www!safewor.australia!go+!au7sites7swa7safetyinyourwor.place7haardoussubstancesanddangerousgoods7pages7haardoussubstancesanddangerousgoods!asp(
http:77www!safewor.australia!go+!au7sites7$J070bout$afeJor.0ustralia7JhatJe"o7#ublications7#ages7&$8==;Criteria2orClassifying%aardous!asp(
http:77www!ntc!go+!au7+iewpage!asp(A0rea1dK<DL"ocument1dK@@;M