APPENDIX A, U.S. EPA Facility Pollution Prevention Guide, EPA/600/R-92/088
POLLUTION PREVENTION
WORKSHEETS
                                                                           

    The worksheets in this appendix were designed to be useful
at various points in the development of a pollution prevention
program.  Table A-1 lists the worksheets and describes the
purpose of each.  
    Since these worksheets are intentionally generic, you may
decide to redesign some or all of them to be more specific to
your facility once you have your program underway.  The check
lists in Appendix B contain information that you may find helpful
in deciding how to customize these worksheets to fit your
situation.  Appendix C contains examples of worksheets as they
might be customized for a pharmaceutical company.  

      Table A-1.  List of Pollution Prevention Assessment Worksheets

Phase   Number and Title     Purpose/Remarks
    1.  Assessment Overview  Summarizes the overall program.
                             Assessment Phase     
    2.  Site Description     Lists background information about the
                             facility, including location, products, 
                             and operations.
    3.  Process Information  This is a checklist of process
                             information that can be collected before 
                             the assessment effort begins.
    4.  Input Materials Summary  Records input material
                                 information for a specific production 
                                 or process area.  This
                                 includes name, supplier, hazardous 
                                 component or properties, cost,
                                 delivery and shelf-life information, 
                                 and possible substitutes.
    5.  Products Summary     Identifies hazardous components,
                             production rate, revenues, and other 
                             information about products.
    6.  Waste Stream Summary Summarizes the information collected for 
                             several waste streams.  This sheet can 
                             be used to prioritize waste streams to assess.
    7.  Option Generation    Records options proposed during
                             brainstorming or nominal group technique 
                             sessions.  Includes the rationale for 
                             proposing each option.
    8.  Option Description   Describes and summarizes information about 
                             a proposed option.  Also notes approval of 
                             promising options.
Feasibility Analysis Phase   
    9.  Profitability        This worksheet is used to identify
                             capital and operating costs and to calculate 
                             the payback period.

(Note: The worksheets are deleted from this electronic version of this 
document.  For a printed copy of this document please call or fax U.S. EPA, 
Pollution Prevention Research Branch and request EPA/600/R-92/088.
 Phone: 513/569-7215        FAX: 513/569-7111

The document may also be obtained by contacting Ohio EPA Office of Pollution
Prevention at 614/644-3469, FAX 614/728-1245.)