Title Page
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Department Name
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Room number:
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Conducted on
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Prepared by
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Location
Housekeeping
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1. Is general housekeeping acceptable?
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2. Are the floors and work surfaces clear of spilled liquids?
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3. Are cords routed so they don’t create a tripping hazard?
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4. Are there any other tripping hazards?
Emergency Evacuation and Exits
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1. Is the Emergency Evacuation Map posted in the area?
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2. Is access to emergency exits free of obstacles?
Fire Hazards
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1. Are the fire extinguisher maintained regularly/monthly?
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2. Is access to fire extinguishers maintained and obstacle free?
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3. Are employees or a lead employee trained to use the fire extinguisher?
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Showers and Eyewashes
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1. Are Shower and Eye Washes maintained regularly/monthly/quarterly/annually?
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2. Is access to the safety shower and eyewash maintained?
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3. Are employees trained on using the shower and eyewashe stations?
Electrical Hazards
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1. Is access to electrical panels maintained?
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2. Are electrical panel access doors closed and latched?
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3. Do any electrical cords have frays or cracks?
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4. Are power strips equipped with a fuse?
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5. Are extension cords only used for temporary uses (<24 hours)?
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6. Have employees completed and up to date on Electrical Safety training?
Hazardous Communication and Chemical Inventory
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1. Are hazardous chemicals properly labeled and stored?
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2. Does the lab have Placards and GHS Labels posted?
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3. Are hazardous chemical containers 1 gallon or larger stored in secondary containment?
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4. Are SDS to all HazMat and Chemicals available for employees?
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5. Have employees completed HazMat Trainings?
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6. Do you maintain a master chemical list? Is the chemical inventory updated and current?
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7. Are there any hazardous chemicals that have not been added to the inventory?
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8. Have employee completed L4U Haz Com training
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9. Are all the chemical containers have labels?
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10. Are all fumehoods and exhausts working properly?
Compressed Gasses
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1. Are compressed gas cylinders restrained at 2 heights with metal chains or straps?
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2. Have employees completed Compressed Gasses Trainings?
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3. Are compressed gas cylinders stored in areas that are protected from external heat sources 20 feet away from highly cumbustible materail?
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4. Are stored or transported in a manner to prevent them from creating a hazard by slipping, falling, or rolling?
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5. Are all valves closed off before a cylinder is moved when the cylinder is empty and at the completion of each job?
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6. Are compressed gas cylinders regularly examined for expired hydrostatic test dates, obvious signs of defect, deep rusting, or leaking?
Lockout/Tagout Procedures
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1. Have all equipment involving hazardous energy sources identified for LO/TO?
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2. Are all LO/TO performed by authorized employees only? Is there a list of Authorized employees? Please list.
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3. Are there any new equipment involving hazardous energy need a LO/TO procedure?
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4. Are LO/TO procedures posted or readly available near the equipment?
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Personal Protective Equipment (PPE) and Respiratory Protection
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1. Are protective goggles or face shields provided and worn where there is a danger of flying particals or corrosive materials?
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2. Are approved safety googles worn at all times in areas where there is a risk of eye injury/damage?
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3. Are protective gloves, lab coats, shields, or other means provided where employees could be cut or where there is a reasonably anticipated exposure to corrosive liquids, chemicals, blood or other potentially infectious materials?
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4. Is foot protection required as appropriate?
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5. Are PPE mainted in sanitary condition and ready for use?
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6. Are employees trained in use limitations, maintetance, and/or decontamination of PPEs?
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7. Have all your employees completed L4U PPE training?
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8. Have employees read written respiratory protection procedure for the selection and use of respirators where needed?
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9. Are respirator users given periodic medical evaluations to determine their ability to wear respirators?
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10. Are respirators given annual fit test?
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11. Are respirators regularly inspected, cleaned, sanitized and maintained?
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12. Are respirators stored in clean convenient and sanitary location?
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13. Are fumehoods and exhausts working properly?
Hazardous/Biohazardous Waste Handling
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1. Are hazardous/biohardous wastes properly labeled and stored?
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2. Are proper secondary containments used for storing waste
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3. Are biohazard signs posted in the area?
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4. Is there a written procedure on how biohazard waste is handled?
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5. Have employees completed L4U Biohazard training?
Ergonomics and Incident Reporting
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1. Are employees working in a comfortable and safe posture?
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2. Are workstations and chairs adjusted properly?
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3. Have Tumeke Ergo-Assessments performed in your lab?
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4. Have employees completed the myCority training?
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5. Are employees using myCority for incident reporting?