Title Page

  • Department Name

  • Room number:

  • Conducted on

  • Prepared by

  • Location

Housekeeping

  • 1. Is general housekeeping acceptable?

  • 2. Are the floors and work surfaces clear of spilled liquids?

  • 3. Are cords routed so they don’t create a tripping hazard?

  • 4. Are there any other tripping hazards?

Emergency Evacuation and Exits

  • 1. Is the Emergency Evacuation Map posted in the area?

  • 2. Is access to emergency exits free of obstacles?

Fire Hazards

  • 1. Are the fire extinguisher maintained regularly/monthly?

  • 2. Is access to fire extinguishers maintained and obstacle free?

  • 3. Are employees or a lead employee trained to use the fire extinguisher?

Showers and Eyewashes

  • 1. Are Shower and Eye Washes maintained regularly/monthly/quarterly/annually?

  • 2. Is access to the safety shower and eyewash maintained?

  • 3. Are employees trained on using the shower and eyewashe stations?

Electrical Hazards

  • 1. Is access to electrical panels maintained?

  • 2. Are electrical panel access doors closed and latched?

  • 3. Do any electrical cords have frays or cracks?

  • 4. Are power strips equipped with a fuse?

  • 5. Are extension cords only used for temporary uses (<24 hours)?

  • 6. Have employees completed and up to date on Electrical Safety training?

Hazardous Communication and Chemical Inventory

  • 1. Are hazardous chemicals properly labeled and stored?

  • 2. Does the lab have Placards and GHS Labels posted?

  • 3. Are hazardous chemical containers 1 gallon or larger stored in secondary containment?

  • 4. Are SDS to all HazMat and Chemicals available for employees?

  • 5. Have employees completed HazMat Trainings?

  • 6. Do you maintain a master chemical list? Is the chemical inventory updated and current?

  • 7. Are there any hazardous chemicals that have not been added to the inventory?

  • 8. Have employee completed L4U Haz Com training

  • 9. Are all the chemical containers have labels?

  • 10. Are all fumehoods and exhausts working properly?

Compressed Gasses

  • 1. Are compressed gas cylinders restrained at 2 heights with metal chains or straps?

  • 2. Have employees completed Compressed Gasses Trainings?

  • 3. Are compressed gas cylinders stored in areas that are protected from external heat sources 20 feet away from highly cumbustible materail?

  • 4. Are stored or transported in a manner to prevent them from creating a hazard by slipping, falling, or rolling?

  • 5. Are all valves closed off before a cylinder is moved when the cylinder is empty and at the completion of each job?

  • 6. Are compressed gas cylinders regularly examined for expired hydrostatic test dates, obvious signs of defect, deep rusting, or leaking?

Lockout/Tagout Procedures

  • 1. Have all equipment involving hazardous energy sources identified for LO/TO?

  • 2. Are all LO/TO performed by authorized employees only? Is there a list of Authorized employees? Please list.

  • 3. Are there any new equipment involving hazardous energy need a LO/TO procedure?

  • 4. Are LO/TO procedures posted or readly available near the equipment?

Personal Protective Equipment (PPE) and Respiratory Protection

  • 1. Are protective goggles or face shields provided and worn where there is a danger of flying particals or corrosive materials?

  • 2. Are approved safety googles worn at all times in areas where there is a risk of eye injury/damage?

  • 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?

  • 4. Is foot protection required as appropriate?

  • 5. Are PPE mainted in sanitary condition and ready for use?

  • 6. Are employees trained in use limitations, maintetance, and/or decontamination of PPEs?

  • 7. Have all your employees completed L4U PPE training?

  • 8. Have employees read written respiratory protection procedure for the selection and use of respirators where needed?

  • 9. Are respirator users given periodic medical evaluations to determine their ability to wear respirators?

  • 10. Are respirators given annual fit test?

  • 11. Are respirators regularly inspected, cleaned, sanitized and maintained?

  • 12. Are respirators stored in clean convenient and sanitary location?

  • 13. Are fumehoods and exhausts working properly?

Hazardous/Biohazardous Waste Handling

  • 1. Are hazardous/biohardous wastes properly labeled and stored?

  • 2. Are proper secondary containments used for storing waste

  • 3. Are biohazard signs posted in the area?

  • 4. Is there a written procedure on how biohazard waste is handled?

  • 5. Have employees completed L4U Biohazard training?

Ergonomics and Incident Reporting

  • 1. Are employees working in a comfortable and safe posture?

  • 2. Are workstations and chairs adjusted properly?

  • 3. Have Tumeke Ergo-Assessments performed in your lab?

  • 4. Have employees completed the myCority training?

  • 5. Are employees using myCority for incident reporting?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.