Hazard Surveillance Inspection Report - Laboratory Inspection - duplicate

• Audit Title

• Document No.

• Select date

  Date

• Prepared by:

• Manager Director

• Location
  Address

• Please Note: This Information Is Reported To The Director And Manager For Corrective Action For Clinical Issues Only. All Facility Related Issues Will Be Entered Into Archibus via Safety Operations.

General

• 002. Are exit signs readily visible and illuminated?

  Yes

  No

  N/A

• 003. Smoke barrier doors have proper gaps (1/8" max opening between doors and 1/4" from door to floor)?

  Yes

  No

  N/A

• 004. Are smoke barrier doors self closing/automatic?

  Yes

  No

  N/A

• 005. Are windows in smoke doors or walls made of fixed wire glass?

  Yes

  No

  N/A

• 007. There are no voids in fire or smoke barriers?

  Yes

  No

  N/A

• 008. Are fire doors free of damage and do they close properly? There are no doors propped or wedged open.

  Yes

  No

  N/A

• 010. Are pull stations visible?

  Yes

  No

  N/A

• 011. Are fire extinguishers properly charged?

  Yes

  No

  N/A

• 012. Does fire extinguisher inspection tag indicate extinguishers are being inspected monthly?

  Yes

  No

  N/A

• 013. Are fire extinguishers accessible?

  Yes

  No

  N/A

• 014. Are emergency evacuation route signs current?

  Yes

  No

  N/A

• 017. Are the No Smoking rules followed?

  Yes

  No

  N/A

• 020. Are there at least two posted emergency exits on each unit or floor?

  Yes

  No

  N/A

• 701. Is lab safety sign information up to date?

  Yes

  No

  N/A

• 702. Do aisles have sufficient width for passing?

  Yes

  No

  N/A

• 703. Is food stored properly, not in refrigerators or cabinet used to store lab samples or chemicals?

  Yes

  No

  N/A

• 704. Exit doors and corridors unobstructed?

  Yes

  No

  N/A

• 705. Non-explosive proof refrigerator/freezers are posted with sign to warn people not to store flammable liquids in this equipment?

  Yes

  No

  N/A

• 706. Doors are not blocked or wedged open?

  Yes

  No

  N/A

Hazardous Materials

• 301. Is the hazardous chemical inventory current?

  Yes

  No

  N/A

• 302. Staff know how to retrieve SDS (MSDS)?

  Yes

  No

  N/A

• 303. Are all chemicals properly labeled?

  Yes

  No

  N/A

• 304. Are stored chemicals properly secured?

  Yes

  No

  N/A

• 307. Are waist/used chemicals disposed of properly?

  Yes

  No

  N/A

• 308. Are chemicals stored in the proper storage cabinets according to their compatibility?

  Yes

  No

  N/A

• 309. Are emergency eyewash stations and safety showers available in required areas?

  Yes

  No

  N/A

• 310. Are plumbed emergency eyewash station tested weekly?

  Yes

  No

  N/A

• 311. Solids stored above and liquids below?

  Yes

  No

  N/A

• 312. Flammable liquids are stored in an NFPA approved cabinet with a self closing door?

  Yes

  No

  N/A

• 313. Peroxideable and/or shock sensitive compounds are properly stored and labeled with last date opened?

  Yes

  No

  N/A

• 314. Gas cylinders in an upright position?

  Yes

  No

  N/A

• 315. Are protective caps in place over the value of all gas cylinders which are not in use?

  Yes

  No

  N/A

• 316. Respirators used? Necessary? Correct procedure followed?

  Yes

  No

  N/A

• 317. Fume hoods and Biological Safety Cabinets tested within the last year?

  Yes

  No

  N/A

• 318. Access to appropriate eye protection including face shields, gloves, and other PPE?

  Yes

  No

  N/A

• 319. Proper lab attire including: no shorts, sandals, or open toe shoes, and no loose hair or clothing.

  Yes

  No

  N/A

• 320. Shelves are not overloaded, crowed, have excessive weight on shelves, or are inadequate?

  Yes

  No

  N/A

• 322. There are no combustible metals being used liked lithium, magnesium, or sodium?

  Yes

  No

  N/A

Storage, Housekeeping, & Supplies

• 402. Are refrigerators clean?

  Yes

  No

  N/A

• 403. Are refrigerator temperature logs current?

  Yes

  No

  N/A

• 405. Is food consumption, including drinking, prohibited in patient care areas?

  Yes

  No

  N/A

• 406. Is infectious waist disposed of properly?

  Yes

  No

  N/A

• 407. Are chemicals, medications, and/or supplies current and do not have expired dates?

  Yes

  No

  N/A

• 409. Are sterile items stored/high level disinfectants items stored at least 10" off the floor, 6" from outside walls, and 18" from ceiling fixtures?

  Yes

  No

  N/A

• 411. Sharps containers not overfilled above the 3/4 full mark?

  Yes

  No

  N/A

• 418. Laboratory work and storage areas are clean, orderly, and free of clutter?

  Yes

  No

  N/A

• 419. Supplies stored within arms reach without the use of a ladder?

  Yes

  No

  N/A

• 420. Is broken glass disposed of properly? Is the condition of the broken glass box adequate?

  Yes

  No

  N/A

• 421. Are they any sinks or floor drains that are infrequently used?

  Yes

  No

  N/A

• 422. Adequate hand washing facilities?

  Yes

  No

  N/A

• 423. Are boxes, equipment, ect, not being stored on floor to allow/provide for floor cleaning?

  Yes

  No

  N/A

• 424. A UL listed waste can is available where solvent soaked rags are used?

  Yes

  No

  N/A

Compressed Gases

• 801. Gas cylinders are secured in an upright position?

  Yes

  No

  N/A

• 802. Cylinders capped when not in use?

  Yes

  No

  N/A

• 803. Main valve closed and pressure in regulator released when cylinder not in use?

  Yes

  No

  N/A

• 804. Flammable gas storage limited to those tanks currently in use and 1 spare?

  Yes

  No

  N/A

Electrical

• 201. Are fluorescents lights equipped with working bulbs?

  Yes

  No

  N/A

• 202. Do emergency lights work properly in areas provided?

  Yes

  No

  N/A

• 205. Is electrical equipment and wiring undamaged?

  Yes

  No

  N/A

• 206. There are no portal space heaters in the area?

  Yes

  No

  N/A

• 207. Extension cords are not used (Exception: Emergency and/or single not ganged fused circuit breaker bars)?

  Yes

  No

  N/A

• 212. No usage of three way plugs?

  Yes

  No

  N/A

• 213. Equipment is grounded properly?

  Yes

  No

  N/A

• 214. All electrical panels and breaker boxes have a clear area of 3 feet?

  Yes

  No

  N/A

• 217. Are all heat producing devices (toaster, coffee pots, etc.) unplugged when not in use?

  Yes

  No

  N/A

• 107. Are inspections on equipment being completed in a timely manner.

  Yes

  No

  N/A

Safety Management

• 401. Refrigerators used for specimens, medications, chemicals ect. Are free of food?

  Yes

  No

  N/A

• 402. Are refrigerators clean?

  Yes

  No

  N/A

• 403. Are refrigerators temperature logs current?

  Yes

  No

  N/A

• 404. Are specimens and/or medications stored in a separate refrigerators? In patient care areas, a separate refrigerator is used for each of the following: unit medications, patient food, staff food, and patient specimens?

  Yes

  No

  N/A

• 405. Is food consumption, including drinking, prohibited in lab/patient areas?

  Yes

  No

  N/A

• 406. Is infectious waste disposed of properly?

  Yes

  No

  N/A

• 408. Are sterile and clean supplies stored separately?

  Yes

  No

  N/A

• 414. There are no damaged floor tiles, torn carpet, or trip hazards?

  Yes

  No

  N/A

• 415. There are no damaged/missing ceiling tiles?

  Yes

  No

  N/A

• 501. Is there an emergency procedures posted and current?

  Yes

  No

  N/A

• 503. The fire alarm location page and other emergency announcements in buildings which voice annunciation are clearly audible in this area?

  Yes

  No

  N/A

Security

• 601. Are valuables secured (purse, expensive equipment, ect.)?

  Yes

  No

  N/A

• 604. Are fax machines in non-public areas to protect confidential information?

  Yes

  No

  N/A

• 605. Are copy machine in non-public areas to protect confidential information (if in public areas copies are not left in machine)?

  Yes

  No

  N/A

• 606. Research information is not visible from public areas?

  Yes

  No

  N/A

• 607. Lab area is secured when not occupied?

  Yes

  No

  N/A

• 608. Staff is trained to question unknown individuals and report suspicious activity behavior?

  Yes

  No

  N/A

• 609. Hazardous material is secured?

  Yes

  No

  N/A

• 610. Name tags available or being worn?

  Yes

  No

  N/A

Miscellaneous

• 999. No other deficiencies or areas of concern were noted?

  Yes

  No

  N/A

If the following question is answered Yes, information must be forwarded to the institutional Biosafety Officer

• Are you using any recombinant DNA and/or other biohazardous agent in your laboratory? (Most common: for bacteria, E. Coil, K12, for virus Andeno-associated virus, Replication deficient adenovirus.)

  Yes

  No

  N/A

• Signature

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