Hazardous Surveillance - Hazardous Material & Waste Copy

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

• What is the hospitals hazard communication program?

  Yes

  No

  N/A

• What type of chemicals do you use regularly?

  Knowledgeable

  needs additional orientation

• Demonstrate how to locate a SDS.<br>

  Knowledgeable

  needs additional orientation

• If you are exposed to a chemical what action would you take?

  Knowledgeable

  needs additional orientation

• Are chemicals properly stored? (Observation)

  Yes

  No

  N/A

• Are chemicals properly labeled? (Observation)

  Yes

  No

  N/A

• Are secondary containers labeled with product name, hazard label and manufacturer? (observation)

  Yes

  No

  N/A

• Is waste disposed of properly? (Observation)

  Yes

  No

  N/A

• Gas cylinders are secured, capped, away from heat source, and tar orated safely. (Observation)

  Yes

  No

  N/A

• What is the emergency number for this location?

  Knowledgeable

  needs additional orientation

• Where is the nearest eye wash station or full body station?

  Knowledgeable

  needs additional orientation

Comments and additional findings.

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