Title Page
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Building
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Room Number
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Personal Investigator/ Lab Manager
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Department
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Conducted By
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Conducted On
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Employee interviewed during assessment
Assessment Questions
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Door Signage
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Access Restriction is posted on door
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Chemical Inventory List
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No eating or drinking sign
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Hazard Identification Door Sign
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27/7 Emergency contact information is posted on door
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Employees are wearing lab coats when handling chemicals
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Employees are wearing safety glasses when handling chemicals
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Staff are wearing close toed shoes
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Employees are wearing gloves when handling chemicals
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PI has done PPE assessment for chemicals used in the lab
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Staff is trained on general use of fire extinguisher's
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Staff is aware of their labs emergency action plan
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Laboratory has spill kit
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Staff is aware of spill kit location and how to use in case of spill
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Eye wash and emergency shower stations have facility barcodes and assets tags
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Eye wash log is up to date and filled out correctly
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Emergency shower log is up to date
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Chemical inventory list is uploaded to Chem watch
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Total amount of Flammable liquids stored outside flame cabinet is <10 gallons
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Flammable storage cabinet is compliant
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Chemicals are properly segregated
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Chemicals are stored at or below shoulder level
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Secondary use containers are properly labeled
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Department has reviewed high hazard chemicals for potential employee monitoring
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Compressed gas cylinders are properly secured
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The lab has a designated hazardous waste storage area
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Hazardous waste containers are properly labeled
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All waste containers are closed
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Staff know how to submit FixIt ticket request for waste removal
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Infectious waste containers are labelled clearly with the biohazardous symbol and closed unless actively filling
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BSC equipment has a label that includes make/model, current designated lab owner and his/her contact information and Current up-to-date certification. Or “out of service/compliance” sign posted.
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Fume Hoods are equipped with functioning flow alarms and sash distance indicators. Assessment date is within one year of last test date and FPM is between 80-120