Title Page

  • Building

  • Room Number

  • Personal Investigator/ Lab Manager

  • Department

  • Conducted By

  • Conducted On

  • Employee interviewed during assessment

Assessment Questions

  • Door Signage

  • Access Restriction is posted on door

  • Chemical Inventory List

  • No eating or drinking sign

  • Hazard Identification Door Sign

  • 27/7 Emergency contact information is posted on door

  • Employees are wearing lab coats when handling chemicals

  • Employees are wearing safety glasses when handling chemicals

  • Staff are wearing close toed shoes

  • Employees are wearing gloves when handling chemicals

  • PI has done PPE assessment for chemicals used in the lab

  • Staff is trained on general use of fire extinguisher's

  • Staff is aware of their labs emergency action plan

  • Laboratory has spill kit

  • Staff is aware of spill kit location and how to use in case of spill

  • Eye wash and emergency shower stations have facility barcodes and assets tags

  • Eye wash log is up to date and filled out correctly

  • Emergency shower log is up to date

  • Chemical inventory list is uploaded to Chem watch

  • Total amount of Flammable liquids stored outside flame cabinet is <10 gallons

  • Flammable storage cabinet is compliant

  • Chemicals are properly segregated

  • Chemicals are stored at or below shoulder level

  • Secondary use containers are properly labeled

  • Department has reviewed high hazard chemicals for potential employee monitoring

  • Compressed gas cylinders are properly secured

  • The lab has a designated hazardous waste storage area

  • Hazardous waste containers are properly labeled

  • All waste containers are closed

  • Staff know how to submit FixIt ticket request for waste removal

  • Infectious waste containers are labelled clearly with the biohazardous symbol and closed unless actively filling

  • 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.

  • 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

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.