PRINCETON UNIVERSITY Checklist E - duplicate

• Document No.

• Conducted on

  Date

• Laboratory Director/Principal Investigator

• Chemical or Product Name

• Location
  Address

• Prepared by

High Hazard Chemical (HHC) Checklist

• High Hazard Classification

• High acute toxicity

• Carcinogen

• Reproductive toxin

• Air reactive/ Pyrophoric

• Water reactive

• Explosive/Unstable

• Physical state/Concentration

• Maximum quantity on hand

• Estimated rate of use (e.g., grams/month)

• Toxicity: LD50 Oral (rat), Skin (rabbit), Other (please specify)

• Reactivity and incompatibility

Significant Route(s) of Exposure

• Inhalation

• Skin contact

• Percutaneous injection

• Eye contact

• Ingestion

Exposure Controls

• Ventilation/Isolation: Personnel must work under/in the following equipment to minimize personal exposure:

• Chemical hood

• Glove box/AtmosBag

• identify gas environment

• Biosafety cabinet

• Balance enclosure

• Other (specify)

• Personal protective equipment (PPE)/Clothing: Laboratory coats, closed-toe shoes, clothing that covers the legs, and gloves are the minimum PPE requirements for all personnel working in the laboratory. Identify additional PPE requirements for work with HHC:

• Disposable lab coat

• Fire-resistant lab coat (e.g., Nomex)

• Face shield

• Chemical splash goggles

• Safety glasses

• Respirator

• Respirator type

• Glove type

Use and Storage

• Yes

  No

  N/A

• Authorized Personnel: Identify categories of laboratory personnel who could obtain approval to handle and use this HHC:

• Principal Investigator

• Employee/Staff

• Graduate Student

• Undergraduate Student

• Volunteer

• Post-Doctoral Associate

• Other (describe)

• Are personnel allowed to work alone in the laboratory while handling this material?

  Yes

  No

• Procedure: In addition to the institution's chemical hygiene plan, identify what procedures/guidelines are available for the safe handling and use of this HHC. Check all that apply.

  Select Laboratory procedures Journals Manufacturer Guidelines Other

  • Laboratory procedures
  • Journals
  • Manufacturer Guidelines
  • Other

• List all procedures:

• Vacuum system used?

  Yes

  No

  N/A

• Cold trap

• Filter

• Other

• Administered to animals?

  Yes

  No

  N/A

• Use Location: Building/Room(s):

• Identify location(s) where HHC is used (check all that apply):

• Entire laboratory

• Chemical hood

• Designated area

• Other (list)

• Storage Location: Building/Room(s)

• Identify location(s) where HHC is stored (check all that apply):

• Refrigerator/freezer

• Chemical hood

• Double containment

• Vented cabinet

• Flammble liquid storage cabinet

• Other (list)

• Hazard Communication and Signage: Confirm that the hazards of the HHC are communicated to laboratory personnel and visitors where HHS is stored and used.

• All containers are clearly labeled with the identify of the HHC

• Designated storage and use locations within laboratory have signage identifying the HHC hazards present in those locations.

Medical Attention and First Aid

• Laboratory personnel should seek medical attention when:
  - signs or symptoms associated with a hazardous chemical exposure are experienced, or
  - exposure monitoring reveals an exposure level routinely above acceptable levels, or
  - a spill, leak, explosion or other event results in the likelihood of a hazardous expsoure.

• Emergency medical provider:

• Location:

• Contact information:

• Are specific first aid supplies/procedures required (e.g., antitoxin) for work with this material? If yes, document the the specific procedures to be followed post-exposure.

  Yes

  No

  N/A

Decontamination

• Are special decontamination procedures required for this HHC?

  Yes

  No

  N/A

• Identify items that require decontamination

  Select Work areas Non-disposable equipment Glassware Disposable laboratory equipment and supplies

  • Work areas
  • Non-disposable equipment
  • Glassware
  • Disposable laboratory equipment and supplies

• Other (list)

• Decontamination Method (describe):

Emergency Procedures and Spill Response

• Emergency Safety Equipment: In addition to an eyewash station, emergency shower and ABC fire extinguisher, are any other specialized emergency spill control or clean-up supplies required when working with his HHC?

  Yes

  No

  N/A

• List all required supplies/equipment with locations:

Waste Management and Disposal

• Identify waste management methods for all research and waste by-products associated with this HHC:

• Chemical wastes are collected and disposed as hazardous waste via EHS, including chemically-contaminated sharps.

• Neutralization or deactivation in laboratory prior to disposal

• Describe method - this option requires EHS pre-approval

• HHC is EPA acutely toxic chemical. Collect sharps and used containers as hazardous waste.

• Other disposal method

• Describe method - this option requires EHS pre-approval

• Chemical waste storage location

Training

• All laboratory personnel must at a minimum completed safety training on an annual basis. Additionally, laboratory personnel who handle or use the High Hazard Substance must demonstrate specific competency and familiarity regarding the safe handling and use of this HHC prior to purchase or use. The Principal Investigator is responsible for ensuring all laboratory personnel handling and using this HHC are trained in the following:
  

• Review of HHC Checklist and associated documentation including Exposure Controls and PPE

• Review Safety Data Sheets including signs and symptoms of exposure

• Hands-on training with the Principal Investigator or other knowledgeable an experienced senior laboratory staff member on the safe handling and use of the HHC

• New personnel must work under close supervision of Principal Investigator or other knowledgeable and experienced laboratory staff member.

• Other (list)