Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Waltham HSE Inspection Form

Eyewash Facility

  • Routinely inspected?

  • Accessible?

  • Signage in place?

Safety Showers

  • Routinely inspected?

  • Accessible?

  • Signage in place?

PPE/Protective Clothing

  • Used appropriately?

  • Safety glasses worn?

  • Gloves available?

  • Closed-toed shoes worn?

  • Lab coats worn appropriately?

  • Lab coats not in carpeted areas?

Fire Extinguishers

  • Routinely inspected monthly?

  • Accessible?

  • Signage in place?

Material Storage

  • Materials are stored below 18 inches of the ceiling?

Electrical Safety

  • Cords in good condition?

  • Limited use of extension cords?

  • Panel boxes accessible and labeled?

  • Cord-connected electrical equipment is grounded and GFCI is in use?

  • Cover plates are firmly attached to the wall outlets and in good conditions?

  • No cords on the floors and in wet areas?

  • High voltage apparatus is labeled and protected?

  • Fixtures do not have exposed light bulbs?


  • Room is free of clutter?

  • benchtops are free of clutter?

  • Lab is free of slip, trip, and falls?

  • All potential slip/trip/fall issues reported to facilities management and HSE?

Lab Fume Hoods

  • Free of excess storage?

  • Volatile materials used/contained within?

  • Used with sash at or lower than the calibration line?

Chemical Storage

  • Acids and bases segregated?

  • Volume of chemicals are kept to a minimum?

  • Organic acids and oxidizers segregated?

  • Flammable liquids segregated from oxidizing agents?

  • Stored away from heat sources or direct sunlight?

  • Storage of chemicals on or below benchtop height (not on floor or above head height)?

  • Containers are stored upright and securely closed?

  • Containers are free of rust, corrosion, or leakage?

  • Are containers properly labeled (No abbreviations, HMIS, or NFPA, or approved internal system being used, all waste has correct label)?

  • Secondary containment present?

Reactive Stored Properly

  • Peroxide Formers?

  • Dated upon receipt?

  • Dated upon opening?

  • Properly disposed of?

Flammable Storage

  • Stored in safety cans?

  • Stored in rated cabinets?

  • Stored in rated refrigerator?

  • Away from ignition sources?

  • Storage of combustibles are prohibited from top of and inside of flammable storage cabinets

  • Drying ovens are free of flammables and combustibles?

General Safety

  • Labels on gas valves on bench tops and fume hoods are present?

  • Consumption or storage of food or drinks?

  • Spill kits are stocked and labeled?

Compressed Gas Cylinders

  • Properly secured?

  • One cylinder per securing device?

  • Properly stored/labeled?

  • Cylinders are free of rust?

  • Cylinders not in use have protective caps in place?

  • No more than one spare stank is stored in the lab?

  • Cylinders are marked full and empty?

Liquid Nitrogen

  • Properly stored?

  • Appropriate PPE available?

  • PPE used?

Radiation Safety

  • Does the lab have radiation sources?

  • Most updated license posted in the lab?

  • Badge access required for entry?

  • Wipe tests routinely performed?

  • Isotope inventory for the lab posted?

Biosafety Cabinets

  • Volatiles prohibited from storage in BSCs?

  • Flames are prohibited from storage in BSCs?

  • BSCs are free of obstructions?

Sharps Containers

  • Accessible?

  • Leak proof and puncture resistant?

  • Not overfilled?

  • No regular trash in sharps container?

Biohazardous Waste

  • In leak resistant container?

  • Labeled correctly?

  • Waste is properly segregated?

  • Covered/closed when not in use?


  • Handled properly?

  • Syringes are not left out?

Satellite Accumulation Area

  • Containers labeled properly?

  • Secondary containment available?

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.