Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Waltham HSE Inspection Form
Eyewash Facility
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Routinely inspected?
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Accessible?
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Signage in place?
Safety Showers
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Routinely inspected?
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Accessible?
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Signage in place?
PPE/Protective Clothing
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Used appropriately?
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Safety glasses worn?
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Gloves available?
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Closed-toed shoes worn?
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Lab coats worn appropriately?
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Lab coats not in carpeted areas?
Fire Extinguishers
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Routinely inspected monthly?
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Accessible?
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Signage in place?
Material Storage
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Materials are stored below 18 inches of the ceiling?
Electrical Safety
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Cords in good condition?
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Limited use of extension cords?
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Panel boxes accessible and labeled?
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Cord-connected electrical equipment is grounded and GFCI is in use?
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Cover plates are firmly attached to the wall outlets and in good conditions?
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No cords on the floors and in wet areas?
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High voltage apparatus is labeled and protected?
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Fixtures do not have exposed light bulbs?
Housekeeping
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Room is free of clutter?
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benchtops are free of clutter?
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Lab is free of slip, trip, and falls?
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All potential slip/trip/fall issues reported to facilities management and HSE?
Lab Fume Hoods
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Free of excess storage?
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Volatile materials used/contained within?
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Used with sash at or lower than the calibration line?
Chemical Storage
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Acids and bases segregated?
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Volume of chemicals are kept to a minimum?
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Organic acids and oxidizers segregated?
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Flammable liquids segregated from oxidizing agents?
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Stored away from heat sources or direct sunlight?
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Storage of chemicals on or below benchtop height (not on floor or above head height)?
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Containers are stored upright and securely closed?
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Containers are free of rust, corrosion, or leakage?
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Are containers properly labeled (No abbreviations, HMIS, or NFPA, or approved internal system being used, all waste has correct label)?
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Secondary containment present?
Reactive Stored Properly
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Peroxide Formers?
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Dated upon receipt?
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Dated upon opening?
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Properly disposed of?
Flammable Storage
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Stored in safety cans?
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Stored in rated cabinets?
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Stored in rated refrigerator?
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Away from ignition sources?
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Storage of combustibles are prohibited from top of and inside of flammable storage cabinets
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Drying ovens are free of flammables and combustibles?
General Safety
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Labels on gas valves on bench tops and fume hoods are present?
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Consumption or storage of food or drinks?
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Spill kits are stocked and labeled?
Compressed Gas Cylinders
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Properly secured?
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One cylinder per securing device?
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Properly stored/labeled?
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Cylinders are free of rust?
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Cylinders not in use have protective caps in place?
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No more than one spare stank is stored in the lab?
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Cylinders are marked full and empty?
Liquid Nitrogen
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Properly stored?
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Appropriate PPE available?
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PPE used?
Radiation Safety
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Does the lab have radiation sources?
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Most updated license posted in the lab?
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Badge access required for entry?
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Wipe tests routinely performed?
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Isotope inventory for the lab posted?
Biosafety Cabinets
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Volatiles prohibited from storage in BSCs?
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Flames are prohibited from storage in BSCs?
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BSCs are free of obstructions?
Sharps Containers
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Accessible?
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Leak proof and puncture resistant?
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Not overfilled?
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No regular trash in sharps container?
Biohazardous Waste
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In leak resistant container?
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Labeled correctly?
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Waste is properly segregated?
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Covered/closed when not in use?
Sharps
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Handled properly?
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Syringes are not left out?
Satellite Accumulation Area
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Containers labeled properly?
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Secondary containment available?