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2 Laboratory Safety Assessment Assessor : Members Present : Date : Primary Room Last Assessment Rooms Assessment Rooms Lab Name LSC LSC Mailstop LSC Phone Last Assessment Information and training A1 Applicable written programs are available and accessible to laboratory workers. A2-a Appropriate, current laboratory safety signage is posted near main laboratory entrance. A2-b Appropriate, current emergency information is posted near main laboratory entrance and near phones. A3 All laboratory workers have completed applicable safety training. A4 Laboratory has laboratory specific procedures and applicable workers are trained on them. A5 Training records are maintained. A6 Incident/Accident/Illness Report and Supervisor s Accident Report forms are available. A7 Chemical Inventory is available, current, and stored near main laboratory exit or outside of the laboratory. A8 Material Safety Data Sheets are available and stored near main laboratory exit or outside of the laboratory. A9 Monthly Walkthrough Sheets are in a clearly labeled binder. General B1 Sharps properly stored and disposed. B2 Equipment over four (4) feet high is seismically braced. B3 Sinks are posted with Non-potable Water sign. Page 2 of 5
3 B4 Culinary water supply has sufficient backflow prevention in place. This is especially important if equipment is supplied through the culinary system. B5 NO evidence of food or drink for human consumption in the lab. B6 Work surfaces are clean and uncluttered. B7 Equipment guards in place for protection against mechanical hazards. Safety equipment c1 Eyewash and/or safety shower are available and unobstructed. c2-a Eyewash and/or safety shower are tested monthly. c2-b Eyewash is activated monthly and documented. c3 First aid kit available, properly stocked, and unobstructed. c4 Fire extinguisher is maintained and unobstructed. c5 Spill kit is available, properly stocked, and easily accessible. c6 Signage is posted indicating locations of fire extinguishers, eyewash, shower, fire blanket, and spill kit. Local exhaust ventilation (LEV) d1 Fume hood certified annually. d2 LEV is properly used. d3 Fume hood sash is operational and used at proper height. d4 Storage of materials is minimized and baffles/exhaust points have adequate clearance. d5 LEV alarms are functioning properly. Hazardous materials e1 Less than 10 gallons of flammable liquids are stored outside flammable cabinet(s). e2 Compressed gas cylinders are properly secured, stored, and used. E3 Mercury containing devices are NOT in use or stored. E4 Dangerously unstable chemicals (e.g. peroxide formers) are properly Page 3 of 5
4 dated, stored, and tested or disposed prior to expiration date. E5 Containers are securely capped/closed. E6 Flammable liquids (all Class I) containers greater than one (1) gallon are safety cans. E7 Chemical waste accumulated for less than six (6) months. E8 Chemical storage areas/cabinets are clearly labeled (SAA, flammable, corrosive, etc.). E9 Hazardous liquids are stored in secondary containment. E10 Safety lips installed on chemical storage shelves. E11 Chemicals are stored properly; including storage with compatible chemicals and materials. E12 Only bleach and compatible cleaning agents are stored near sinks. E13 Hazardous liquids are stored below eye level. E14 Flammable materials are not stored in standard refrigerators or freezers. E15 Carcinogen hazard signage posted on lab door and containers. E16 All containers are properly labeled. Personal protective equipment (PPE) f1 Appropriate gloves are available and in good condition. f2 All latex gloves are powder free. f3 Appropriate eye, ear and face protection is available and in good, sanitary condition. f4 Appropriate PPE is available for liquid nitrogen handling/use. f5 Appropriate lab coats, aprons, or other protective clothing is available and in good condition. f6 Respirators are in good use. F7 Respirators use meets voluntary use. F8 Respirators users have proper training, medical clearance, and/or fit testing. F9 Appropriate PPE is used and used properly. F10 Closed-toed shoes are worn. Fire and life safety g1 No storage within twenty-four (24) inches (un-sprinkled) or eighteen (18) Page 4 of 5
5 inches (sprinkled) of ceiling. g2 Aisles and exits are kept clear with no tripping hazards. G3 Fire doors are not improperly propped or blocked open. G4 All ceiling tiles are in place. G5 Fire blanket is available and unobstructed. G6 Equipment and cords appear to be in good condition. G7 Electrical outlets and power strips are in good working condition and properly used. G8 NO space heaters are used in lab. G9 Electrical extension cords are used for only temporary purpose, properly used, and in good condition. G10 Electrical panels are unobstructed and closed. Page 5 of 5
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