Laboratory Safety Self Assessment Worksheet
Principal Investigator: ________________________________________Building/Room No.___________________________________________ Department: _________________________________________________________Date: _____________________________________________ Please have all laboratory personnel (including the Principal Investigator) answer the following questions. Print your name(s) and sign. Thank you. 1. General Housekeeping: Corridors, Circulating Spaces Are equipment and materials crowding the exit? Are the circulating areas free from obstructions? 2. Chemicals: Inventory, Storage, and Handling Is the annual, room by room chemical inventory complete (on disk)? Are chemicals stored and segregated properly? Are chemicals labeled properly especially those on the bench top? 3. Blood-borne Pathogens(BBP) and M. tuberculosis(TB):Training, Exposure, etc. Has everyone had the annual TB screening? Does the BBP Standard apply? If yes, then, Hepatitis B Vaccine forms complete? Annual BBP/TB training complete (this includes physicians, PIs, and all other personnel)? 4. Biomedical Waste Disposal Procedures. Approved sharps containers? Approved red biohazard waste bags? Are the red bags properly labeled? Biomedical and non-biomedical waste segregated properly? Has the department prepared a site specific biomedical waste plan? 5. Hazardous Waste Disposal Procedures: Labeling, Packaging. Chemical waste containers properly labeled (chemical names) and capped? Peroxide forming chemicals (ethers, dioxane, etc.) dated? 6. Fume Hoods, Biosafety Cabinets (BSCs), and Laminar Flow Hoods. Fume Hoods Annual inspection labels present? Hoods free of all unnecessary items? If Radioactive, properly labeled and inspected? Biosafety Cabinets and Laminar Flow Hoods Annual certification label present? Vents blocked? 7. Spill Control Kits. Is one present? Suitable for the needs of the laboratory? Labeled and accessible? Are personnel aware of procedures and emergency contacts for large spills? 8. Gas Cylinders. Properly capped and secured? Stored away from doorways? 9. Safety Showers/Eyewash stations. Proper type? (no eyewash bottles) Within 10 seconds of the laboratory or unobstructed and readily accessible? 10. Emergency Procedures: Fire Extinguishers, Etc. Fire Extinguishers: Inspection tag current? Mounted properly? Is the means of egress free from obstruction? Are you aware of the Medical Center Chemical, Biological, Explosion, Fire, or Radiological Disaster Plan? Yes No N/A
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11. Personal Protective Equipment. Is appropriate safety clothing (lab coats, aprons, gloves, etc.) being used? Is eye protection (goggles, safety glasses, face shields) available? Are respirators being used in compliance with the Respiratory Protection Policy? 12. General Laboratory Hazards Information Are hazardous biological agents being used? What Biosafety Level I, II, or III? (Circle one). Do you handle pathogens found on the Select Agents list (42CFR 73)*? Is (are) Laser(s) being used? What class 1, 2, 3a, 3b, 4? (Circle one) Have all laser users been trained? 13. Safety Signs. “No food” signs on refrigerator doors? Proper signs for Lasers? Proper radiation safety labels? General safety signs? (biohazard, restricted access, etc.) 14. First Aid Kit. Present and properly stocked? Labeled and accessible? 15. Laboratory Personnel Habits. Are laboratory benches and work areas cluttered? Is food being consumed in the laboratory? 16. Electrical Safety. Do extension cords power permanent fixtures? Are power outlets overloaded? Are electrical cords damaged or frayed? 17. Shipment of Dangerous Goods (IATA Dangerous Goods Regulation) Do you ship or intend to ship Dangerous Goods (blood samples, chemicals, etc.)? If yes, have you attended the mandatory training seminars?
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18. Chemicals of Interest (COI) Yes No N/A The Department of Homeland Security (DHS) Chemical Facility Anti-Terrorism Standards (72 FR 65395) requires the University to identify and report all chemicals of interest used/stored within its facilities. Has your lab completed the COI Form? If not, please complete and submit the COI Form to EHS. If the form was previously completed within the last year, please update the amount(s) of COI stored/used in your lab. *Per 42 CFR 73. - Penalties. Individuals in violation of this part are subject to a fine of no more than $ 250,000 and no more than $500,000 in the case of any other person.
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