Date: Lab InformationDepartmentPrincipal investigator (PI)PI telephone numberPI email addressBuildingLab room numbersLab Safety contact personLab Safety contact telephone numberLab Safety contact email addressLab phone numberInspection InformationInspectorInspector email addressSecondary inspector Secondary inspector email addressAccompanied byHazards Present in LaboratoryDrop down selectionsBiosafety o BSL-1o BSL-2o BSL-3o BSL-4Chemical Safety o Pryrophoricso Water Reactiveso Flammableso Explosiveso Toxico Compressed gaso Peroxide Formerso Corrosives o Oxidizers o Inhalation hazard o Carcinogenso CryogenicsRadiation Safety o Isotopes o Laserso X-rayOther o Animals use in labo Nanomaterials1.0 Emergency & Safety InformationComply C N/A Inspected Comments1.1 [ ] [ ] Emergency assistance information posted in lab o Not postedo Missing information1.2 [ ] [ ] Laboratory Caution Sign is posted on laboratory door and is updatedo Posted but not updatedo Not postedo Missing information2.0 Documentation & Training Comply C N/A Inspected Comments2.1 [ ] [ ] Site specific Lab Safety Manual accessible to all laboratory personnelo Not accessibleo Incomplete SOPSo Not updated 2.2 [ ] [ ] Initial EH&S Safety training documented Missing training(s):o GSU Laboratory Safety o Chematix Trainingo Radiation Safetyo Biosafety Trainingo Respirator trainingo Hazardous Waste Handlingo Security Awareness training 2.3 [ ] [ ] Board of Regents Trainings Missing training(s): o Right-2-Know Trainingo Hazardous Waste Awareness o Bloodborne Pathogens2.4 [ ] [ ] Laboratory accidents documented o Not documentedo Not familiar with accident/incident reporting system3.0 Hazard CommunicationComply C N/A Inspected Comments3.1 [ ] [ ] SDS accessible o Computer not availableo Incomplete SDS collection o Lab personnel don’t have access to Chematixo Lab personnel not aware of SDS location3.2 [ ] [ ] Current chemical inventory is updated in Chematixo Inventory not updatedo Incomplete3.3 [ ] [ ] Containers labeled with contents (full name, hazard warning, and date)o Not approved abbreviationso Unlabeled containerso Label damaged and illegible o Conflicting labels3.4 [ ] [ ] Refrigerators/freezers labeled with food and drink specificationso Not labelled with food and drink specifications4.0 General SafetyComply C N/A Inspected Comments4.1 [ ] [ ] Shelves o No 18" clearance from sprinkler headso Storage shelves do not have restraints o Shelving and file cabinets 5' or over not anchored/boltedo Heavy objects stored high o Objects overhang the shelves o Cluttero Liquids stored above eye levelo High overhead storage is not secured 4.2 [ ] [ ] Fire extinguisher o Not availableo Tag not updatedo Signage not clearly visible4.3 [ ] [ ] Laboratory doors o Not kept closedo Exits/aisles/corridors blocked4.4 [ ] [ ] Emergency shower o Not tested annuallyo Signage not visibleo Access blockedo Not taggedo Not available but required4.5 [ ] [ ] Eyewash station o Not tested weeklyo Access blockedo Signage not visibleo Not taggedo Not available but requiredo Not functioning o Eyewash station not approved4.6 [ ] [ ] First-aid kits if available o Not stockedo Expired productso Not available but required4.7 [ ] [ ] Spill Kit o Procedure not known to stafo Not available 4.8 [ ] [ ] Gas cylinders o Not secured to a structural component o Inadequately securedo Protective cap not placed when not in use o Used as a hanging toolo Cylinders placed near sources of heat4.9 [ ] [ ] Sink available for hand washing o No soapo No paper towelso No sinko Hand washing not enforced4.10 [ ] [ ] Sturdy cart available for transport of hazardous waste as neededo Cart not sturdyo Cart not available but required4.11 [ ] [ ] No food or drink in lab areas o Food foundo Beverages foundo Water bottle foundo Food used for experimental purposes not labelled4.12 [ ] [ ] Glassware and Sharps o Secondary containment not provided for floor storage ofglass bottles o Excessive glassware on bench topo Excessive glassware in sinko Improper disposal of sharps (pipettes, needles, razors)o Improper disposal of glasswareo Sharps containers more than ¾ full4.13 [ ] [ ] Mechanical and Electrical Safety o Moveable parts not guardedon equipment as appropriateo Electric panel not accessibleo Nothing posted on electric panelo Plugs, cords, outlets in poor conditiono Overloaded outlets / daisy-chained power strips usedo Extension cords only present for immediate use and do not pose trip hazards (i.e., taped down, covered)o Power strips not secured ofthe floor and away from liquidso Power cords found under doors, carpets, or through ceilings4.14 Other laboratory associated hazards o Painto Batterieso Mercury5.0 Personal Protective Equipment (PPE)Comply C N/A Inspected Comments5.1 [ ] [ ] Laboratory coats worn as required by campus PPE policyo Lab coats not worno Lab coats not closedo Lab coat not availableo Lab coat is excessively stained5.2 [ ] [ ] Gloves worn as required by campus PPE policy o Gloves not worno Gloves reusedo Gloves worn outside lab 5.3 [ ] [ ] Eye protection worn as required by campus PPE policy o Safely glasses not worno Goggles not worn for procedures involving chemical splasheso Prescription glasses with no side shields worn5.4 [ ] [ ] Closed-toe shoes and long pants worn by laboratory personnel as required by campus PPE policyo Open footwearoo Shorts/Capri’s/skirts worn5.5 [ ] [ ] Adequate supply of specialty PPE available o Class 3b & 4 lasers require safety glasseso UV/IR glasses not usedo Face shields not usedo Lab aprons not worno Cryogenic gloves not used5.6 [ ] [ ] PPE contaminated with hazardous materials disposed of as Hazardous Wasteo Contaminated PPE thrown in regular wasteo Contaminated PPE not washed or disposed of6.0 Chemical SafetyComply C N/A Inspected Comments6.1 [ ] [ ] Flammable Liquids o More than 10 gallons of flammables located outside flammable storage cabineto More than 60 gallons flammable liquids per flammable storage cabineto More than 3 flammable storage cabinets per lab/firearea.o Paper, fiberboard, and/or wood is stored with flammable chemicals6.2 [ ] [ ] Flammable storage refrigerator/freezer o Freezer/refrigerator notapproved and labeled approved for flammable storageo Freezer/refrigerator not labeledo Flammables not stored in a flammable storage cabinet6.3 [ ] [ ] Chemical compatibility o Incompatible materials not properly segregatedo Strong acids and strong bases not stored in secondary containerso Water reactive