Appendix A: Routine Laboratory Chemical Safety Inspection Checklist
Specialty
ID #
Category
UA # :
C1
Administration
C 1a
Audit reports
C 1b
Availability of MSDS
C 1c
Registered toxins updated
C 1f
Other
C2
Labeling
C 2a
Flammable storage cabinet posting
C 2b
Corrosive storage area posting
C 2c
Cylinder labeled full/empty
C 2d
Containers labeled
C 2f
Other
C3
Personnel/Safety
C 3a
Personnel trained in Haz-Comm
C 3b
Emergency procedures known
C 3c
Personnel protective equipment use
C 3d
Personnel know MSDS access/use
C 3e
Response to questions
C 3f
Other
C4
Use Area
C 4a
Other
S/NS/NA
Category B
Location
Comments
P.I. :
C5
Contamination Control
C 5a
Spilled chemicals observed
C 5b
Secondary containment used
C 5c
Chemicals stored closed/capped
C 5e
Other
C6
Personnel Exposure Control
C 6a
Fume hoods used for volatile chemicals
C 6b
Cryogenics used in ventilated areas
C 6d
Registered carcinogen monitoring
C 6e
Personnel monitoring
C 6f
Other
C7
Equipment
C 7h
Other
C8
Inventory Control
C 8a
Flammable stored away from heat
C 8h
Other
C9
Emergency Action Plan
DSA:
NA
Q: 1 / 2 / 3 /4
NA
S = Satisfactory, NS = Not Satisfactory, NA = Not Applicable
NA
Lab Representative :
Standard Violation Statements for Chemical Safety Audits
Specialty
C
C
C
C
C
C
C
C
C
C
C
C
C
C
ID #
1a
1b
1c
1d
1e
1f
2a
2b
2c
2d
2e
2f
3a
3b
Description
The previous audit has not had the noted deficiencies corrected.
MSDSs for chemicals were found ___________ (incomplete/nonexistent).
Toxin ________ used by your laboratory is subject to DHSS / CDC registration.
A copy of the Chemical Safety Manual was sent to your laboratory. Please make it available to your staff.
A copy of the incident on _________ needs to be forwarded to EH&S. The report should include corrective actions and steps taken to prevent
its reoccurrence.
In the following location(s) ___________ flammable liquids cabinets need to be labeled.
In the following location(s) ___________ corrosive liquid cabinets need to be labele.
In the following location(s) ___________ compressed gas cylinders were found not labele.
In the following location(s) ___________ chemical containers were found improperly labeled.
In the following location(s)____________ (peroxides/ethers) ____________ were found undated.
The following chemical user(s) __________________ were not certified in hazard communication by EH&S.
Personnel in the laboratory need to be trained in Emergency Response procedures. Please contact the DSA for arranging a training session.
C 3c
In the following location(s) ___________ personnel protective equipment shall be worn when there is a potential for occupational exposure.
C 3d
Please make sure that personnel working with chemicals are provided with, and use, personnel protective equipment. This includes the use of
_______________ .
C 3e
Staff working in the laboratory need general chemical safety training. Please contact the DSA to arrange for a training session.
C
C
C
C
C
C
C
3f
4a
5a
5b
5c
5d
5e
In the following location(s) ___________ hazardous materials spill was found.
In the following location(s) ___________ secondary containment was absent.
In the following location(s) ___________ containers were stored without being properly closed/capped.
All chemical storage containers, including waste containers, must be kept closed and capped when not in use.
C 6a
C 6b
Volatile chemicals must be used inside a chemical fume hood and not on workbenches.
Cryogenics must be used in well ventilated areas. Room ____ where liquid nitrogen is used does not have appropriate ventilation. Please either
improve the ventilation or move the use location.
C 6c
C 6d
________ was observed mouth pipetting, this is strictly forbidden.
_____________ is a Cal-OSHA registered carcinogen. Work areas need to be identified for area monitoring. Please contact the DSA to
arrange for proper monitoring.
C 6e
_____________ is a Cal-OSHA registered carcinogen. Personnel working with this chemical need to be identified and be subject to personnel
monitoring. Please contact the DSA to arrange for proper monitoring.
C
C
C
C
C
C
C
C
C
6f
7a1
7a2
7b1
7b2
7c
7d
7e
7f1
C
C
C
C
7f2
7g
7h
8a
In the following location(s) ___________ compressed gas cylinders were found improperly stored.
In the following location(s) ___________ unused compressed gas cylinders were found not capped.
C
C
C
C
C
C
C
C
C
8b1
8b2
8c
8d
8e
8f
8g
8h
9
In the following location(s) ___________ incompatible chemicals were stored together.
In the following location(s) ___________ chemicals were stacked and stored improperly.
Please contact EH&S Hazardous Materials Management Program to arrange for disposal of old (past expiration date) ethers.
In the following location(s) ___________ chemicals that are outdated or in bad conditioned containers need to be disposed.
In the following location(s) ___________ chemical waste was found improperly labeled, please use the EH&S Waste Tag.
Waste stored in room _______ is past 60 days limit. Please arrange for its disposal within on week.
Chemical waste containers must be kept closed and locked, except when adding waste to the container..
In the following location(s) ___________ the fume hood needs the annual certification performed.
In the following location(s) __________ chemical storage was noted in the fume hood. This is not permitted.
In the following location(s) ___________ deluge shower certification was found not current.
In the following location(s) ___________ deluge shower access was found obstructed.
Eye washes located at _____ needs to be inspected monthly.
Please provide an approved flammable chemical storage cabinet for room ________.
Please provide an approved corrosive chemical storage cabinet for room ________.
In the following location(s) ___________ compressed gas cylinders were found not secured.
In the following location(s) ___________ flammable chemicals were stored and or handled in close proximity of ignition sources.
Not applicable